Visa Application Form - Embassy Of The Federal Democratic Republic Of Ethiopia In Pretoria
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1Embassy of
the Federal Democratic Republic of Ethiopia in Pretoria
Visa Application Form
First Name: _________________ Middle Name: _____________________ Last Name: _______________________________
Sex: _________ Birth Date: D________/M_______/Yr.___________ Birth Place_____________________________________
Present Nationality: _______________________ Any Other: ________________ Occupation: _________________________
Official
Passport Type
Ordinary
Service
D iplomatic
A lien
O thers:___________________________________
Passport No ______________________ Issue Date: D_____/M_____/Yr_______ Expiry Date: D_____/M_______/Yr______
Business Address:
________________________________________________________________________________________
Residential Address:
______________________________________________________________________________________
P. O.
Box: _________________________________Contact No: ___________________________________________________
Date of Entry: ___________________ Date of Departure: _______________________ Port of Entry: ___________________
Way of Transport: ________________________ Flight Ticket No: ________________________________________________
If you travel by Land the Vehicle Reg. No: ___________________________________________________________________
CURRENT REQUEST
Pretoria
Place of request
Request Visa Type: ____________________________________ Duration (Days)
______________
Entries:
Single
Double
Multiple (3 Months) Number of Supporting Docs: ___________________________________
Multiple (6 Months)
Multiple (1 year)
DETAILS OF CONTACT PERSON/ ORGANIZATION/ ACCOMMODATION/ IN ETHIOPIA
Full Name of Contact Person
Name Of Organization
Accommodation Details
___________________________________
__________________________________
_________________________________
Address: ____________________________________________________________________Phone No: ______________________
I the Undersigned declare that all the above mentioned statements are true to the best of my knowledge.
___________________________________________
__________________________________________________
Full Name & Signature of the Applicant
Request Date
FOR OFFICE USE ONLY
To be filled at Head Office
Date of Entry: ___________________ Port of Entry: ______________ Visa No. _________Visa Type: ______________________
Place of Issue: _________________ Date of Issue: ____________________ Date Of Expiry: ______________________________
Address in Ethiopia: Hotel: ______________ Tel: ____________ Contact Person: _____________ Phone: __________________
List Of Supporting Documents:
Remarks
Collected By: ___________________________
Signature: ________________________________
________________________________
Tel. Number: ___________________________
Date:
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