DON XIN NHAP XUAT CANH VIET NAM (Diing cho ngudi nude ngoai APPLICATION FOR ENTRY AND EXIT VIETNAM (For foreigners) M3 I< Ho tén (chitin hoa): Name and surname (in block letters) 2 Ney sinh:................3+ Gisi tinh: Date of birth Sex 4 Noi sinh: Place of birth Quée tich ge: ..... Nationality at birth Qude tich hign tai Present nationality 5+ HO chidu sé:.... cece Lowi. Passport N’ Kind of Passport - Nei ofp: seccssees + Ngity hét han: Date of issue Expiry date/ /Co quan cip: : Issued by 7-Nehé nghigy Profession Noi lam vige: Place of employment 86 dign thoai (Telephone N° ). 8- Dia chi cu trd hign nay:.. Present address Sé dign thoai (Telephone N°): 9- Tré em ciing di (ho tén, ngay sinh, quan h@):.... Children accompanying (full name, date of birth, 10- Myc dich xuat nhjip canh: . Purpose of entry and exit Tén, dia chi co quan, 16 ehite hoa ho tén, quan hé, dia chi tia than nhan & Vigt Nam, noi vao lim vige hoe tham: Name, address of office, organization or full name relation, address of your relatives to contact or visit while in Vieonam. L- Tho’ gian dyr kién NXC Vigt Nam: Tirngay ceseedén nga: Proposed duration to entry and exit Vietnam From to 12- S6 lan nhap xuat canh: Entry & exit times 13- Cita khiu XNC Vigt Nam: Port of arrival and departure 14- Toi cam doan nhing ndi dung trén day 18 ding sy that I swear the above declarations are true for which I shall take responsibility relation). Lam ti -.seesesseseee NBBY «. Done at On Kytén Signature Note: ~ Please, fill two forms (attaching tvo latest photos, in 4x6cm size, with a face straight forward) submit one form to the Vietnam visa issuing office, or consulate, and the other to the frontier police post upon your arrival - The accompanying children under 14 years olds maybe included in this form, with two photos.