韩国签证申请表(单次填写)

■出入境管理法实行规则[第17号样式]签证发给申请表APPLICATIONFORVISA<申请表填写方法>‣申请人须以事实为根据，并将在以下空格处完整记载。‣申请人必须用中文或英文填写以下申请表。‣在相关选项的“[]”内打钩。‣如您选择“其他”，请写具体内容。<Howtofilloutthisform>‣Youmustfilloutthisformcompletelyandcorrectly.‣YoumustwriteinblockletterseitherinEnglishorKorean.‣Formultiple-choicequestions,youmustcheck[√]allthatapply.‣Ifyouselect‘Other’,pleaseprovideuswithmoreinformationinthegivenspace.1.个人信息/PERSONALDETAILSPHOTO护照规格照片(35㎜×45㎜)6个月内拍摄的正面免冠彩色相片，相片背景颜色须为纯白色Acolorphototakenwithinlast6months(fullfacewithouthat,frontviewagainstwhiteoroff-whitebackground)1.1护照上的英文姓名/FullnameinEnglish(asshowninyourpassport)姓FamilyNameCAO名GivenNamesLU1.2中文姓名漢字姓名曹璐1.3性别Sex男/Male[]女/Female[√]1.4出生日期DateofBirth(yyyy/mm/dd)1990/10/181.5国籍Nationality中国1.6出生国CountryofBirth中国1.7身份证号码NationalIdentityNo.3508021990101815281.8过去访韩时是否使用过其他姓名HaveyoueverusedanyothernamestoenterordepartKorea?否No[√]是Yes[]→选择‘是’选项时填写详细内容。If‘Yes’pleaseprovidedetails(姓FamilyName名GivenName)1.9是否双重国籍Areyouacitizenofmorethanonecountry?否No[√]是Yes[]→选择‘是’选项时记载详细内容。If‘Yes’pleasewritethecountries()领馆审核栏FOROFFICIALUSEONLY기본사항체류자격체류기간30D유효기간사증종류S▪D▪M접수사항접수일자접수번호처리과허가사항허가일자인정번호고지사항결재담당가[]부[]심사의견><邮票粘贴处><수입인지부착란>B/L:출입국사항:복수대상사유:사건부:불허경력:기타:2.签证发给认定书签发信息（反签号）/DETAILSOFVISAISSUANCECONFIRMATION※仅限于在大韩民国出入国管理事务所·办事处收到签证发给认定书的人(Section2isonlyforthosewhopossessconfirmationofvisaissuanceissuedbytheImmigrationOfficeoftheRepublicofKorea)2.1签证发给认定号码(反签号)ConfirmationNo.2.2签发日期IssueDate2.3护照号码PassportNo.2.4护照有效期PassportExpiryDate‣签证发给认定书持有者直接移到第12部分(誓约)，填写以下空格后提交申请表(不用写第3~11部分)Thosewhohaveconfirmationofvisaissuancemustmovetosection12(Declaration)tocompletethisfrom(Thosewithvisaissuanceconfirmationmustnotfilloutsection3~11).3.护照信息/PASSPORTINFORMATION3.1护照种类PassportType外交Diplomatic[]公务Official[]公务普通Official[]因私Regular[√]其他Other[]→如您选择‘其他’，请写具体内容If‘Other’pleaseprovidedetails()3.2护照号码PassportNo.G567581233.3签发国家CountryofPassport中国3.4签发地点PlaceofIssue福建3.5签发日期DateofIssue2011/12/133.6有效期间DateOfExpiry2021/12/123.7是否持有其他护照Doyouhaveanyothervalidpassport?否No[√]是Yes[]→如您选择‘是’，请写具体内容If‘Yes’pleaseprovidedetailsa)护照种类PassportType外交Diplomatic[]公务Official[]公务普通Official[]因私Regular[√]其他Other[]b)护照号码PassportNo.c)签发国家CountryofPassportd)有效期间DateOfExpiry4.