乌克兰签证申请

1、VISA APPLICATION签证申请表(APPLICATION FOR UKRAINE ENTRY CLEARANCE) Please, complete 一 piiiit or write in pimtiiig letters 一 the form 填写本表格请打印填写或使用印刷字体手填Xcross the boxes where applicable方格中的内容请按提示填写PHOTOGRAPH35 x 45 imn1. SURNAME (as written in your passport) 姓(应与护照相符)2 FULL NAME (as written in your pass

2、port) 全名(应与护照相符)OTHER NAMES OR SURNAMES USED IN THE PAST其他姓名或曾用名DATE OF BIRTH 出生口期daymonthyear口月年town家countiy国地区SEX性别female 女 male 男NATIONALITY 民族presentformer (if any)现过去PERSONAL NUMBER 身份证号码ADDRESS OF PERMANENT RESIDENCE (countiy postal code, town, street, building N； apt M2).现居住地地址(国家，邮政号码，城市，街道，

3、建筑号)PASSPORT DETAILS 护照信息type护照种类number护照号码date of issue day护照发照口期 monthyearvalid until护照有效期monthveaiJ月年月年dayissuing authority护照颁发机关FOR OFFICE USE ONLYA12Br口123Ee冰3H2MARITAL STATUS婚姻情况nianied 己女昏single 未婚divorced 离异widowed 丧偶Ys 是 No 否 Yes是No否Yes是No否 赤s 是No 否DID YOU SUFFER FROM ANY INFECTUOUS DISEASE

4、 DANGEROUS FORPUBLIC HEALTH9您是否患有某种不适宜旅行的传染病Ys是 No否HAVE YOU EVER BEEN CHARGED OF ANY CRIMINAL OFFENCES ANYWHERE?您是否受到任何形式的刑事处罚Ybs是 No否HAVE YOU EVER BEEN LIMITED OR PROHIBITTED FROM AN ENTRY TO UKRAINE?您是否曾被拒绝进入乌克兰Ybs是 No否IF “YES”, PLEASE SPECIFY WHERE如果选择“是气请详细说明HAVE YOU EVER BEEN DEPORTED OR REMOVE

5、D FROM UKRAINE 9 您是否曾被从乌克兰驱逐出境Ybs是 No否PURPOSE OF YOUR JOURNEY?旅行目的DURATION OF STAY IN UKRAINE 预计在乌克兰停留时间 number of daysmonths天数月DATE OF PROPOSED ENTRY TO UKRAINE 前往乌克兰的时间daymonthyear日月年POINT OF ENTRY TO UKRAINE 前往乌克兰何地MEANS OF TRANSPORT FOR ENTRY TO UKRAINE 前往乌克兰的方式NAME AND ADDRESS OF ORGANIZATION W

6、HICH INVITES乌克兰境内邀请单位的名称及地址NAME AND ADDRESS OF PRIWiTE PERSON WHO INVITES 乌克兰境内邀请人的姓名及地址3CITIES IN UKRAINE YOU INTEND TO VISIT 您计划在乌克兰访问的城市ADDRESS OF TEMPORARY RESIDENCE IN UKRAINE你在乌克兰境内停留期期间的住址IN CASE OF NEED WHO WILL GIVE FINANCIAL SUPPORT在乌克兰停留期间经济担保方CHILDREN UNDER 16 YEARS INCLUDED ON YOUR PASS

7、PORT AND WHOWILL TRAVELWITH YOU TO UKRAINE登记在您护照上的未满16周岁的准备与您一同前往乌克兰的儿童date of buth出生日期Surname姓name名place of birth 出生地点 davJmonth月veai-J年nationality民族IF YOU HAVE BEEN TO UKRAINE , INDICATE THE DATE OF LAST VISIT如果您曾经前往过乌克兰，请提供一下最后一次前往的时间davmonthveai*JJ日月年VISA REQUESTED FOR:签证有效往返次数Single entiy 一次 do

8、uble entry 二次 multiple entry 多次 4THIS PART IS TO BE COMPLETED IN CASE OF TRANSIT THROUGH THE TERRITORYOFUKRAINE以下所列内容适用于过境乌克兰前往第三国的人士填写COUNTRY OF DESTINATION前往的目的地国MEANS OF TRANSPORT TO THE POINT OF DEPARTURE FROM UKRAINE 过境乌克兰，出境时所使用的交通工具DO YOU HAVE AN ENTRY CLEARANCE FOR THE DESTINATION?您是否有办理过境签证

9、所必须的文件Ys是 No否PLACE OF PROPOSED DEPARTURE FROM UKRAINE 9过境时，您所选择的途径地点DATE OF PROPOSED DEPARTURE FROM UKRAINE过境时离开乌克兰的时间Daymontliyear日月年ADDITIONAL INFORMATION备注I do hereby confurn that I have read and understood everything stated above. I declare that the information given by me m tliis application to

10、 the best of my knowledge is true. I am aware tliat untruthful data presented by me in tliis application may serves a reason to refiise the issue of Ukraines entiy visa and to reftise me to enter Ukiaine even in the case the entiy visa has been issued.I also know that in the case I am reftised to enter Ukiaine I am not entitled fbr any refiind of expenses mcuned by me.本人在填写本表格之前对本表格已经认真