Visa Application Form - Embassy Of The Republic Of Zambia
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1EMBASSY OF THE REPUBLIC OF ZAMBIA
2419 Massachusetts Avenue,
Telephone: (202) 265-9717
NW Washington, DC 20008
Facsimile: (202) 332-0826
E-mail:
VISA APPLICATION FORM
1. Surname:
2. First Name:
Middle Name:
3. Date of Birth:
Place of Birth:
4. Nationality:
Sex:
5. Profession:
Business Telephone No.
6. Nationality of Parents at time of Birth:
(
)
7. Passport No.
8. Place of Issue:
Date of Issue:
Date of Expiration:
1.
If accompanied by your spouse or children, give the following particulars
: (Note: Every applicant fills out an individual form)
Full Name (s)
Date & Place of Birth
Relationship
10. Present Address:
Telephone No.
(
)
Email:
1.
Permanent Address:
Telephone No.
(
)
Email:
2.
(a) Type of Visa Requested: Tourist ( )
Business ( )
Church Business ( )
Visitor ( )
Diplomatic ( )
Official ( )
Student ( )
Transit ( )
Volunteer ( )
Courtesy (
)
(b) Entry requested:
Single ( )
Double ( )
Multiple ( )
(a) Date of entry into Zambia: ________________________________
(b) Length of Stay in Zambia: ________________________________
13. Final Destination of Journey in Zambia:
Address in Zambia:
1.
Expected Departure Date from Zambia:
Next Destination from Zambia:
1.
Duration and Particulars of any previous residence or visits in Zambia:
2.
If traveling on business, please list names and addresses of persons to be visited in Zambia:
3.
If visiting relatives or friends, please list names and addresses of persons to be visited in Zambia:
18. Signature of Applicant:_______________________________________________________
Date:__________________
For official use only:
Visa fee
Rush Fee
Payment
Visa #
Receipt#
Notations
Date
Tag #
Rev. 04/2006
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Parent category: Business