联系方式/CONTACTINFORMATION4.1本国地址AddressinYourHomeCountry上海市浦东新区海阳路1080号香樟苑14座402室4.1现居住地CurrentResidentialAddress*仅限于现居住地与本国地址不同者/Writeifitisdifferentfromtheaboveaddress4.3手机号码CellPhoneNo.132626776604.4固定电话TelephoneNo.021-508312094.5电子邮箱E-mailamydew1@163.com4.6紧急情况联系人信息EmergencyContactInformationa)姓名FullName张琼仙b)居住国家Countryofresidence中国c)电话号码TelephoneNo)关系Relationshiptoyou母女5.婚姻状况/MARITALSTATUSDETAILS5.1婚姻状况CurrentMaritalStatus已婚Married[]离婚Divorced[]未婚Single[√]丧偶Widowed[]5.2配偶个人信息*标记为已婚时填写If‘Married’pleaseprovidedetailsofyourspousea)姓FamilyName(inEnglish)b)名GivenNames(inEnglish)c)出生日期DateofBirth(yyyy/mm/dd)d)国籍Nationalitye)住址ResidentialAddressf)联系电话ContactNo.6.学历/EDUCATION国家NameofCountry访问目的PurposeofVisit访问期间PeriodofStay(yyyy/mm/dd)~(yyyy/mm/dd)美国攻读硕士2013.7.25-2014.9.22泰国旅游2015.12.31-20.同行家属AreyoutravellingtoKoreawithanyfamilymember?无No[√]有Yes[]→如您选择“有”，请写具体内容If‘Yes’pleaseprovidedetailsofthefamilymembersyouaretravellingwith姓名FullnameinEnglish出生日期DateofBirth(yyyy/mm/dd)国籍Nationality关系Relationshiptoyou*参考:家属范围–配偶,子女,父母,兄弟姐妹Note:DefinitionofaFamilyMember-yourspouse,father,mother,children,brothersandsisters10.访问经费/FUNDINGDETAILS10.1访问经费(美元为基准)Estimatedtravelcosts(inUSdollars)2000美元10.2访韩费用支付者Whowillpayforyourtravel-relatedexpenses?(anypersonincludingyourselfand/orinstitute)a)姓名/单位名称NameofPerson/Company(Institute)本人b)关系Relationshiptoyouc)支援内容TypeofSupportd)联系电话ContactNo.11.填写申请表时是否接受过帮助/ASSISTANCEWITHTHISFORM11.1您在填写申请表时是否接受过别人的帮助？Didyoureceiveassistanceincompletingthisform?否[√]No是Yes[]→如您选择“是”，请写具体内容If‘Yes’pleaseprovidedetailsofthepersonwhoassistedyou姓名FullName出生日期DateofBirth(yyyy/mm/dd)联系电话TelephoneNo.关系Relationshiptoyou12.誓约/DECLARATION*签证发给认定书持有者也须填写Thosewhopossessconfirmationofvisaissuancemustonlycompletesection1,2,and12ofthisform根据本人所知所信，我声明以上所有陈述均真实、准确、完整。我将遵守大韩民国的出入境管理法律法规。Ideclarethatthestatementsmadeinthisapplicationaretrueandcorrecttothebestofmyknowledgeandbelief,andthatIwillcomplywiththeImmigrationActoftheRepublicof申请日期(年.月.日)DATEOFAPPLICATION(yyyy/mm/dd)▪▪▪申请人（签名）SIGNATUREOFAPPLICANT申请人未满17岁，父母或法定监护人签名SignatureofParentorLegalGuardian´sforapersonunder17yearsofage附件ATTACHMENT1.「出入境管理法实行规则」第76条第1项[表格5]签证发给申请等附件注意事项Notice1.有关上述事项，本表如不够填写可另加附页或是追加提供相关材料。Ifextraspaceisneededtocompleteanyitem,recordonaseparatesheetofpaperorsubmitrelevantdocumentswhichcouldsupportyourapplication.2.如您的大韩民国签证得到批准后因遗失、损毁等原因再次签发，必须通知签证处理机构变更的护照信息，以便准确反映个人信息。IfyoureceivedKoreanvisaapproval,andhavenewpassportissuedthereafterinlieuoflost/damagedpassport,youmustnotifythec