Application For Visa - Republic Of Namibia Ministry Of Home Affairs Page 2

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NOTE: COMPLETE ONLY PART A OR B
(A) HOLIDAY / BUSINESS / WORK / TRANSIT VISA
1. Intended date and port of arrival in Namibia: ________________________________________________________________
2. (a) What is the purpose of your visit? ______________________________________________________________________
(b) If it is for business, explain in detail the nature of business: __________________________________________________
____________________________________________________________________________________________________
(c) Duration of intended visit (number of days, weeks or months): _______________________________________________
3. Places to be visited in Namibia (full address, including telephone number must be provided): __________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
4. If the purpose of your visit is for medical treatment, please provide the following information:
(a) Name of doctor, hospital or clinic you will visit: ___________________________________________________________
(b) Who will pay your medical expenses and hospital fees: _____________________________________________________
(c) If you are liable for the expenses and fees above, state amount of funds available: ________________________________
5. Proposed residential address in Namibia: ___________________________________________________________________
__________________________________________________
Telephone number: _______________________________
6. Name and addresses of relatives in Namibia:
NAME
ADDRESS AND TELEPHONE NUMBER
RELATIONSHIP
(a) ________________________
____________________________________
_______________________________
(b) ________________________
____________________________________
_______________________________
7. Date of last visit, if any to Namibia: ________________________________________________________________________
8. Do you contribute professionally or otherwise to publications, radio, television or films? If so, please give details: _________
____________________________________________________________________________________________________
9. (a) Destination after leaving Namibia: ______________________________________________________________________
(b) Mode of travel to destination: __________________________________________________________________________
(c) Intended date and port of departure: _____________________________________________________________________
(d) Is you entry to that destination assured, e.g. do you hold visa or permit for permanent or temporary residence? (Proof to be
submitted)
____________________________________________________________________________________________________
10. Reasons for travelling through Namibia: ____________________________________________________________________
____________________________________________________________________________________________________
(B) RETURN VISA
IMPORTANT
An applicant has to:
(i) produce his or her passport or travel document; and
(ii) submit proof of his or her right of residence in Namibia if not endorsed in his or her passport.
1. (a) Kind of Permit and number: ___________________________________________________________________________
(b) Date of departure: ___________________________________________________________________________________
(c) Expected date of return: ______________________________________________________________________________
2. Particulars of residence in Namibia:
DATE OF FIRST ENTRY
PORT OF ENTRY
PERIODS OF RESIDENCE IN NAMIBIA
From
To
__________________________
__________________________________
_____________
_______________
__________________________
__________________________________
_____________
_______________
__________________________
__________________________________
_____________
_______________
3. Countries to which you will be travelling:
(a) __________________ (b) _______________________ (c) ________________________ (d) _____________________
4. Purpose of journey (explain fully):_________________________________________________________________________
____________________________________________________________________________________________________
I solemnly declare that the above particulars given by me are true in substance and in fact and that I fully understand the meaning thereof.
Date: ____________________________
Signature: ___________________________________________________________
(N.B. Only the signature of the applicant will be accepted)

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