VISA APPLICATION FORM FOR THE KINGDOM OF BHUTAN (PEAS TPE WHITE AN CAPT LETTERS [¥BLUE OK SLACKS 1, Name as in passport: Greta Staponkutd [2 Dae of bith 3. Place and country offbirth [ 4. Curent nationality | 5. Nationality at bir mes Sia, Lituania Liuarian Latwanian Secale [J Female G7] | 7: Mavala Maried 7] Sie J] ‘8. Detail of passport Passports ase oss Das offs [Walia saeees'3 Virus 19) 805.2014 oss. 2026 9. Type ofpassport: Diplomatic [—] Official UNIaisezPaser [] Ordinary BZ] epee sarees Smt 1 hols obah aed Fo Te somo e018 ons or. 08 14. Port of entry/exit: Entry port : a Exit port: ra 15. Purpose of Visit: Opera of Lausanne, invited for exceptional representation in Thimpu to perform during the inauguration ie 3 the Royal Museum of texte. The concert wil take pl 16: Are you accompanying or accompanied by your spouse/pareats/children? If Yes, please provide name of the spouse/parents/children: 17: Ts this your fist visit to Bhutan? Ye Ne IfNo, please provide detail of previous visit: Declaration: hereby affirm that al particulars furnished by me are complete and correct. | understand that providing incomplete, false or misleading information will result in rejection of my visa application/cancellation of my visa/deportation, as may be applicable. Furthermore, I also understand thet I will be liable for prosecution by a court of law andlor any penalties/fines under the Immigration Act of the Kingdom of Bhutan and any other laws, rules and regulations as may be applicable, for submission of false, fabricated or misleading information or for indulging in any other ‘other than the stated. Place and date ‘Signature (if minor, So eusane, tt September, 2019 'G Sar Yor official use only Approved/Rejecied/others Signature of approving officer: