Visa Application Form - High Commission Of The Republic Of Zambia Page 2
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3HIGH COMMISSION OF THE REPUBLIC OF ZAMBIA
Suite 205,
Telephone: (613) 232-4400
151 Slater Street
Facsimile: (613) 232-4410
Ottawa, Ont. K1P 5H3
E-mail:
zhc.ottawa@bellnet.ca
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:
If accompanied by your spouse or children, give the following particulars
9.
: (Note: Every applicant fills out an individual form)
Full Name (s)
Date & Place of Birth
Relationship
10. Present Address:
Telephone No.
(
)
Email:
11. Permanent Address:
Telephone No.
(
)
Email:
12. (a) Type of Visa Requested: Tourist ( )
Business ( )
Church Business ( )
Visitor ( )
Diplomatic ( )
Official ( )
Student ( )
Transit ( )
Volunteer ( )
Courtesy (
)
(b) Entry requested:
Single ( )
Double ( )
Multiple ( )
(c) Date of entry into Zambia: ________________________________
(d) Length of Stay in Zambia: ________________________________
13. Final Destination of Journey in Zambia:
Address in Zambia:
14. Expected Departure Date from Zambia:
Next Destination from Zambia:
15. Duration and Particulars of any previous residence or visits in Zambia:
16. If traveling on business, please list names and addresses of persons to be visited in Zambia:
17. 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. 11/2008
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