Visa Application Form For Kazakhstan Page 2
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1
219.
/Places of destination in the Republic of Kazakhstan:__________________
__________________________________________________________________________________________________________
20.
/The first place of entry into the Republic of Kazakhstan:_________
__________________________________________________________________________________________________________
21.
-
/Temporary address in Kazakhstan:__________________________________
__________________________________________________________________________________________________________
?/Who is
22.
paying for your cost of travelling and for your costs of living during your stay in Kazakhstan?:________________________________
__________________________________________________________________________________________________________
23.
?/Have you got an insurance for the period of your stay in
Kazakhstan?:
/No
/Yes.
,
/If
yes,
please
indicate
its
validity
and
the
name
of
insurance
company:__________________________________________________________________________________________________
24.
,
?/In case of transit through Kazakhstan, have you got an entry visa or residence permit for your destination?:
/No
/Yes.
,
/if
yes,
indicate
the
country
of
destination:______________________________________
/border point through which entry is
planned:_________________________________________________________________
/route of
transit:_____________________________________________________________________________________________________
25.
/Period of requested visa: from________________
to _____________
26.
/Number of entries requested:
1
2
3
/multiple
27.
(
)/Children (please
indicate whether they are traveling with you and are entered in your passport):
,
/
/
/Nationality
Surname, First names
Date and plase of birth
1
2
3
.
.
.
2001
12
«
»
209-II
(
) 514-
;
.
I undertake that the above mentioned personal data are full and correct. I am aware, that wrong data can cause refuse and canceling of
already issued visa. I am obliged to leave the territory of the Republic of Kazakhstan before visa expiration.
I am told, that in accordance with the article 514 of the Tax Code of the Republic of Kazakhstan
209-II of the 12 of June 2001 the sum of
money paid as consular fee is not subject for return; the issued visa does not fully guarantee entry into Kazakhstan and will not serve as basis for
compensation in case the authorized bodies of the Republic of Kazakhstan refuse entry for the owner of visa into territory of Kazakhstan.
/
Place and date: _______________________________________
/Signature: ______________________________________
For official use only
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