Embassy Of Vietnam, Washington, D.c. Visa Application

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Visa Approval/Reference Number (if any):
01
Photo
EMBASSY OF VIETNAM
VISA
th
(2 inches x 2 inches)
1233 20
Street, NW, Suite 400
APPLICATION
Glued photo here
Washington, D.C. 20036
01 additional photo
(FOR NON-VIETNAMESE
stapled to this form for a
Tel: (202) 861-0737 & (202) 861-2293
PASSPORT HOLDERS)
loose -leaf visa request
Fax: (202) 861-0917
______
1. Name (in block letters):
.................................................................................………………………………………….
Family name
First name
Middle name
2. Date of birth:.................../............./….… …
10. Name, address of your contact (sponsor, host,
Date / Month / Year
hotel…) in Vietnam (if any)
................................................………………
3. Male:
Female
................................................................……
4. Place of birth:..............................................
.........................................................................
5. Nationality at birth:......................................
.........................................................................
Nationality at present:..................................
.........................................................................
Passport number
6.
:........................................
..………………………………………….…
Date of issue:................ ........... ........... .........
11. Proposed date of entry:
Date of expiry:........... ........... ........... ...........
.......... …./…............/........
. .....
7. Profession:......................................................
Date
/ Month
/ Year
Place of employment:.....................................
Proposed date of exit:
.................................... ......................... ....
....… … /…………/……...
.....
……….…………………………………………
Date
/ Month
/ Year
Telephone (Office):…....…....................... .....
12. Requesting a visa good for:
8. Present mailing address: (P.O Box Not
 Times of entries:
Accepted for USPS express mail)
………….………………………………………
- Single (one time) visit
…………………………………………………
- Multiple visits
…………………………………………………
 Length of stay:
…………………………………………………
- One month
* Email :………………………….
* Telephone :.......................................
- 03 months
9. Purpose of visit to Vietnam:
- Less than
6 Months (with an approval only)
…………………………………………………
- Up to one
year (with an approval only)
…………………………………………………
…………………………………………………
I solemnly declare that the statements made in this application are true and correct.
Date:…………………………………………………
Signature of Applicant ...............................................
Check list: Before submitting, make sure you have included:
 Original Passport (for a visa sticker request);
or  Passport copy (front photo page, for a loose-leaf visa request)
 Completed and signed Application with One Photo glued or stapled;
 Visa Fee: Money Order (or Cashier’s Check); and
 Prepaid USPS Express Mail or FedEx Slip, (if you want your visa be returned by mail).
* Required for further contact

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