If you answered "No" to all questions, fill in "N/A."
If you answered “Yes” to any of questions 4.3 to 4.7, please give details below.
Section 5: Relevant declaration
(Form V.2011B) Please also complete
the Supplementary Visa Application Form (Form V.2011B) if you are not a U.S. citizen, or if you are applying for work visa or student visa, or if you
will be accompanied by anyone who shares the same passport with you.
Please use the space below or a separate sheet for
additional information / declaration / statement other than already provided in this application.
Section 6: Signature
I have read and understood all the
questions in this application. I declare that the information provided above is true and accurate. I shall take all responsibilities for any false
I understand that the decision on whether to issue a visa, validity/ type of visa, number of entries, and duration
of each stay will be decided by consular officers, and that any false, misleading or incomplete information may result in the refusal of a visa or denial of
entry into China.
Note: Parent or guardian may sign on behalf of an applicant aged under 18.
Section 7 If the application form is completed by another person on the applicant’s behalf, please fill out
If you have completed your own application, fill in all blanks below with "N/A."
Name of the person completing
Relationship to the
this form on the applicant’s behalf
Type of ID document
Number of ID
I declare that I have assisted in the completion of this form at the request of the applicant, and the applicant understands and confirms that the
information provided is true and correct.
Official use only
CNNYCONSULATE JUNE 2011 EDITION
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