Form Application For Entry Visa (Tourist) Page 3
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4Visa is valid for 3-months from the date of issue
Copy No.2
EMBASSY OF THE REPUBLIC OF THE UNION OF MYANMAR, WASHINGTON D.C.
APPLICATION FOR ENTRY VISA (TOURIST)
Official use only
1.
Name in Full ( Fill in Block Letters)
E.V.T(F.I.T)
E.V.T (Package Tour)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ _ _
/
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
( First Name )
(Middle Name )
( Last Name)
_ _ _ _ _ _ _ _ _ _ _
/ _ _ _ _ _ _ _ _ _ _ _ _
/
_ _ _ _ _ _ _ _ _ _ _
2.
Father's Full Name
PHOTO
( First Name )
(Middle Name )
( Last Name)
Recently taken
3. Date of Birth (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
color photo
4.
Place of Birth (City / State / Country): _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _
with full face, front view,
5.
Nationality:
U.S. /
(Others): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. Sex
(F) /
(M)
no hat
and against
6.
Present Occupation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
a plain light background
(If retired write " retired", if student write "student")
7. Marital Status:
Married
Separated
Divorced
Widowed
Single (Never Married)
8. Spouse's Full Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Personal Description
9.
(a) Color of Hair _ _ _ _ _ _ _ _ _ _ _ (b) Height:
m _ cm _ _ /
ft. _ in. _ _
(c) Color of Eyes _ _ _ _ __ _ _ _ _ _ (d) Complexion _ _ _ _ _ _ _ _ _ _ _ _ _ _
Passport
10. (a) Number _ _ _ _ _ _ _ _ _ _ _ _
(b) Date of Issue (dd/mm/yyyy) _ _ / _ _ / _ _ _ _
(c) Dt. of expiration (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
(d) Place of issue:
(e) Issuing Authority:
United States, _ _ _ _ _ _ _ _ _ _ _
United States, Department of State /
Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
National Passport Centre / Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
11. Present Address in U.S. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Include apartment number, street, city, state or province & postal zone)
12. Contact Phn. No. (Res.) ( _ _ _ ) _ _ _ _ _ _ _ (Work) ( _ _ _ ) _ _ _ _ _ _ _ e-mail:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
13. Address in Myanmar:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
14. Have you ever been to Myanmar:
Yes
No (If Yes) Date of Last Visit: (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
15. Have you ever been refused to enter Myanmar:
Yes
No. (If Yes) When: (dd/mm/yyyy): _ _ / _ _ / _ _ _
Why: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
16. Purpose of Visit:
Tourism / _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Expected date of Arrival: _ _ / _ _ / _ _ _ _ Flight No._ _ _ _ _ _ & Departure: _ _ / _ _ / _ _ _ _ , Flight No. _ _ _ _ _ )
dd
mm
yyyyy
dd
mm
yyyyy
Attention for Applicant:
(a)
Apart from the professions mentioned this visa application form applicants are not to engage in any sort of work, with or without charges.
(b) Applicant shall abide by the Laws of the Republic of the Union of Myanmar and shall not interfere in the Internal Affairs of the Republic of the
Union of Myanmar.
(c)
Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of the Republic of the
Union of Myanmar.
I hereby declare that I fully understand the above mentioned conditions, that the particulars given above are true and correct and
that I will not engage in any activities irrelevant to the purpose of entry stated herein.
--------------------------------------------
Signature of Applicant
Date (dd/mm/yyyy) : _ _ / _ _ / _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(FOR OFFICE USE ONLY)
Visa No. ___________________
Date : ________________________
Visa Authority:MOFA Lt. No. 46 11 11 (76) Dated : 11 March 1994
(If other): MOFA Lt. No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, Dated:_ _ _ _ _ _ _
Signature of Officer in-Charge
Embassy of the Republic of the Union of Myanmar WashingtonD.C., U.S.A
Contact : Tel. (202) 332 4352, (202) 238 9332 Fax.(202) 332 4351. , e-mail: )
Up Dated : May, 2014
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