Application For The Issue/ Extension Of A Residence Visa For Sri Lanka Page 3
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424 Period for which a Residence visa is required
Months/Years
25 Was a Residence visa issued previously, If so, state
i) Visa Number
Day
Month
Year
ii) Date of issue
iii) Purpose of which it
was issued
iv) Period for which it was issued
Years
Months
v) Particulars of the Passport on which the permit was issued
Day
Month
Year
i) Passport No
ii) Date of issue
Day
Month
Year
iii) Date of expiry
iv Place of issue
26
i) Number of present residence Visa of spouse or parent, if any
Day
Month
Year
ii) Date of issue visa
27
Particulars of applicant's own children
(only for whom application is also made Children under 16 should be included)
Name
Date of Birth
Gender
Place of Birth
28
(Particulars of responsible persons, relations or friends in Sri Lanka to whom reference can be made regarding
applicant or who are likely to undertake responsibility, if required, for applicant's maintenance and repatriation from
Sri Lanka
Full Name
Nationality
Address
Contact No.
Relationship
29 Any other reason to urge in support of application
30 Finger mark of the applicant
I solemnly declare that the information furnished by me in this application is true and that I have not wilfully
suppressed any information that is required, that in the event of issue of visa I shall comply with the terms and
conditions subject to which the visa is granted, and that I shal not engage myself in any employment, paid or
unpaid, or in any business or trade other than the purpose of visa is granted, and that I shall notify the Controller of
Immigration and Emigration of any change in my addresses during my stay in Sri Lanka.
Date: …………………………….
………………………………………………
Signature of applicant
Page 3
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