Application For Visa - Republic Of Namibia
ADVERTISEMENT
1
2
3
43-1/0033
FOR OFFICIAL USE ONLY
Approved / Not Approved
Single / Multiple entry
File No.:
Date of issue:
REPUBLIC OF NAMIBIA
Date of expiry:
Ministry of Home Affairs and Immigration
Immigration Control Act, 1993
Remarks:
APPLICATION FOR VISA
(Sections 12 and 13 / Regulation 11)
Items 4 to 10 to be completed by inserting an “X” in the appropriate box.
Signature:
1.
Surname:
Date:
2.
First names:
3.
Maiden name (if applicant is or was a married woman):
4.
Sex:
Male
Female
5.
Marital status:
Never Married
Married
Divorced
Widow/Widower
6.
Have you at any time applied for a permit to settle permanently in Namibia?
Yes
No
7.
Have you ever been restricted or refused entry to Namibia?
Yes
No
8.
Have you ever been deported or ordered to leave Namibia?
Yes
No
9.
Have you ever been convicted of any crime in any country?
Yes
No
10.
Are you suffering from tuberculosis, or any other contagious lung disease; trachoma, or any other chronic eye infection, frambesia, yaws,
scabies or any other contagious bacterial skin disease; syphilis or any other venereal disease; or leprosy or Acquired Immune Deficiency
Syndrome virus (AIDS virus), or any mental illness or affliction?
Yes
No
11.
If the reply to any one of the questions 6 to 10 is in the affirmative, attach full particulars.
12.
Birth (a) Date:
(b) Place:
Country
13.
Citizenship:
(if acquired by naturalization, state original citizenship)
14.
Passport: (a) Number:
(b) Place of issue
(c) Date of issue:
(d) Date of expiry:
(e) Is passport valid for travel to Namibia:
Yes
No
15.
(a) Present residential address:
(b) Telephone no.: (
)
16.
Address and period of residence in country of which you are a permanent resident:
(a) Residential address:
(b) Telephone no.: (
)
(c) Period:
Occupation or Profession:
17.
18. Firm, company, university, etc., to which you are attached or which you represent:
(a) Name and address of employer:
(b) Telephone no.: (
)
(c) Nature of business:
(d) If a student, name of university to which you are attached and the course pursued:
19. If accompanied by your wife and children state:
First Names
Date of Birth
Place of Birth
(a)
(b)
(c)
20. (a) What amount of money will you have available on arrival in Namibia for your own use? N$
(b) Will you be in possession of an onward/return ticket?
Yes
No
(N.B. separate applications have to be completed in respect of your spouse or children over the age of 16 years and children travelling with their own passports.)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business