EMBASSY OF VIETNAM
470 Wilbrod Street
APPLICATION FOR ENTRY-EXIT VISA TO VIETNAM
PHOTO
Ottawa, Ont., Canada
DON XIN NHAP-XUAT CANH VIET NAM
K1N 6M8
4 x 6cm/passport
Tel: (613) 236 1398
sized;
Fax: (613) 236 0819
colour or black &
white
(glue or staple
Please write in block letters
photo here)
De nghi dien don bang chu in
1. Name and surname: __________________________________________________________________
Ho va ten:
2. Date of birth: ________________ 3. Sex: ________
10. Purpose of visit to Vietnam: ____________
_____________________________________
Ngay sinh:
dd
mm
yy
Gioi tinh:
11. Name, address of contact in Vietnam*
4. Place of birth: ______________________________
(office, organization or individual):
Noi sinh:
Ten, dia chi co quan, to chuc hoac cua
5. Nationality at birth: __________________________
than nhan ve tham hoac lam viec o Viet Nam:
Quoc tich goc:
Present nationality: __________________________
_________________________________
Quoc tich hien nay:
6. Passport number: ____________________________
_________________________________
Ho chieu so:
Date of issue: _________ Date of expiry: ________
__________________________________
(*For tourists going to stay at hotel without any
sponsoring organizations or individuals, just write
TOURIST/HOTEL for this item 11).
12. Proposed duration in Vietnam
Ngay cap:Ngay het han :
Issued by: _________________________________
from_____________ to_________________
Co quan cap
Thoi gian du kien o Viet Nam
Tu ngay:
den ngay:
7. Profession: _________________________________
Nghe nghiep :
Employer’s address: _________________________
13. Number of entries:
Noi lam viec:
So lan nhap canh:
Business telephone #_________________________
Single: _________ Multiple: ____________
So Dien thoai noi lam viec:
Mot lan :
Nhieu lan :
8. Present address: ____________________________
Dia chi cu tru hien nay:
Home telephone #: __________________________
Dien thoai nha o:
I declare that the statements above are
9. Accompanying children
(full name, date of birth, relationship)
true and correct
Tre em cung di (ho ten, ngay sinh, quan he)
Declared at/in__________ on (date) _______
_________________________________________
Lam tai:
ngay:
_________________________________________
Signature/
Ky ten
For visa processing, please submit:
1. One completed visa application form
with 01 latest photo (4 x 6cm or passport sized; color or black & white);
2. Valid passport (still valid at least one month after the expiry date of the requested visa);
3. Visa fee (cash, money order or certified check, payable to Embassy of Vietnam);
4. Prepaid courier self-addressed Envelope, preferably FEDEX, for visa/passport returns.