中国公民出入境证件申请表

PAGE/r/n护照条码/r/n港澳证件条码/r/n护照条码/r/n港澳证件条码/r/n赴台证件条码/r/n（请用/r/n黑色/r/n签字/r/n笔或钢笔/r/n书写，并在相应/r/n选项/r/n内/r/n打/r/n“/r/n√/r/n”/r/n）/r/n：/r/n姓名/r/n身份/r/n证/r/n号码/r/n正面免冠半身/r/n彩色照片/r/n大小：40X/r/n30/r/n性别/r/n民族/r/n出生/r/n日期/r/n出生地/r/n户口/r/n所在地/r/n本人/r/n联系/r/n电话/r/n紧急情况联系人/r/n及电话/r/n□/r/n普通/r/n护照/r/n□/r/n首次申领/r/n□/r/n补、换发/r/n□/r/n失效重新申领/r/n□/r/n加注/r/n加注/r/n内容/r/n□/r/n曾用名加注（曾用名：）/r/n□/r/n姓名加注（姓名：）/r/n□/r/n曾持照加注（曾持护照号码：）/r/n□/r/n往来/r/n港澳/r/n通行/r/n证和/r/n签注/r/n□/r/n通行证和签注/r/n□/r/n仅申请签注/r/n□/r/n仅申请通行证/r/n□/r/n团队旅游/r/n□/r/n个人旅游/r/n□/r/n商务/r/n□/r/n探亲/r/n□/r/n其他/r/n□/r/n逗留/r/n往来/r/n香港签注/r/n□/r/n3个月一次/r/n□/r/n3个月/r/n二/r/n次/r/n□/r/n1年一次/r/n□/r/n1年二次/r/n□/r/n3个月一次/r/n□/r/n3个月/r/n二/r/n次/r/n□/r/n1年一次/r/n□/r/n1年二次/r/n□/r/n3个月一次/r/n□/r/n3个月多次/r/n□/r/n1年多次/r/n□/r/n3个月一次/r/n□/r/n3个月多次/r/n□/r/n1年多次/r/n□/r/n3个月一次/r/n□/r/n3个月/r/n二/r/n次/r/n□/r/n1年一次/r/n□/r/n1年二次/r/n多次有效/r/n往来/r/n澳门/r/n签注/r/n□/r/n3个月一次/r/n□/r/n3个月/r/n二/r/n次/r/n□/r/n1年一次/r/n□/r/n1年二次/r/n□/r/n3个月一次/r/n□/r/n3个月/r/n二/r/n次/r/n□/r/n1年一次/r/n□/r/n1年二次/r/n□/r/n3个月一次/r/n□/r/n3个月多次/r/n□/r/n1年多次/r/n□/r/n3个月一次/r/n□/r/n3个月多次/r/n□/r/n1年多次/r/n□/r/n3个月一次/r/n□/r/n3个月/r/n二/r/n次/r/n□/r/n1年一次/r/n□/r/n1年二次/r/n多次有效/r/n仅探亲类/r/n签注填写/r/n港澳亲属姓名_____________________，性别______，港澳身份证号码__________________________，与申请人关系_______________。/r/n□/r/n往来/r/n台湾/r/n通行/r/n证和/r/n签注/r/n□/r/n通行证和签注/r/n□/r/n仅申请签注/r/n□/r/n仅申请通行证/r/n□/r/n加注/r/n申请/r/n事由/r/n□/r/n团队旅游/r/n（/r/n□/r/n3个月一次/r/n/r/n□/r/n多/r/n次/r/n有效）/r/n/r/n/r/n□/r/n探亲/r/n（/r/n□/r/n6/r/n个月一次/r/n/r/n□/r/n多/r/n次/r/n有效）/r/n□/r/n经贸交流/r/n（/r/n□/r/n6/r/n个月一次/r/n/r/n□/r/n多/r/n次/r/n有效）/r/n□/r/n应邀（/r/n□/r/n6/r/n个月一次/r/n/r/n□/r/n多/r/n次/r/n有效）/r/n□/r/n个人旅游/r/n□/r/n定居/r/n/r/n□/r/n居留/r/n□/r/n就学/r/n□/r/n乘务/r/n/r/n□/r/n其他/r/n取证/r/n方式/r/n□/r/n前往公安机关出入境管理部门领取/r/n□/r/n邮/r/n寄送达/r/n/r/n邮寄地址/r/n邮/r/n编/r/n收件人/r/n联系/r/n电话/r/n监护人意见或委托他人办证/r/n本人系申请人的_______________，/r/n□/r/n同意申请人办理出入境证件//r/n□/r/n受申请人的委托代为办理出入境证件/r/n。/r/n□/r/n监护人/r/n/r/n//r/n/r/n□/r/n被委托人签名：/r/n年/r/n/r/n月/r/n/r/n日/r/n申/r/n请/r/n人/r/n声/r/n明/r/n/r/n本人谨此声明：/r/n此申请表所填内容真实正确无误，所提交的申请材料真实有效/r/n，/r/n如存在虚假情形，本人愿意承担法律责任。/r/n申请人签/r/n名：/r/n/r/n年/r/n/r/n月/r/n/r/n日/r/n/r/n电子往来港澳通行证持证人免登记/r/n使用港澳地区自助查验通道声明/r/n本人/r/n谨此/r/n声明：/r/n持证人/r/n希望/r/n免登记/r/n使用港澳地区自助查验通道，同意香港入境事务处、澳门治安警察局在口岸查验工作中读取/r/n持证人/r/n电子往来港澳通行证中的指纹模板信息。/r/n□/r/n持证/r/n人//r/n□/r/n监护人签名：/r/n年/r/n/r/n月/r/n/r/n日/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n/r/n以下栏目由公安机关出入境管理部门填写/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n/r/n◈/r/n指/r/n纹/r/n采/r/n集/r/n情/r/n况/r/n右手：/r/n□/r/n拇指/r/n□/r/n食指/r/n□/r/n中指/r/n□/r/n环指/r/n□/r/n小指/r/n左手：/r/n□/r/n拇指/r/n□/r/n食指/r/n□/r/n中指/r/n□/r/n环指/r/n□/r/n小指/r/n采集人签名：年月日/r/n/r/n复核人签名：年月日/r/n无法正常/r/n采集指纹的原因：/r/n□/r/n无法采集拇指指纹/r/n□/r/n指纹缺失、损坏/r/n□/r/n其他/r/n/r/n受理/r/n意见/r/n/r/n受理人签名：/r/n年/r/n/r/n月/r/n/r/n日/r/n普通护照：/r/n□/r/n同意/r/n/r/n□/r/n不同意/r/n往来港澳通行证和签注：/r/n□/r/n同意/r/n/r/n□/r/n不同意/r/n往来台湾通行证和签注：/r/n□/r/n同意/r/n/r/n□/r/n不同意/r/n/r/n审核人签名或签章：/r/n/r/n年/r/n/r/n月/r/n/r/n日/r/n审批/r/n签发/r/n意见/r/n普通护照：/r/n□/r/n同意/r/n/r/n□/r/n不同意/r/n往来港澳通行证和签注：/r/n/r/n□/r/n同意/r/n/r/n□/r/n不同意/r/n往来台湾通行证和签注：/r/n/r/n□/r/n同意/r/n