Visa Application Form - Embassy Of The Kyrgyz Republic

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EMBASSY OF THE KYRGYZ REPUBLIC
在 在 在 在 日 日 日 日 本 本 本 本 国 国 国 国 キ キ キ キ ル ル ル ル ギ ギ ギ ギ ス ス ス ス 共 共 共 共 和 和 和 和 国 国 国 国 大 大 大 大 使 使 使 使 館 館 館 館
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5-6-16, Shimomeguro, Meguro-ku, Tokyo, 153-0064, Japan
〒153-0064 東京目黒区下目黒 5 丁目 6-16
Tel: 03-3719-0828 Fax: 03-3719-0868
e-mail:
office@kyrgyzembassy.jp
VISA APPLICATION FORM
(Application form must be typed or written in block letters)
Citizenship:
Passport number:
Expiration date:
Type of passport
(Diplomatic/Official/Ordinary):
Last name (in capital letters):
First name:
Middle name(s):
Date of Birth (day/month/year):
Place of Birth (country/city):
Sex (male/female):
Emergency contact person
Contact organization or private host in Kyrgyz Republic, including
(Name/telephone No./e-mail):
address and telephone:
Purpose of trip (business/tourism):
Specific purpose of visit:
Type of visa requested (business single entry/ business double entry/transit/tourist single entry/tourist double
entry):
Intended duration:
(For official use only)
From ________________ Until __________________
Номер:
(day/month/year)
(day/month/year)
Occupation, office address:
Permanent address:
Дата поступления:
Дата выдачи:
Telephone:
Telephone:
Сроком с:
E-mail:
Сроком до:
Dates of all precious visits to the Kyrgyz Republic:
Категория:
Дип Служ Обыкн Тур
Вид:
I declare that the data given in this application are correct and
Транз Одн Двукр Многокр
comprehensive.
____дней
____мес
_____________
_____________
____год
Signature
Date
Примечание:

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