青少年数学国际城市邀请赛

1、：BI-84) Form 11DEPARTMENT OF HOME AFFAIRSREPUBLIC OF SOUTH AFRICAAPPLICATION FOR VISA OR TRANSIT VISASection 7(1)(g) read with section 10A and 10B; Regulation 8(1)Failure to complete this application form in full may result in the visa being delayed or refused.Please use block letters and black ink

2、only.表格請全部使用黑筆填寫正體英文PERSONAL PARTICULARSSurname:First names (in full):Maiden name:Previous surname(s):Y Y Y Y M M D DDate of birth:City of birth: Country of birth: TaiwanGender: MaleFemale姓名可不填必須與護照相同填寫四碼出生西元年份(出生民國年+1911)填寫二碼出生月份填寫二碼出生日填出生城市男生在此打勾 女生在此打勾PERSONAL PARTICULARSNationality: Taiwan.If ac

3、quired by naturalisation, state original nationality: Where and when was present nationality obtained: .Passport/Travel Document Number: .Type of document: Diplomatic/Official/Ordinary Passport/Travel Document/other (specify) Passport.Issuing authority: .Date of expiry: .曾由外國入籍台灣才需填寫取得台灣國籍地點、時間(直接填T

4、aiwan、出生日期)填護照號碼發照機關，填Ministry of Foreign Affairs填護照有效期限PERSONAL PARTICULARSPermanent residential address: Period resident at this address: Telephone number: (.) (code) (number)Country of permanent residence: TaiwanPeriod resident in that country: Occupation or profession: Name, address and telephon

5、e no. of employer, university, organisation, etc. to which you are attached, or that you attend or which you represent: .居住地址(可至中華郵政網頁查詢)在居住地居住期間886聯絡電話在台灣居住期間職業工作單位、地址、電話(本人為受顧員工)PERSONAL PARTICULARSIf self-employed, state name, address, telephone no. and nature of business:.Marital status:Never ma

6、rriedMarriedWidowedSeparatedDivorcedFirst name(s) of spouse:Maiden name:Y Y Y Y M M D DDate of birth:NationalityNB: SEPARATE FORMS MUST BE COMPLETED IN RESPECT OF PERSONS OVER THE AGE OF 16 AND CHILDREN UNDER THE AGE OF 16 TRAVELLING ON THEIR OWN PASSPORTS.公司名稱、地址、電話(本人為老闆)未婚已婚喪偶分居離婚配偶資料PERSONAL PAR

7、TICULARSParticulars of children endorsed on your passport accompanying you:SurnameFirst name(s)Date of birthPlace of birth(1)(2) (3) (4) 若與隨行小孩同一本護照才需填寫姓名出生日期出生地VISIT TO SOUTH AFRICAI SOLEMNLY DECLARE THAT THE ABOVE PARTICULARS PROVIDED BY ME ARE TRUE IN SUBSTANCE AND IN FACT AND THAT I FULLY UNDERSTAND THE MEANING THEREOF. I FURTHER DECLARE THAT I DO NOT CONTEMPLATE CHANGING THE PURPOSE OF MY VISIT WHILST IN THE REPUBLIC. .Signature of applicant Date簽名(與護照上的簽名一樣)填寫日期填寫學生英文姓