The Embassy of the Socialist Republic of Vietnam in Australia

Address: No. 6 Timbarra Crescent - O'Malley, ACT 2606

Tel:61-2-62901556 / 62866059 Fax: 61-2-62864534
Website: http://www.vietnamembassy.org.au

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APPLICATION FOR VISA (Passport
(This form is for non-Vietnamese applicants only) size)

1. Full name (print in capital letters):

2. Date of Birth (dd/mm/yyyy): __ __/__ __/__ __ __ __ 3. Sex: Male Female

4. Place of Birth: 5. Nationality:

6. Marital status: Single Married Divorced Widowed Separated Other

7.Education qualification: 8. Occupation:

9. Residential address:

Telephone: Mobile:

10. Work address:

Telephone: Fax:

11. Purpose of entry: Tourist Business Diplomat Education Other

12. Estimated date of arrival

__ __/__ __/__ __ 13. Estimated date of exit __ __/__ __/__ __
in Vietnam (dd/mm/yy): from Vietnam (dd/mm/yy):

14. Address in Vietnam (if known):

15. Type of visa: Single entry Multiple entries

16. Passport details:

Types of passport: Standard Official Diplomatic Passport number:

Date of issue: __ __/__ __/__ __ __ __ Expiry date: __ __/__ __/__ __ __ __

17. Have you visited Vietnam before?

No Yes If Yes, what is the last arrival date: __ __/__ __/__ __ __ __

18. Signature: 19. Date: __ __/__ __/__ __ __ __

(!) Please make sure:
- You have filled in the Home address and Contact telephone number
- You have included the Passport, Visa application form, Money order
(or Bank check) and Returned addressed prepaid envelope in the post
bag you are going to send to us. (Express post is recommended).