THE EMBASSY OF THE UNITED REPUBLIC OF TANZANIA
1232 22nd St. NW, Washington DC, 20037
Tel. (202) 939-6125 and (202) 884-1080 Fax (202) 797-7408
FOR OFFICIAL USE ONLY
VISA APPLICATION FORM
2 Passport Size
(Visa Regulations on the next page)
GRR NO.___________________
Photograph
Size: 2x2
VISA NO.___________________
Do not paste or
staple
Ref. NO.____________________
1.
Surname or Family Name (Mr./Mrs./Miss/Ms/Dr./Prof.)___________________________________
First Names in Full_______________________________________________________________
Former or Maiden Name (if different from above) _______________________________________
2.
Date of Birth (DD/MM/YY)_______________________________________Sex (M/F)___________
3.
Place of Birth____________________________Country of Birth___________________________
Current Nationality (State if Dual Nationality) ___________________________________________
Nationality at Birth________________________________________________________________
4.
Marital Status (Mark):
Single
Married
Divorced
Widowed
Legally Separated.
5.
Passport No _________________Date Issued ______________Valid Until ___________________
Issued At ___________________Issuing Authority______________________________________
6.
Profession/Occupation_____________________________________________________________
Employer Address: _______________________________________________________________
7.
Current Address__________________________________________________________________
Tel.__________________Fax__________________E-mail________________________________
8.
Name of Travel Agent/Tour Operator__________________________________________________
LAUREN SANS, +255 75 351 6613
9.
Contact Person(s) in Tanzania_______________________________________________________
MADIRA ESTATE, TENGERU, ARUSHA, PO BOX 16363, TANZANIA
Address_________________________________________________________________________
29/06/2016
04/08/2016
10. Date of Entry___________________________Depature Date______________________________
37 DAYS
Duration of Stay_________________________ (Max. 90 Days)
Type of Visa Requested
Travel Visa
Transit Visa
11. Purpose of visit
Leisure, Holiday
Other Business
Various
Visiting friends, relatives
Study
Diplomatic
Mission
Transit
Official
.
Meeting, Conference
Health Treatment
Same day visitor
12. Requested Number of Entries:
Single
Double
Multiple.
In
13.
Case Of Transit: Do you have an Entry Permit for the Final Country of Destination?
No
Yes Valid Until:
CASH AND CREDIT
14.
_________________________________
Budget Available For Your Stay
15. I Hereby Declare That The Information Stated Above Is True And Correct :
Signature of Applicant___________________________________________Date________________________________