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3. 7 ~U '*1'f *;tv~!Y.& Tiff 1m:1t 1'~llWa1l: (j'~ jJ,:1'l!l1=5 ~ij[: $ tJ!J tlH'dJ\l
WI ftlltuIG!i3 t~ Ylljlj ,
If you have more information about your visa application other than the above to declal'e,please give details below or type on
separate paper,

II

N/A

:!lu $iJliAtf'JmI:j:l iJ1~WA1=5I'llfj!JA-'Ir1J1*fr, ij!f~t'1ll'1fAH\{)HMltitETilIT1+J\~1W1f A1~,~, If someone else travels and sll8l'es
the same passport with the applicant, please affIX their photos and give their information below.

3.8

11i\'1fA 1
Person 1
1~1fA1~L~

:rJfilii!lf( #

Infirmation

r J1t

AffIX Photo

11il'1fA 2
Person 2

11i\'1fA 3
Person 3

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iJM!If(#rfit

4/r1X Photo

AffIX Photo

here

here

here

N/A
N/A
N/A

t41';
Full name

tl:!J}V
Sex

1:8
DOB(yyyy-mm-dd)

Ii] , fEl'JJ.!.&%:~ Part 4: Declaration & Signature

4. 1 :f!t,a ~~, fit B I!'IJ w;;)+ rmf6ll1 Jit*fi.JT1'f ~ ~~* , ;)+ J,!mtfi.JT~1ij:rn ,~-rU $ iN *1'*'1- iJ. ~ ,Vt~ 1Ja -11] !~ J '*,
I hereby declare that I have read and understood all the questions in this application and shall bear all the legal consequences for the
authe!'ticity of the information and materials I provided.
4.2 :f!tJJEM, ~~f'f$t1~~lHiE, $t1~'friJ#~~iE, A:ljHj;:lJ&~.&1I~J:AA, 1~OOAA~~i:l:l~l.1r J!ljU~, 1f1riJ/j\~, ~~~.L~~/j\7'G~;I$J
PJ~~-\i!3\j~iiE if1i]lj~m~fllY.!t~m~f1JJAI:j:l 00
I understand that whether to issue a visa, type of visa, number of entries, validity and duration of each stay will be determined by
consular official, and that any false, misleading 01' incomplete statement may result in the refusal of a visa for or denial of entry into
,China.
4.3 :f!tJJll.f9lf, .wmI:j:lOOi't1:'f!:, $i]1fA&P1~*1'fI:j:lOO~liEmffPJ~~i1t1~AJi';,
I understand that, according to Chinese law, applicant may be refused entry into China even if a visa is granted.
0

. . $iJliA~1';

ElM

Applicant's signature:,

i': 5tdP.1J 18 )i!iJ;# iJ *MiF A~j)j El3 x: ilfY.!t.lJii.tf'A 1-'G~

Date (yyyy-mm-dd): .................................

Note: The parent or guardlauha\l sign on behalf ora minor under 18 years orage.

Ii. , 1m A 1~:I:. $ it S1 :1:" ~ IV, r I*J '$ Part 5: If the application form is completed hy another person on the
appJlcan
r t' s b eh aIf., please
I
nn out th em
. fiormatIOn
. 0 fth e one W h 0 compJJetes t he fiorm
5. 1 j(11'; Name

KALLAS KANGANE

5. 2 ~ $l~A~~
with the applicant

5. 3 }It!J.Jl: Address

oT11 FL (JIll rON IlOUSE .K,DUBAS'I MAIlG.MUMllAl11l1l1l1l1

5.4

It-m

HIRING AGENT

Relationship

022-22040770/788

Phone number

5. 5 ,a i1A Declaration
:f!t,ai1A*A~*~$~A~*W~~~*, ~~$mArmM;)+~~*l:j:lm~~~~~~x~o
I declare that I have assisted in the completion of this form at the request of the applicant and that the applicant understands and
agrees that the information provided is true and correct.
,

1t:l:~A~;g/Signature:

.............. .................................... ...... " .... " .

~

_._....__ .

1=1 ;llJjlDate (yyyy-mm-dd):

-

....

!i\Hi" 11,4 $ I Page 4 of4

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