ef Canberra, Australia Application for Tourist Visa to Nepal Please complete all sections of the form in BLOCK LETTERS. Ph vow rteareryncron C1ssoay map cory vies Cl 2004p muri tntry van C290 ay ule nt Via Family Name: fas sate your passport) iven Namo) (as aie Date of Birth ; (stray) Country of Birth: Occupation Current Nationality Marital Status: Please atx a recent Passport size photo Residential addross Street Address: Suburbs State: Postcode’ Telephone: Work| _) Home:[_) Mobile Email Malling address if efferent from above) PO Bowl Street Address: Suburb: State: Postcode! Passport number: Date of issue: Date of expiry Country of passport Issuing authority/ Place of issue: Date of arival Lenath of stay ‘Mode of Travel and| in Nepal: in Nepal: Entry Point ‘Address in Nepal ELS I you are accompanied by minors traveling with the same passport, please provide their details below: Winors Full Names Gender (iF) Date of Birth Signature of applicant OFFICE USE ONLY ‘Visa Number Date of tsue Issuing Officer Issuing Post CBR/ MEU SYD/ BNE! PER Payment made by Clcash Ol Cheque