Fenayrte Recon FORMULARIO DE VISA VCA-4 Por favor eseriba on letra de molde y claremente, completando sus datos lal como aparecen an su pasaporte Please write clearly In print letters, with the information 25 it appears in your passport T DATOS GENERALES/GENERNL DATA 7. peo ast wae omve! Given are: 2. Neconaldad /Natonaly Bioosar Ow OF 4 gary feta 6 Nacimeni / Pes and dat obi Doro Pru / Ado Hera a Telefon para” pvt Ba bor 7 omre Ebsronc J exalt 1 Tipe de Pasapotl Type of Passport: C] ornare’ Orarary: CI oneaiSerweo Oneal C) Dplonstia/ Dporat 6 Homer de Parapet! pats: 0, Lary fsa do ExpUicon: /Date a po of sve "7. oats de Vonsimono / xpraion oe 1, rfeson/Oeupaion Atul /Profsson/Occupaton 7. Naive y Nasional ci i cnyuge:/ Name and Matonaly Of Spe 7 ara Mencros: Nombre y Waconaiad de pacts: 2) Macrmacto: For thnors: Nama and natonany of 1D) PodevFane: ravens Ti DATOS DEL VIA /TRIPDATA Rel o rani dl je Ray reason Tok 9 future) Nese ees TH. onewomat Chg transarrast: C2) Contrencreangeso/ conferences Cangrese stu tnvetigan Study sear: xo (speeiguey/ omer (lease 2 Pass que dno prov vistaron eso ajo: / Coos yu expect to vit on Us ip a} rsovedoe C{ 0) Cutormin E}o)hnnaye C)- 4) Meargee CL). Spee ol psy pert do ett CA / Spay county and pet of wi to bw CAA rapa Fecha pvt de eyesa/ Dat of aval Ch-& 6. Temp ds esata prevsto ono) CA Eaivalad ng oF Say WON Let Gane eg SiR so you tas yur a) pos owns CB) Fars any s.r snes ‘Goberna/ Goverment C1: otro 4 i [ves ae Star ype Ws eed) Oar Usa Sa Eg CTO TT ia ae Soles: /Tp of saree 0) Une Eas’ Sie Ey CT) RATA ik LT Oem rs | ery os) caso orate, ir pl eda aly dts dove ri, Upa ys wep) apt de ro Incase eftonk, dete Sostinon cout td vs0 daar esto nny (ane, ype na oxen St): Lig de etc on CA Foc sao ee yu wl tay the Ch 11 ACONERTANTES pga Wave WR JOE NORE Ti Parents / ation oo papers! peso Lil OTROS ONTOS ¥ DOCUMENTOS GUE SE APORTAN/OTHER DATA AND INSTRUMENTS SUBMITTED [Raney Drexion de uhagar rangooeStd: / Rane aa Aces of place of eileen 2 ekefono de Taba Busines phone 3: REFERENCIAS PERSONALTS, ESTUDIONO GE WECOCIOS ENEL CA (VERIFICABIES, FAVOR SER ESPECIICOS) Personal, School or business refrencasin he C4 rust bo oni please be specie) Nombre Cargo Namo an poste: "Tolono phora We Nomteo ola Erpresa/ Nome of Banos contat: Dees fos of Busines contact 1 a solace anton va Ge eros 8 Un FS GE cies reqursed a Visa to a C4 County lore; []__ Onde whee suse” P1NO/ m0 Cuno J wh ‘Lom oorade? Was kgiatea?: Lisiiyes CWO na 5. Pose came do residnta paranoia exanne aio: ‘Do youre a vai peurarink escony ca? C'S! 7. Be quo pas ram what county No! no see was vgptes de GU Pa? 8, De que pastes) rm nat county es) Doyoutare ober val vsus? [)31yes_C1NO/ no 7. ies documoncs. anesar asl db sigantosdocuirtos, saga sea e caso y Consiga bets Tnmulae) 7 ‘her decuens (pease ata ny ofthe leng documents ws rete) 0) ns dab ek eee: ‘Observaclones/Comments (us oficlal/ official usa only) Co cotati at ter: 0 afc esmereaton /Hetonmeniton er 1) onstancia de weston egal Prot of egal