Mu (Form) N14/M

N NGH CP, B SUNG, SA I TH THC, GIA HN TM TR (1)

Application for visa renewal, replacement of modification, length of stay extension
(dng cho ngi nc ngoi ang tm tr ti Vit Nam)
To be completed by foreign non permanent residents in Viet Nam

1 Ngi lm n (Details of the applicant):

H tn (ch in hoa)..............................................................Gii tnh. nam

n:

Full name (in block letters)

Sex
Male
Female
Sinh ngy............... thng ..........nm................ Quc tch................................................................
Date of birth (day, month, year)
Nationality
H chiu s:..............................c gi tr n ngy......./......../....... Ngh nghip:...........................
Passport No.

Expiry date (day, month, year)

Occupation

Ngy nhp cnh Vit Nam.................................Mc ch nhp cnh..............................................

Date of latest entry

Purpose of entry

a ch tm tr ti Vit Nam:.............................................................................................................
Current residential address in Viet Nam
in thoi lin h/ Contact telephone number.....................................................................................

2 C quan, t chc hoc thn nhn Vit Nam mi, bo lnh:

(Details of the receiving, sponsoring agency/employer or guarantor in Vietnam)
- C quan, t chc: tn (Name of receiving, sponsoring agency/employer).......................................
i ch /Address:...................................................................................................................................
- Thn nhn: h tn:........................................................................ngy sinh....................................
Full name of the guarantor (a ralative of the applicant)
Date of birth (day, month, year)
Giy chng minh nhn dn/h chiu/th thng tr s:.................................................................
Indentify card/Passport/Permanent Residence Card number.
cp ngy: ...........................................c quan cp:..............................................................................
Date of issue
Issuing authority
- Quan h vi ngi lm n /Relationship to the applicant.............................................................
- a ch thng tr/tm tr ti Vit Nam.........................................................................................
Permanent/temporary residential address in Vietnam
in thoi lin h/ Contact telephone number.....................................................................................
3 Ni dung ngh /Details of application:
- Cp th thc:

mt ln

nhiu ln
c gi tr n ngy .........../............/.........
Multiple
Validity to (day, month, year)
- B sung, sa i th thc /Visa modified as:....................................................................................
Gia hn tm tr n: .............../.............../.............
Length of stay extended to date (day, month, year)
L do/ Reason of the request.................................................................................................................
4 Nhng iu cn trnh by thm /Aadditional explainations:........................................................
............................................................................................................. ..................................................
Entries requested: Single

Xc nhn (2) /Certified by

(K, h tn, chc v, ng du)
Signature, full name, title and seal

..................., ngy........... thng ............nm..............

Place and date (day, month, year) of the application
Ngi bo lnh /The sponsor Ngi lm n /The applicant
(K, h tn)

( K, h tn)

Signature and full name

Signature and full name

Ghi ch /Note on the mark (1), (2):

(1). Mi ngi khai 1 bn, km theo h chiu gi trc tip n c quan qun l xut nhp cnh
To apply, please submit a completed application form enclosed with his/her passport in person at the Immigration Office
(2). Xc nhn ca th trng c quan, t chc mi, bo lnh hoc Trng cng an Phng, x ni ngi bo lnh thng tr
Certification is given by the chief of receiving, sponsoring agency organization of the applicant or of the Chief Police of the Ward/Commune
where the sponsor resides).