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The Republic of Kazakhstan
VISA APPLICATION FORM

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Attention!

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Application form should be filled in fully and accurately, in block letters.
Wrong filling of application form can become a cause of refuse in issue of entry visa.

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1. $378/Surname(s):_____________________________________________________________________
2. !59/First names: ____________________________________________________________________
3. :;73 <3 5378 =3> ?59/Other names and surnames: _________________________________________
4. @9>919/Sex:

'4/;ale

AB3C/Female

5. $DE?> 2F>8/Date of birth:
2F>8/day

?B9/month

G9C9/year

6. $DE?> G348 (H?C? GI>3 3C)/Place of birth (city and country): _______________________________________________________
7. !;?=?559E9/Nationality: ___________________________________________________________________________________
$DE?> 23;8><378 ?;?=?559E9/Nationality by birth: _________________________________________________________________
8. J5K?19 G?E<?B9/Marital status:
KLB<?H/single

FBC3>73> (2FB3D<3)/married

?G94?1H?>/divorced

5MC 34 (G3184)/widow(er)

9. '734 FBC3>73> (2FB3D<3) KLC1?N9; GMK?B9N9;<9N (;?B9K9N9;<9N) ?59-GO>8> GI>3 ?;?=?559E9> 2O41358N8;/If you
are married, please, inform your spouse’s full name and nationality: ____________________________________________________
__________________________________________________________________________________________________________
10. $M4?H59 5M4?59> =323>-G?B9/Your permanent home address: __________________________________________________
________________________________________________________53C/tel. ____________________________________________
11. 0?=?><9E9 GI>3 C?D?;9=9/Occupation (educational background and position): ____________________________________
__________________________________________________________________________________________________________
12. @M=91 L4>9/Place of work:________________________________________________________________________________
=323>-G?B9/address:______________________________________________________53C/tel.____________________________
13. (?16L45 5F48/Type of passport:
<P6CL=?559H/diplomatic

H9;=35582/service

MC559H/ordinary
K?1H? HMG?5 5F48/other type of document
%O=848/Number: ___________________________K348C73> 2F>8/date of issue: __________________K348C73> G348/issued by:
___________________________________________________HLC<?>91 =34;8=8/valid till:________________________________
14. $DE?> 3C8>3> 591 5M4?59> ?<?=<?4 FQ8>: 5M4?59> =3=C32358>3 H?B5DE? 4MH1?59 K?4 =??/For person who lives outside
of the country of origin: have you got a permission to return to the country of living?:

@LH/No

*?4/Yes

&MH1?59 KLCE?> G?E<?B<?, HMG?5 >O=848> GI>3 HLC<?>91 =34;8=8> 2O41358N8;/If yes, please indicate the number of this
document and its validity:______________________________________________________________________________________
15. *M49> ?;?H15?><? KLCE?>19; K??/Have you visited the Republic of Kazakhstan before?:
@LH/No
,I/Yes
*LCE?> G?E<?B<?, KM49>E9 1?6?4C?49N9;<9N 2F><348> GI>3 =?H1?59> 2O41358N8;/If yes, indicate the date and purpose
of the visit(s): _______________________________________________________________________________________________
__________________________________________________________________________________________________________
16. #8;<8N ?;?H15?> &316DKCP2?19>? 23CD8N8;73 KM49> 4MH1?5 K348C=373> G?E<?B KLC<9 =??/Have you ever been refused
entry to the Republic of Kazakhstan?:

@LH/No

,I/Yes. *?1 5?459CE?> G?E<?B<?, 13K365348> G?;9N9; (H?Q?>

GI>3 28= 4MH1?559 K3473> GLH)/If yes, please give details below (when and by whom):___________________________________
__________________________________________________________________________________________________________
17. #?6?4<9N =?H1?59/Purpose of travel: _______________________________________________________________________
18. ?K9C<?B59> 5?4?6 (=323>-G?B9, 53C.)/Inviting organization (address, tel.):_______________________________________
__________________________________________________________________________________________________________
>3=313 G?D?659 5MCE? 5D4?C9 =IC8=35 (5LC9H ?59-GO>8, =323>-G?B9, 53C.)/or person, arranging your visit to Kazakhstan (full
name, address, tel.):__________________________________________________________________________________________
__________________________________________________________________________________________________________

