The Embassy of the Socialist Republic of Vietnam in Australia

Tel:61-2-62901556 / 62866059
Address: No. 6 Timbarra Crescent - O'Malley, ACT 2606
Website: http://www.vietnamembassy.org.au
APPLICATION FOR VISA
(This form is for non-Vietnamese applicants only)
Male
1. Full name (print in capital letters):
Female
4. Place of Birth: 5. Nationality:
Married Single
__ __/__ __/__ __ __ __
Widowed Divorced Separated Other
8. Occupation: 7.Education qualification:
9. Residential address:
Telephone: Mobile:
Business Tourist Diplomat Other
14. Address in Vietnam (if known):
Single entry Multiple entries
Official Standard Diplomatic
Yes No
__ __/__ __/__ __ __ __
If Yes, what is the last arrival date:
Fax: 61-2-62864534
__ __/__ __/__ __
__ __/__ __/__ __
__ __/__ __/__ __ __ __ __ __/__ __/__ __ __ __
__ __/__ __/__ __ __ __
3. Sex:
2. Date of Birth (dd/mm/yyyy):
6. Marital status:
11. Purpose of entry:
12. Estimated date of arrival
in Vietnam (dd/mm/yy):
13. Estimated date of exit
from Vietnam (dd/mm/yy):
15. Type of visa:
16. Passport details:
Types of passport:
Date of issue:
Expiry date:
17. Have you visited Vietnam before?
18. Signature: 19. Date:
Education
Photo
(Passport
size)
Passport number:
10. Work address:
Telephone: Fax:
(!) 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).