Visa Application Form of the Peoples Republic of China

Please type your answer in capital English letters in the spaces provided or
check the appropriate box to select.

/ Section 1. Information about Yourself /Reset Form

1.1 / Full Name:
/ Photo
/ Surname / Middle Name:
1
/ Given Name 1.2 / Sex:

/ M /F
1.3 / Chinese Name if Applicable: 1.4 / Current Nationality: Please affix one recent
passport style color photo,
with full face, front view,
1.5 / Other or Former Name: 1.6 / Former Nationality: no hat, and against a plain
light background.

1.7 / Date of Birth(YY-MM-DD): 1.8 (/) / Place (Province/State, Country) of Birth:

1.9 / Diplomatic / Service or Official / Regular

Passport Type () / Other (Please specify):
1.10 / Passport Number: 1.11 / Date of Issue(YY-MM-DD):

1.12 (/) / Place (Province/State, Country) of Issue: 1.13 / Expiration Date(YY-MM-DD):

1.14 / Your Current Occupation(s):

/ Businessman / Teacher or Student / Government Official
/ Crew Member of Airlines, Trains or Ships / Staff of Media
/ Member of Parliament, Congressman or Senator / Clergy
() /Other (Please specify):

/ Section 2. Your Visit to China

2.1 / Major Purpose(s) of Your Visit(s) to China:
/ Tourism / As Crew Member of Airlines, Trains or Ships
/ Visiting Relatives / As Resident Journalist
/ Business Trip / As Journalist for Temporary News Coverage
/ Transit / As Resident Diplomat or Consul in China
/ Study / Official Visit
/ Commercial Performance / Employment
() / Other (Please specify):

(3 ) / Single entry valid for 3 months;

2.2 / (6 ) / Double entry valid for 6 months;
Intended Number of Entries / Multi-entry valid for 6 months;
/ Multi-entry valid for 12 months.

2.3 / Date of Your First Possible Entry into China (YY-MM-DD)

2.4 / Your Longest Intended Stay in China Days

2.5
/ / Please list Counties/Cities and
Provinces to visit in China in a time sequence:
2.6 4
(2-3 ) / Express for 2-3 working days;
/ Normally, visa
processing takes 4 working days. Do you request (1 ) / Rush for 1 working day.
express or rush service by paying extra fee?

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 / Section 3. Your Health Condition and Previous Overseas Tour
3.1 ?
/ No /Yes
Have you ever been refused a visa for China?
3.2 ?
/ No /Yes
Have you ever been refused entry into or deported from China?
3.3 ?
/ No /Yes
Do you have any criminal record in China or any other country?
3.4 / Do you suffer from any of the following diseases?
/ Mental Diseases / Open Tuberculosis
/ No /Yes
/ Venereal Diseases HIV / HIV Positive or AIDS
/ Leprosy / Other infectious diseases
3.5 /Have you ever visited China before? / No /Yes
3.6 3.1-3.4 / If you select Yes to any question
from 3.1 to 3.4, you do not lose eligibility for visa application. Please give detailed reasons for your answer.

/ Section 4. Your Contact Information

4.1 / Name of Your Employer or School: 4.2 / Daytime Phone Number:

4.3 / Address of Your Employer or School: 4.4 / Nighttime Phone Number:

4.5 / Your Home Address: 4.6 / Your Email:

4.7 / Name of 4.8 / Phone Number of Your Contact:

Inviter, Contact or Your Relative in China:

4.9 / Address of 4.10 / Email of Your Contact:

Inviter, Contact or Your Relative in China:

/ Section 5.Other Declaration

/ If there is more information to declare, please give the information below.

/ Section 6. Application Form Completed by Another Person

/ If this application was completed by another person on behalf of
youplease have that person complete this section.
6.1 /Name of Person Completing the Form: 6.2 / Relationship to the Applicant:

6.3 /Address and Phone Number of that Person: 6.4 /Signature of that Person:

/ Section 7. Important

I have read and understood all the questions in this application. I shall be fully responsible for the answers and the photo,
which are true and correct. I understand that type of visa, number of entries and duration of each stay will be decided by
consuls, and any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into China.

/ Applicants Signature: /Date(YY-MM-DD):

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