1、 Mu (Form) NA1Ban hnh km theo thng t s 04 /2015/TT-BCAngy 05 thng 01 nm 2015 T KHAI NGH CP TH THC VIT NAM (1)VIETNAMESE VISA APPLICATION FORM(Dng cho ngi nc ngoi For foreigners)1- H tn (ch in hoa):. Full name (in capital letters) 2- Gii tnh: Nam N 3- Sinh ngy.thng.nmSex Male Female Date of birth (Da
2、y, Month, Year)4- Ni sinh:. Place of birth 5- Quc tch gc: 6- Quc tch hin nay:Nationality at birth Current nationality7- Tn gio: .8- Ngh nghip: .Religion Occupation9- Ni lm vic: Employer and business address10- a ch thng tr: .Permanent residential address.S in thoi/Email:.Telephone/Email11- Thn nhn F
3、amily members:Quan h (3)RelationshipH tn (ch in hoa)Full name(in capital letters)Gii tnhSexNgy thng nm sinhDate of birth(Day, Month, Year)Quc tchNationalitya ch thng trPermanent residential address12- H chiu/giy t c gi tr i li quc t s: loi (4): .Passport or International Travel Document number Type
4、C quan cp: . c gi tr n ngy:././.Issuing authority: Expiry date (Day, Month, Year)13- Ngy nhp cnh Vit Nam gn nht (nu c): Date of the previous entry into Viet Nam (if any)14- D kin nhp cnh Vit Nam ngy /./.; tm tr Vit Nam .ngy Intended date of entry (Day, Month, Year) Intended length of stay in Viet Na
5、m days 15- Mc ch nhp cnh: Purpose of entry16- D kin a ch tm tr Vit Nam:Intended temporary residential address in Viet Nam17- C quan, t chc hoc c nhn ti Vit Nam mi, bo lnhHosting organisation/individual in Viet Nam C quan, t chc: Name of hosting organisationa ch: Addressnh - photo4x6 cm(1)See notesnh
6、 - photo4x6 cmSee notes(2)C nhn (h tn) Hosting individual (full name)a ch.Address Quan h vi bn thn .Relationship to the applicant18- ngh cp th thc: mt ln nhiu ln Applying for a visa Single Multiplet ngy: /. n ngy/. valid from (Day, Month, Year) to (Day, Month, Year) 19- ngh khc lin quan vic cp th th
7、c (nu c):.Other requests (if any)Ti xin cam oan nhng ni dung trn l ng s tht.I declare to the best of my knowledge that all the above particulars are correctLm ti: ngy thng nm .Done at date (Day, Month, Year)Ngi ngh (k, ghi r h tn) The applicants signature and full name Ghi ch/Notes:(1) Mi ngi khai 0
8、1 bn km h chiu hoc giy t c gi tr i li quc t, np trc tip ti c quan i din Vit Nam nc ngoi hoc n v kim sot xut nhp cnh ti ca khu quc t ni nhn th thc.Submit in person one completed application form enclosed with passport or International Travel Document at the Vietnamese Diplomatic Mission abroad or at
9、the international border checkpoint immigration office where the visa is issued.(2) Km 02 nh mi chp, c 4x6cm, phng nn trng, mt nhn thng, u trn, khng eo knh mu (01 nh dn vo t khai, 01 nh ri). Enclose 2 recently taken photos in 4x6 cm size, with white background, front view, bare head, without sunglas
10、ses (one on the form and the other separate).(3) Ghi r b, m, v, chng, con, anh, ch, em rut (nu c).State clearly the information about parents, spouse, children and siblings (if any).(4) Ghi r loi h chiu ph thng, cng v, ngoi giao hoc giy t c gi tr i li quc t.Specify type of passport whether it is Ordinary, Official or Diplomatic or specify name of the International Travel Document.
