Application

Embassy of Vietnam

APPLICATION FOR ENTRY AND EXIT VISA

(FOR FOREIGNERS)

1. First name, last name :
10. Purpose of visit:

2. Date of birth:                            11. Name & address of your contact in Vietnam

3. Male / Female

4. Place of birth:                                                                     (Organization, office, or individual)

5. Nationality at birth:                                                              12. Proposed date of entry into, and exit from, Vietnam

Nationality at present:                                                             from                         to

6. Passport number:                                                       13. Number of entries:   Single/Double

Issued by:                                14. Port of arrival and departure:

Date of issue:                         Date of expiration:

7. Profession:

Place of employment:

Office telephone:

8. Present address:



Home telephone:

9. Accompanying children (Full name, date of birth):

I solemnly declare that the statements made in this application are true and correct.

Signed at:                                                                                       Date:
                           (City)

Signature:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Please note:
Official Use Only
1. Print legibly when filling out this application.
2. Submit two (2) copies of this application, each with a photo attached.
3. YOUR ORIGINAL PASSPORT MUST ACCOMPANY THIS APPLICATION.
4. If the applicant was born in Vietnam, regardless of present nationality, a different application must be filled out. This one cannot be used.

Visa #

1. First name, last name :	10. Purpose of visit:
2. Date of birth:	11. Name & address of your contact in Vietnam
3. Male / Female
4. Place of birth:	(Organization, office, or individual)
5. Nationality at birth:	12. Proposed date of entry into, and exit from, Vietnam
Nationality at present:	from to
6. Passport number:	13. Number of entries: Single/Double
Issued by:	14. Port of arrival and departure:
Date of issue:	Date of expiration:
7. Profession:
Place of employment:
Office telephone:
8. Present address:

Home telephone:
9. Accompanying children (Full name, date of birth):