resieney. — C) See : 17 Raterencas barca, sli. 6o Uo do agosa u oes (Espodfea nanos y presnir rapa Bans rforoness. othr icone sous or oho (pasty ao nerna sours a sub eens) Fa. a wstogo ants kn does pats para los eval estas walla” 7 Have you ove Vio ny of ie Coun Tor WRT BS ica val? ugar(Cudee, Estat Pas) Pace (ty, stare cout) Fecha: date: ‘emo ce extela as): / bration of Sty (ay):TW. DATOS V DOCUMENTOS ADIGIONALES SOLIGITADUS A LA GATEGORIAO™ (VISA CONSULTADAY [DAA AND ADDITIONAL DOCUMENTS REQUESTED £OR CATEGORY “C* (CONSULTED VISA) THEA. Msconales de pases dea sta de Categoria“ pnden ing eso carer al pas que emit ts Vi Nats, National of Gategay “0 eons con. ony ent Oe courts tat sg he i {Inia bs. aionaades de os famiares (tena faconsked de aiuno de os Poses de! CA) Irleto the rons of yur fly marsars toy are tonne ony of ts eounes of the C4 eon) conyuge / Spous: Pate! Father Hira hon okay soe: 2. nombre y Naceraided de wu eonyuge:/ Name and Nationally f Spouse Contacto an ot pts aay ven soa, yi nermactn de cntato goa alzava (wo apie para vs en rans) 7 Contact dormaton ine Gourty whose vis you ae requesting, an contact ryormston (nt appoable for Vast visa eques): Nomtre completo ul name: ‘eu: etonsip: Infmacen ge comacte (reseanetetong) Contstevermaten (aides/phene number: 7 paren garni 3) apa decumniasn despa; LTS LTWO (near arena emia, nome, ar aeson,Taeand) Poot of sprsorsip 2) submiting documentation: C1 YES; C1. (Spay turaferences name, adress, pre) 5 a GE Ve ene cap pT av ay RG Cay oH eeTAF LT. Wy ovowe BRITT martina Lsgoda’ Arik Sida Doparwes TT ponds do vis Gobors Fayesa a rgin por sua Goegaton Taio ol pas que BES Wa {Las ves cones NO npn emi cron @ os tars oe hs paes Ga CA¢ The sa hoker must ener ie regon trough eny ination oe om Ge cout suing the vse Tha vio granted DOES NOT quran uncondonal onvancat the taars f tha GA Rel. FIRRIA DEL INTERESADO / Signature of applicant ugar y oor aoa Scie Pac ae de Engeso la pormanenea a ict estan syets ala deen na es auordoaes migrates su Haga aa regen, "he treatin ffcas he pa of enc to the Ce region Mave the fra decsen regard asso ar eiraben of ay akoHea tO 2 orig natona copa do passe do a y woos copy of round texce opi deta pagina de detos de passport y copia de 3s Ge oes pes / copy of passpent nein copies of vos issued by har cert de vain a CA ian eter to CAA censian baie = ingresos Wark — com ett» Fara vsas tips / or ule erty vias xponer ysis of atv desta do Visa Kt. #. st he need for mip etry visa Prose Cra Ga eps Chg oe. 0 Oa Qa uae cntetos Crete ce FaMEAES © mos oe CA qe espe a sa, Presenter om your busines ot pesone contact Vat aks yOu Sa Legs 'V__USO OFICIAL (NO LLENAR) / OFFICIAL USE ONLY (OO NOT FIELUP) SK OTORSADA Corsaro si Carsita (8) Cl, cCorsutada (c) C, ugarzncion DoW fordnara: CI Ocak Cl; Diploraie: Conese: Tansto: [1 une enrade); Trans: C1 (es entradas) na entradas CL watp: CP mer de Via Erica fecha de emir: ff Fecha de exphacen: of im [OaSERVACIONES ‘SELLO Y FIRMA DEL FUNCIONARIO CONSULAR GUE AUTORIZOLA VISA,