Form V.2011a - Visa Application Form Of The People'S Republic Of China Page 7
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11Form V.2011A
Section 3: Information about your family, work or study
3.1
Address
City
Province/State
Zip code
Current home address
3.3
3.2
Mobile phone
Home phone number
number
3.4
Email address
3.5
Name
Name, phone number and
Address
Phone number
address of your current
employer or school
City
Province/State
Zip code
(List company name and
brief description of the
industry, such as "Smith and
Name
Nationality
Occupation
Relationship
Smith LLC- attorneys" or
"Self-Employed - architect.")
3.6
Major family members
(Fill in details for spouse and
all family members who live
with you. If you live alone, list
at least one close relative.)
3.7
3.8
Contact person in case of
Contact person’s
emergency
phone number
Section 4: Other information
No
4.1
Have you ever visited China
before? If “Yes”, please specify date, places and purpose of the
Yes
latest visit.
No
4.2
12
Have you ever visited other
countries or territories in the past 12 months? If “yes”, please
specify date, name of countries or territories and purpose of the
Yes
visits.
4.3
Yes
No
Have you ever overstayed your visa or residence permit in China?
4.4
Yes
No
Have you ever been refused a visa for China, or been refused entry into China?
4.5
Yes
No
Do you have any criminal record in China or any other country?
4.6
? Are you suffering from any of the following diseases?
Serious mental disorder
Yes
No
Infectious pulmonary tuberculosis
Other infectious disease of public health hazards
4.7
30
Yes
No
Did you visit countries or territories infected by infectious diseases in the past 30 days?
CNNYCONSULATE JUNE 2011 EDITION
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