Visa Application Form - Embassy Of The Kyrgyz Republic
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1EMBASSY OF THE KYRGYZ REPUBLIC
affix the
2360 Massachusetts Ave, Washington, DC 20016
photo here
Tel: (202) 338-5141 / (202 ) 742 6602; Fax: 202 742 6501
E-mail:
VISA APPLICATION FORM
(Application form must be typed or written in block letters)
Citizenship:
Passport number:
Expiration date:
Type:
United States
Regular
Last name (in capital letters)
First
Middle name(s)
Place of Birth:
Sex:
Date of Birth:
Male
Female
day
month
year
Name of spouse:
Contact organization or private host in Kyrgyzstan, including address and tel.:
Purpose of trip:
Business
Pleasure
Specific purpose of visit
Type of visa requested:
Transit
Single Entry
Tourist
Double-entry
6 Months
1 Year
Intended duration
(For official use only)
From:
Until:
Occupation, office address:
Permanent Address:
Номер:
Дата поступления:
Дата выдачи:
Сроком с:
Сроком до:
Tel:
Tel:
Категория:
Дип Служ Обыкн Тур
Dates of all previous visits to the Kyrgyz Republic:
Вид:
Транз Одн Двукр Многокр
I declare that the data given in this application are correct and comprehensive.
________________________________________________________
Signature
Date
……… мес…………год
Примечание:
№
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