T KHAI NGH CP TH THC VIT NAM (1) VIETNAMESE VISA APPLICATION FORM (Dng cho ngi nc ngo i For foreigners) 1- H t n (ch in hoa) : Full name (in capital letters) 中文中文姓名姓名（大写大写字母字母） 2- Gii t nh: 3- Sinh ng y : Sex 性别性别 Date of birth (day, month, year) 出生日期出生日期 4- Ni sinh : Place of birth 出生地出生地 5- Quc tch gc : 6- Quc tch hin nay:. Nationality at birth 出生出生国家国家 Current nationality 目前目前国籍国籍 7- T n gi o: 8- Ngh nghip: Religion 宗教宗教信仰信仰 Occupation 职业职业 9- Ni lm vic : Employer and business address 工作工作地址地址 10- a ch thng tr : Permanent residential address 永久永久居住地居住地 S in thoi/Email: . Telephone/Email 11- Th n nh n (Family members): Quan h Relationship H t n (ch in hoa) Full name (in capital letters) Gii t nh Sex Ng y sinh Date of birth (Day, Month, Year) Quc tch Nationality a ch thng tr Permanent residential address 家庭家庭成员关系成员关系 中文中文姓名姓名（大写大写字母字母） 性别性别 出生年月日出生年月日 国籍国籍 永久居住地永久居住地 12- H chiu s/ giy t c gi tr thay h chiu s: .loi (4): Passport or International Travel Document number C quan cp: c gi tr n ng y Issuing authority: Expiry date (day, month, year) 13- Ng y nhp xut cnh Vit Nam gn nht (nu c ): . Date of previous entry into Viet Nam (if any) 14- D kin nhp cnh Vit Nam ng y ; tm tr Vit Nam ng y Intended date of entry (Day, Month, Year) Intended length of stay in Viet Nam: days 15- Mc ch nhp cnh: TOURIST Purpose of entry 16- D kin a ch tm tr Viet Nam: Intended temporary residential address in Viet Nam 17- C quan, t chc hoc c nh n ti Vit Nam mi, bo l nh: Hosting organisation/ individual in Viet Nam - C quan, t chc: Chi nh nh C ng ty c phn du lch Qung Tri ti H Ni Name of hosting organization nh photo 4x6 cm See notes (2) 此处此处贴照片贴照片 4cm*6cm a ch: Address - C nh n: (h t n) Hosting individual (full name) a ch Address Quan h vi bn th n Relationship to the applicant 18- Tr em di 14 tui i cng h chiu (nu c ): Accompanying child(ren) under 14 years old included in your passport (if any) S TT No H t n (chu in hoa) Full name (in capital letters) Gii t nh (sex) Ngy thng nm sinh Date of birth 中文中文姓名姓名（大写大写字母字母） 性别性别 出生年月日出生年月日 19- ngh cp th thc: mt ln nhiu ln Applying for a visa Single Multiple T ngy:/.n ng y:/ Valid from (Day, Month, Year) to (Day, Month, Year) 20- ngh kh c li n quan vic cp th thc (nu c ):. Other requests (if any) Ti xin cam oan nhng ni dung trn y l ng s tht. I declare to the best of any knowledge that all the above particular are corect. L m ti: , ngy thng .nm . Done at date (Day, Month, Year) Ngi ngh (k , ghi r h t n) 此处此处签名签名 The applicants signature and full name Ghi ch /Notes: (1) Mi ngi khai 01 bn k m theo h chiu hoc giy t i li quc t, np trc tip ti c quan i din Vit Nam nc ngo i hoc n v kim so t 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 the international border checkpoint immigration office where the visa is issued. (2) K m 02 nh mi chp, c 4 x 6 cm, ph ng nn trng, mt nh n thng, u trn, khng eo knh mu (01 nh d n v o t khai, 01 nh ri). Enclose 2 recently taken photos in 4x6cm size, with white background, front view, bare head, without sunglasses (one of 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 th ng, c ng v, ngoi giao hoc giy t c gi tr i li quc t. Specific type of passport whether it is Ordinary, Official or Diplomatic or specify name of the International Travel Document. nh photo 4x6 cm See notes (2) 低于低于 14 岁以岁以 下儿童下儿童贴照片贴照片 nh photo 4x6 cm See notes (2)