Solicitud De Visado Diplomatico/oficial (Diplomatic/official Visa Application Form)

Embajada de la República Argentina

Washington D.C., EE.UU.

SOLICITUD DE VISADO DIPLOMÁTICO/OFICIAL

Diplomatic/Official visa application form

APELLIDO: .................................................................................................................................

Surname as in passport

NOMBRES: ...............................................................................................................................................................

Names as in passport

NACIONALIDAD: ..................................................................................................................................................

Citizenship

PAÍS Y FECHA DE NACIMIENTO: ....................................................................................................................

Country, Date of Birth (DD/month/YYYY)

LUGAR DONDE TRABAJA: .................................................................................................................................

Organization/Agency you work for

CARGO QUE OCUPA: ...........................................................................................................................................

Current position

LUGAR DE RESIDENCIA HABITUAL: .............................................................................................................

Home address

TIPO Y N° DOCUMENTO DE VIAJE: ................................................................................................................

Travel document type and number

LUGAR Y FECHA DE EXPEDICIÓN: ………………………………..…… VENCIMIENTO: ..................................

Place and date of issue

Expiration Date

MOTIVO DEL VIAJE /

Purpose of the trip:

a. Meeting Argentine officials? Please specify Agency: ...............................................................................................................

b. Meeting private sector representatives? Company/Organization: ...........................................................................................

c. Attending a Conference? Name: ..............................................................................................................................................

d. Attending internal meetings of your organization? Yes / No ..................................................................................................

e. Other .........................................................................................................................................................................................

PERSONA DE CONTACTO EN LA ARGENTINA (Nombre, Organización, Cargo y número de teléfono):

Contact person in Argentina – Name, organization, position, and phone number

………………………………………………………………………………………………………………: (+54 11 …….……-…………….......)

FECHAS EN LAS QUE VIAJARÍA: from .................................................. to .......................................................

Dates of your trip to Argentina.

Washington D.C.: ……./……./ 2017

…………………………………………………………..

……………………………………………………….

FIRMA DEL INTERESADO

FIRMA FUNCIONARIO

Applicant’s signature

Consular Officer’s signature

Recibió:

SAM:

e-DAC:

Firma:

Received by: