Visa Application Form For Us Citizens - Russian Universal Services
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1
2VISA APPLICATION
IMPORTANT! Please type or print using ballpoint
I declare that data supplied by me is correct and complete. I am aware that any false statements will lead to my application being rejected or
to the annulment of a visa already granted and may also render me liable to prosecution under Russian law. I undertake to leave the territory
of the Russian Federation upon the expiry of the visa, if granted. I understand that possession of a visa does not entitle its bearer to enter
Russia. I will not seek compensation if I am refused to enter Russia.
** - not to be filled by holders of diplomatic and official passports
1. Nationality(
)
6. Purpose of visit
If you formerly had USSR or Russian citizenship, please indicate when and why you lost it
7. Category and type of visa
2. Last name(
)
8. Number of entries
as in passport
Single entry
Double entry
Multiple entry
3. First and middle names (
)
9. Date of entry in Russia
10. Date of departure from Russia
as in passport
4. Date of birth
5. Sex
M
F
(
)
dd/mm/yy
(
)
(
)
dd/mm/yy
dd/mm/yy
11. Passport No
Date of issue (
)
dd/mm/yy
Issued by
Valid until (
)
dd/mm/yy
12. Type of passport
diplomatic
official
tourist
other
please specify
13. Russian institution or organization to be visited? (
for tourists – name and reference number of the host tourist company, for businessmen – name of the host organization and town, for private
)
persons – last name, first name, middle names and home address of the host
14. Itinerary(
)
places of visit
**15. Do you have a medical insurance valid in Russia?
yes
Please specify?
no
16. Who will pay for your trip to and stay in Russia?
17. Marital status
married
single (never married)
divorced
separated
widowed
18. Spouse’s full name (
)
19. Spouse’s date of birth
if divorced or separated, please indicate maiden name if applicable
(
)
dd/mm/yy
20. Spouse’s place of birth
**21. Your father’s full name
**22. Your mother’s full name
23. Have you ever been issued a Russian visa? (
)
When and where?
**24. Has your passport ever been lost or stolen?
yes
no
**25. List all countries you have visited in the last ten years and indicate
**26. List all countries which have ever issued you a passport
the year of visit
**27. List your last two places of work, excluding the current one
1. Name
Phone number
Address
Your chief’s surname
Your position
Dates of joining – dismissal
(
)
(
)
mm/yy
mm/yy
2. Name
Phone number
Address
Your chief’s surname
Your position
Dates of joining – dismissal
(
)
(
)
mm/yy
mm/yy
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