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    This document is a visa application form for entry into the Kingdom of Cambodia. It requests personal information such as name, date of birth, nationality, passport details, contact information, purpose and duration of visit, and transportation details. The form also has sections for listing any children or relatives traveling with the applicant. By signing the form, the applicant declares that all information provided is true and correct.

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    This document is a visa application form for entry into the Kingdom of Cambodia. It requests personal information such as name, date of birth, nationality, passport details, contact information, purpose and duration of visit, and transportation details. The form also has sections for listing any children or relatives traveling with the applicant. By signing the form, the applicant declares that all information provided is true and correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    42 views1 page

    New Blank Document

    Uploaded by

    api-290924156
    This document is a visa application form for entry into the Kingdom of Cambodia. It requests personal information such as name, date of birth, nationality, passport details, contact information, purpose and duration of visit, and transportation details. The form also has sections for listing any children or relatives traveling with the applicant. By signing the form, the applicant declares that all information provided is true and correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    KINGDOM OF CAMBODIA

    Nation-Religion-King
    VISA APPLICATION FORM
    LastName : _____________________________________ Occupation : _____________________________________
    FirstName : _____________________________________ Work Place : ____________________________________
    Gender :

    Male

    Female

    Current Home Address : ___________________________

    Date of Birth : ____/ __________/ ______ Age : ______


    Day
    Month
    Year
    Place of Birth : ______________________________________

    _______________________________________________
    Mobile Phone : ___________________________________

    Birth Nationality : ____________________________________

    Home Phone : ___________________________________

    Present Nationality : __________________________________

    Email Address: ___________________________________

    Passport Number : ______________________________


    Place of Issue : _________________________________
    Date of Issue:

    _______/ _____________/ ________

    Date of Expiration : ______/ ______________/ ________


    Point of Entry : ______________________________________

    Point of Exit : ______________________________________

    Means of Transportation : _____________________________

    Means of Transportation : ____________________________

    Organization, Person to be visited : ______________________

    Address during the visit : ____________________________

    Date of Entry in
    Cambodia

    ______ / _____________ / _______

    Departure Date from ______ / _____________ / _______


    Cambodia
    Children under 12 years old travelling with you
    LastName
    FirstName/ Patronymic
    Gender
    _________________
    __________________________ M / F
    _________________
    __________________________ M / F
    _________________
    __________________________ M / F
    Relative in the Kingdom of Cambodia
    _________________
    __________________________ M / F
    _________________
    __________________________ M / F
    For Official Use only

    First trip to Cambodia:


    Yes
    No
    Travelling on group tour:
    Yes
    No
    Travel Company: _____________________

    Date of Birth
    _____________
    _____________
    _____________

    Address
    _____________________________
    _____________________________
    _____________________________

    _____________
    _____________

    _____________________________
    _____________________________

    I hereby declare that all of the information on this form are true and correct
    Done in _____________________,Day____/ Month_____/ Year_____

    ____________________
    ____________________

    _________________________________
    Applicant Full Name & Signature

    ____________________
    ____________________________________________________________________________________________________
    4530 16th Street, N.W.
    Website: www.embassyofcambodia.org
    Tel# (202)-726-7742 ext. 13
    Washington, D.C. 20011, USA
    Email: consular.camemb.usa@gmail.com
    Fax# (202)-726-8381

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