烏克蘭簽證申請

1、VISA APPLICATION簽證申請表(APPLICATION FOR UKRAINE ENTRY CLEARANCE) Please, complete 一 piiiit or write in pimtiiig letters 一 the form 填寫本表格請打印填寫或使用印刷字體手填Xcross the boxes where applicable方格中的內(nèi)容請按提示填寫PHOTOGRAPH35 x 45 imn1. SURNAME (as written in your passport) 姓(應(yīng)與護(hù)照相符)2 FULL NAME (as written in your pass

2、port) 全名(應(yīng)與護(hù)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國地區(qū)SEX性別female 女 male 男NATIONALITY 民族presentformer (if any)現(xiàn)過去PERSONAL NUMBER 身份證號碼ADDRESS OF PERMANENT RESIDENCE (countiy postal code, town, street, building N； apt M2).現(xiàn)居住地地址(國家，郵政號碼，城市，街道，

3、建筑號)PASSPORT DETAILS 護(hù)照信息type護(hù)照種類number護(hù)照號碼date of issue day護(hù)照發(fā)照口期 monthyearvalid until護(hù)照有效期monthveaiJ月年月年dayissuing authority護(hù)照頒發(fā)機(jī)關(guān)FOR OFFICE USE ONLYA12Br口123Ee冰3H2MARITAL STATUS婚姻情況nianied 己女昏single 未婚divorced 離異widowed 喪偶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您是否患有某種不適宜旅行的傳染病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處罰Ybs是 No否HAVE YOU EVER BEEN LIMITED OR PROHIBITTED FROM AN ENTRY TO UKRAINE?您是否曾被拒絕進(jìn)入烏克蘭Ybs是 No否IF “YES”, PLEASE SPECIFY WHERE如果選擇“是氣請?jiān)敿?xì)說明HAVE YOU EVER BEEN DEPORTED OR REMOVE

5、D FROM UKRAINE 9 您是否曾被從烏克蘭驅(qū)逐出境Ybs是 No否PURPOSE OF YOUR JOURNEY?旅行目的DURATION OF STAY IN UKRAINE 預(yù)計(jì)在烏克蘭停留時(shí)間 number of daysmonths天數(shù)月DATE OF PROPOSED ENTRY TO UKRAINE 前往烏克蘭的時(shí)間daymonthyear日月年P(guān)OINT OF ENTRY TO UKRAINE 前往烏克蘭何地MEANS OF TRANSPORT FOR ENTRY TO UKRAINE 前往烏克蘭的方式NAME AND ADDRESS OF ORGANIZATION W

6、HICH INVITES烏克蘭境內(nèi)邀請單位的名稱及地址NAME AND ADDRESS OF PRIWiTE PERSON WHO INVITES 烏克蘭境內(nèi)邀請人的姓名及地址3CITIES IN UKRAINE YOU INTEND TO VISIT 您計(jì)劃在烏克蘭訪問的城市ADDRESS OF TEMPORARY RESIDENCE IN UKRAINE你在烏克蘭境內(nèi)停留期期間的住址IN CASE OF NEED WHO WILL GIVE FINANCIAL SUPPORT在烏克蘭停留期間經(jīng)濟(jì)擔(dān)保方CHILDREN UNDER 16 YEARS INCLUDED ON YOUR PASS

7、PORT AND WHOWILL TRAVELWITH YOU TO UKRAINE登記在您護(hù)照上的未滿16周歲的準(zhǔn)備與您一同前往烏克蘭的兒童date of buth出生日期Surname姓name名place of birth 出生地點(diǎn) davJmonth月veai-J年nationality民族IF YOU HAVE BEEN TO UKRAINE , INDICATE THE DATE OF LAST VISIT如果您曾經(jīng)前往過烏克蘭，請?zhí)峁┮幌伦詈笠淮吻巴臅r(shí)間davmonthveai*JJ日月年VISA REQUESTED FOR:簽證有效往返次數(shù)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以下所列內(nèi)容適用于過境烏克蘭前往第三國的人士填寫COUNTRY OF DESTINATION前往的目的地國MEANS OF TRANSPORT TO THE POINT OF DEPARTURE FROM UKRAINE 過境烏克蘭，出境時(shí)所使用的交通工具DO YOU HAVE AN ENTRY CLEARANCE FOR THE DESTINATION?您是否有辦理過境簽證

9、所必須的文件Ys是 No否PLACE OF PROPOSED DEPARTURE FROM UKRAINE 9過境時(shí)，您所選擇的途徑地點(diǎn)DATE OF PROPOSED DEPARTURE FROM UKRAINE過境時(shí)離開烏克蘭的時(shí)間Daymontliyear日月年ADDITIONAL INFORMATION備注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.本人在填寫本表格之前對本表格已經(jīng)認(rèn)真