&8. I undertake that the above mentioned personal data are full and correct. >$(!)*.?H15?><?E9 D?H95Q? 5M4?59> =323>-G?B9/Temporary address in Kazakhstan:__________________________________ __________________________________________________________________________________________________________ 22. *?C?C?49 (18.-.%- .8=8/Period of requested visa: from________________ K?15?6 to _____________ <3B8> 26. First names < $DE?> G348 =3> 2F>8/ Date and plase of birth !." %6% *+%" :!*382-5)%*'"' !" 2001 #'.!" )$"*8-(' %6% *+%" % ).&8.*)! %8/% '"%" . ?59/ Surname. # "! %-'/(%& *$/%*'"' %6% *+%" :!*382-5)%*'"' %6% *+%" %8/% '"% ).8=8>3 1?H5?><94D9N9.?19 >3=313 5M4DE? 9H5PR4T?59 K?4 =??/In case of transit through Kazakhstan./.-. ?.P558N K?E959> 2O41358N8. 2!&/!0+./route of transit:_____________________________________________________________________________________________________ 25. have you got an entry visa or residence permit for your destination?: @LH/No *?4/Yes.. 2!&.! /. -F>8 GI>3 G348/ Place and date: _______________________________________ LC9/Signature: ______________________________________ !"#$$%& '(!)(*(+ For official use only .?H15?> ?4H9C9 54?>. that in accordance with the article 514 of the Tax Code of the Republic of Kazakhstan ' 209-II of the 12 of June 2001 the sum of money paid as consular fee is not subject for return.) 2!&/!0+./!++!& 2!&." 2%* % (% /. ?.P563> O523> G?E<?B<?. #M4?D 1?C9>?59> SP. indicate the country of destination:______________________________________284D GL16?4C?>E?> Q32?4? 6D>258>/border point through which entry is planned:_________________________________________________________________54?>.?H15?><? KLCD =34. «<%-' # "! 27(#!+)! + -!"!+."./! )!-. %9 +%-8'"% (!0." !)!"(. that wrong data can cause refuse and canceling of already issued visa.-. I am obliged to leave the territory of the Republic of Kazakhstan before visa expiration./. I am told.?H15?><? KLCD =34. >378..8=8><3 5M4D Q9E915?49N9."(!++. *LCE?> G?E<?B<?./ 2!&8(!" 2%* +%&+ %" #% (%0(% +!/% ' % ' ?%2%&(%&/'". ?."(!++.?>9N =I453C878/Number of entries requested: 1 2 3 2O6 =I453C82/multiple 27.) 514-2%2'"% * 0)!* + -!".-. ?. ?.<9 GI>3 ?. 1%. %*8 /!&6.%" / -. %0+%&'-/%0+'"'. I am aware.<9 28= H?4G9C?><94?<9?/Who is paying for your cost of travelling and for your costs of living during your stay in Kazakhstan?:________________________________ __________________________________________________________________________________________________________ 23. /% %" / -./.8C73> G?E<?B<? E?>? 5LC5949C?<9)/Children (please indicate whether they are traveling with you and are entered in your passport): $378.' 12 /%8*'/(% ' + -!/(!& +8&%-'» = 209-II >$(!)*.E? 3>78.*.!" 456% 6'&!++.".K3> K8473 GF473> K?C?C?4 6?16L459N9./!++!&(.%"(%&' /!".-(." &%*+%0/'". K?4 =??/Have you got an insurance for the period of your stay in Kazakhstan?: 2L=6?>PR19>9N @LH/No ?5?D9> *?4/Yes. +$-' # "! ( &'* !)!".' '3 )!+8.! +$-' )!3.?>9N =34.3 $0 %" 456%"' #$7 % "!/!*! $"' 2!&8(!" 2%* +%&+8 % *!2!3 2$-8' / /).!" 456%"' .".?=?559E9/Nationality 1 2 3 !" #$ %&'(% ) &*!+./If yes.". L>9N HLC<?>91 =34. $&. +8&%-' %6% *+%" :!*382-5)%*'"' (<%-' % %" 2!&.78 K?4?59> =3=C323558N SP.?H15?> &316DKCP2?19><?E9 23C358> K?15?6H9 6D>258/The first place of entry into the Republic of Kazakhstan:_________ __________________________________________________________________________________________________________ 21.<8N 1?6?49N9.8=8> GI>3 1?H5?><94D 2O41358N8. K?4?59> =3=C323558/if yes. #M4?D 1?C9>?59> SP. the issued visa does not fully guarantee entry into Kazakhstan and will not serve as basis for compensation in case the authorized bodies of the Republic of Kazakhstan refuse entry for the owner of visa into territory of Kazakhstan. #8. #?H5?><94D KLCE?> G?E<?B<?.!" / -.?H15?> &316DKCP2?19><? KLC?59> 6D>255348/Places of destination in the Republic of Kazakhstan:__________________ __________________________________________________________________________________________________________ 20. please indicate its validity and the name of insurance company:__________________________________________________________________________________________________ 24.19.