Visa Application Sample - Embassy Of The Russian Federation In Usa
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1
2Embassy of the Russian Federation in USA
VISA APPLICATION
IMPORTANT! Please type or print using ballpoint pen
I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will lead to my application being
rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the legislation of the Russian Federation. I undertake to leave
the territory of the Russian Federation upon the expiry of the visa, if granted/ I am aware that the fact that a visa has been granted to me does not mean that I will be
entitled to enter the territory of the Russian Federation, if any reasons are appear. In a case of refusal of entry I do not have a right to compensation of damage.
** - Not to be filled by holders of diplomatic and official passports
1. Present citizenship (if you formerly had USSR or Russian
2. Last name (as in passport, in capital letters)
citizenship, please indicate when and why you lost it)
DOE
USA
3. First and middle names (as in passport)
4. Other names ever used (maiden name, professional, religious aliases)
JOHN
(maiden, etc.) or N/A
5. Place of birth (if born in Russia, please indicate when and to
6. Date of birth (DD/MM/YY)
7. Sex
Check appropriate box below.
what country you emigrated)
M
F
M M
D D
Y Y
YOUR CITY, PA, USA
9. Russian institution or organization to be visited (name and address,
phone, fax number, E-mail (if known), name of contact person)
8. Purpose of visit
official
tourism
medical
business
x
private
cultural
sports
other, please specify
**10. Itinerary (places to be visited)
11. Date of entry (DD/MM/YY)
12. Date of departure (DD/MM/YY)
1 6
0 4 0 8
2 1 0 4 0 8
St. Petersburg, Russia
13. Number of entries
1
2
multiple
X
14. Passport number
Passport issued by
Date of issue
Valid until
D D
M M
Y Y
D D
M M
Y Y
1 1 1 1 1 1 1 1 1
National Passport Center
15.Type of passport
diplomatic
official
tourist
seaman’s passport
alien’s travel document
x
other (please specify)
N/A
**16. Name and reference number of the tourist group
No (or yes, if you do)
**17. Do you have а medical insurance policy valid in Russia (please specify)?
Myself
18. Who will pay for your trip to and stay in Russia?
single (never married)
divorced
separated
widowed
*
19. Marital status
мarried
20. Spouse’s full name (even if divorced or separated, please indicate maiden name if applicable)
21.Spouse’s date of birth (dd/mm/yy)
J A N E
D O E
M M
D D
Y Y
22. Spouse’s place of birth
YOUR CITY, PA, USA
**23. Your father’s full name
**24. Your mother’s full name
JAMES DOE
MARY DOE
25. Have you ever been issued a Russian visa?
Yes
When?
Where?
Mark what is appropriate. {2007 competitors mark Yes, 04/18/2007, St. Petersburg}
No
X
Yes
No
**26. Have you ever lost your passport or had one stolen?
X
Mark what is appropriate.
**27. List all countries you have visited in the last ten years and indicate the year of visit
**28. List all countries which have
previously issued you a passport
List all countries you visited, for example:
Germany 2006; France 2004; Jamaica 2005;
N/A or whatever is applicable
(Or, Not Applicable if you haven’t left the United States)
**29. List your last two places of work, excluding the current one
1. Name
Phone number
{self explanatory}
{self explanatory}
Address
Your supervisor’s full name
Your position
Dates of employment
2. Name
Phone number
{self explanatory}
{self explanatory}
Address
Your supervisor’s full name
Your position
Dates of employment
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