Visa Application Form - High Commission Of The Republic Of Zambia printable pdf download

1000 Finch Ave West, Suite 900

Toronto, ON, M3J 2V5

Ph: 1-866-334-0811

Fax: 416-352-1794

A division of RCTC Corporation

1. Please provide your contact information:

Last Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

First Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Phone: ( _ _ _ ) _ _ _ - _ _ _ _

Email: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

2. Returning documents

FedEx Priority Overnight ($25 to Canada; $35 to continental US)

Use my pre-paid courier. Self-address waybill & envelope are attached

(FedEx, DHL, Purolator & UPS only)

I will pick up my passport from your office

Name

Street address :

: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Phone: ( _ _ _ ) _ _ _ - _ _ _ _

Suite :

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

City :

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Prov/State : _ _

Postal Code/Zip

: _ _ _ _ _ _ _

3. Payment

Service cost $ ______ + 5% GST $ _______ + Courier $ ______ = TOTAL $ _______

Method of Payment :

I enclose a certified cheque / money order made out to “RCTC Corporation”

Charge my credit card

(Charges on your statement will appear as “RCTC Corporation”)

authorize RCTC Corp to charge my card the above TOTAL amount.

______________________

signature here

Visa

MasterCard

AMEX

Card Number

Exp. Date (mm/yy)

_______________________________________________

_ _ / _ _ _ _

: _______________________________

CCard Billing Address

Cardholder Signature:

street address

_______________________________

_________________

city

state/province

zip/postal code

4. Terms and Conditions:

By using the services of RCTC Corp., I authorize the company to handle my personal information and my

passport and to hand over such passport and information to a foreign diplomatic mission in Canada or the USA for the purpose of acquiring a visa. By using the

services of RCTC Corp I am accepting in whole the following terms and conditions and limitations: RCTC Corp. cannot and does not guarantee a visa will be

issued by a diplomatic office, as this is the sole prerogative of the foreign government. RCTC Corp. is not responsible for the safety or security of your passport

once the passport has entered the diplomatic grounds or passed into the control of the courier. RCTC Corp. is not liable for any stolen or lost passport, and has

no liability for late delivery of passports and visas, and RCTC Corp. does not bear any financial, legal or other obligations whatsoever for client ticket or other

purchases, down payments, bookings or any kind of travel or other arrangements that were done prior to the issuance of visa or that may be affected by

processing times or denial of visa. Likewise, RCTC Corp. does not bear any financial (or otherwise) responsibility from issues arising from errors and improper

issuance of visas by the consulates; for losses resulting from, and does not compensate for travel expenses arising from any of the above. RCTC Corp. will

charge $50.00 per passport for cancelled visa applications. I understand and fully accept the abovementioned.

Name ______________________________ Signature: _______________________ Date: ______________________

Major credit cards accepted