nh photo

4x6 cm
See notes
(2)

T KHAI NGH CP TH THC VIT NAM (1)

VIETNAMESE VISA APPLICATION FORM
(Dng cho ngi nc ngoi For foreigners)

1- H tn (ch in hoa) :
Full name (in capital letters)
2- Gii tnh:
3- Sinh ngy :
Sex
Female
Date of birth (day, month, year)
4- Ni sinh :
Place of birth
5- Quc tch gc :
6- Quc tch hin nay:.
Nationality at birth
Current nationality
7- Tn gio:
8- Ngh nghip:
Religion
Occupation
9- Ni lm vic :
Employer and business address
10- a ch thng tr:
Permanent residential address
......................................................................S in thoi/Email: .....................................
Telephone/Email
11- Thn nhn (Family members):
Ngy sinh
a ch thng tr
H tn (ch in
Quan h
Date of birth
Quc tch
Permanent
hoa)
Gii tnh
Relationship
(Day, Month,
Nationality
residential
Full name
Sex
Year)
address
(in capital letters)

12- H chiu s/ giy t c gi tr thay h chiu s:

.loi (4):
Passport or International Travel Document number
C quan cp:
c gi tr n ngy
Issuing authority:
Expiry date (day, month, year)
13- Ngy nhp xut cnh Vit Nam gn nht (nu c): .....................................................
Date of previous entry into Viet Nam (if any)
14- D kin nhp cnh Vit Nam ngy
; tm tr Vit Nam
ngy
Intended date of entry (Day, Month, Year)
Intended length of stay in Viet Nam: days
15- Mc ch nhp cnh:
TOURIST
Purpose of entry
16- D kin a ch tm tr Viet Nam:
Intended temporary residential address in Viet Nam
17- C quan, t chc hoc c nhn ti Vit Nam mi, bo lnh:
Hosting organisation/ individual in Viet Nam
- C quan, t chc: Chi nhnh Cng ty c phn du lch Qung Tri ti H Ni
Name of hosting organization

a ch:
Address
- C nhn: (h tn) ............................................................................................................
Hosting individual (full name)
a ch..........................................................................................................................
Address
Quan h vi bn thn ..................................................................................................
Relationship to the applicant
18- Tr em di 14 tui i cng h chiu (nu c):
Accompanying child(ren) under 14 years old included in your passport (if any)
nh photo
4x6 cm
See notes
(2)

S TT
No

H tn (chu in hoa)
Full name
(in capital letters)

Gii tnh
(sex)

nh photo
4x6 cm
See notes
(2)

Ngy thng nm
sinh
Date of birth

19- ngh cp th thc:

mt ln
nhiu ln
Applying for a visa
Single
Multiple
T ngy:............../......../.............n ngy:........../........../..........
Valid from (Day, Month, Year) to (Day, Month, Year)
20- ngh khc lin quan vic cp th thc (nu c):.....................................................
Other requests (if any)
......................................................................................................................................
Ti xin cam oan nhng ni dung trn y l ng s tht.
I declare to the best of any knowledge that all the above particular are corect.
, ngy ...... thng ...nm ...........
date (Day, Month, Year)
Ngi ngh (k, ghi r h tn)
The applicants signature and full name

Lm ti:
Done at

Ghi ch/Notes:
(1) Mi ngi khai 01 bn km theo h chiu hoc giy t i li quc t, np trc tip ti c quan i din Vit
Nam nc ngoi hoc n v kim sot xut nhp cnh ti ca khu quc t ni nhn th thc.
Submit in person one completed application form enclosed with passport or International Travel Document at the
Vietnamese Diplomatic Mission abroad or at the international border checkpoint immigration office where the visa
is issued.
(2) Km 02 nh mi chp, c 4 x 6 cm, phng nn trng, mt nhn thng, u trn, khng eo knh mu (01 nh
dn vo t khai, 01 nh ri).
Enclose 2 recently taken photos in 4x6cm size, with white background, front view, bare head, without sunglasses
(one of the form and the other separate)
(3) Ghi r b, m, v, chng, con, anh, ch, em rut (nu c).
State clearly the information about parents, spouse, children and siblings (if any).
(4) Ghi r loi h chiu ph thng, cng v, ngoi giao hoc giy t c gi tr i li quc t.
Specific type of passport whether it is Ordinary, Official or Diplomatic or specify name of the International Travel
Document.