Russian Visa Application Form For Non-U.s. Citizens
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1VISA APPLICATION
IMPORTANT! Please print or write in block letters using ball-point pen
I declare that all data given in this form is complete and true. 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 Russia 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.
7. Purpose of visit
1. Nationality (
)
If you had USSR or Russian nationality at some time please indicate when you lost it
8. Category and type of visa
2. Surname (
)
9. Number of entries
as in passport
Single entry
Double entry
Multiple entry
3. First name, other names, patronymic names (
)
10. Date of entry into Russia
11. Date of exit from Russia
as in passport
(
)
(
)
dd/mm/yy
dd/mm/yy
4. Date of birth
5. Sex
12. How many times have you been to Russia?
M
F
(
)
dd/mm/yy
6. Passport No
Date of last trip to Russia (
)
dd/mm/yy
Date of issue
Expires on
from
till
(
)
(
)
dd/mm/yy
dd/mm/yy
13. Name of host organisation you intend to visit? (
for tourists – name and reference number of host travel company, for business visas – name of host organisation and destination city,
)
for private visas - full name and address of host
14. Route of journey (
)
points of destination
15. Do you have health insurance that is valid in Russia?
yes
?
Provide details
no
16. Children under 16 years and other relatives written in your passport and travelling with you:
no
yes
Surname, first name, date of birth (
), your home address
dd/mm/yy
17. Other names used in the past (
)
maiden, religious, etc.
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18. Your permanent address, telephone, fax, email
For Photo
Place for photograph
19. Your place of birth (
)
if you were born in Russia, specify when and which country you have immigrated to
Requirements
name of employer, address, tel, fax, email
20. Present occupation, position (
)
I hereby agree that my personal data will be
processed and communicated electronically for
approval of my visa application.
21. Do you currently have relatives in Russia?
Date (
), signature
(
)
dd/mm/yy
Please indicate their full names, relation degree, dates of birth, address
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