Visa Application Form For Us Citizens - Russian Universal Services Page 2
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2** - not to be filled by holders of diplomatic and official passports
**28. List all educational institutions you ever attended, except high schools
1. Name
Address and phone number
Course of study
Dates of admission and graduation
(
)
(
)
mm/yy
mm/yy
2. Name
Address and phone number
Course of study
Dates of admission and graduation
(
)
(
)
mm/yy
mm/yy
**29. List all professional, civil and charity organizations which you are /
**30. Do you have any specialized skills, training or experience
were a member of or cooperate / cooperated with
related to fire-arms and explosives or to nuclear matters, biological or
chemical substance? If yes, please specify
**31. Have you ever performed a military service? If yes, indicate the country, branch of service, rank, military occupation and dates of service
**32. Have you ever been involved in an armed conflicts, either as a member of the military service or a victim? If yes, please specify
33. IMPORTANT! EACH APPLICANT MUST READ AND GIVE ANSWERS TO THE FOLLOWING QUESTIONS
A visa may be refused to persons who are within specific categories defined by the law as inadmissible to Russia.
Have you ever been arrested or convicted for any offence?
yes
When? (
)
Where?
no
dd/mm/yy
Have you ever been afflicted with a communicable disease of public health significance or a dangerous physical or mental
yes
no
disorder? Have you ever been a drug abuser or a addict?
Have you ever been refused a Russian visa?
yes
When? (
)
Where?
no
dd/mm/yy
Has your Russian visa ever been canceled?
yes
When? (
)
Where?
no
dd/mm/yy
Have you ever tried to obtain or assisted others to obtain a Russian visa or enter Russia by providing misleading or false
yes
no
information?
Have you ever overstayed your Russian visa or stayed unlawfully in Russia?
yes
no
Have you ever been deported from Russia?
yes
When? (
)
Where?
no
dd/mm/yy
Your answer yes in item 33 does not automatically signify ineligibility for a visa. In this case you may be required to personally
appear before a consular officer.
34.
Name, address and phone number of a person or hotel in Russia that you plan to stay with
35. Has this application been completed personally by you? If no, indicate the person completing this application in item 36
yes
no
36. Application completed:
Surname, first name
Relationship to
Applicant’s
applicant
address
37. Other names ever used (
)
maiden name, pen-name, holy orders, et..
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38. Your permanent address, phone and fax number, E-mail
For Photo
Place for photograph
39. Place of birth (
)
If born in Russia, please indicate when and what country you emigrated to
Requirements
40. Place of work or study, present position (
)
name, address, phone and fax numbers, E-mail
I agree to my personal data on this application
form being processed and communicated to the
appropriate Russian authorities for the issue of a
visa.
41. Are any of your relatives staying in Russia now?
Date (
), applicant’s signature
(
)
dd/mm/yy
full name, relation degree, date of birth, permanent address
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