Visa Application Form - Consulate Of The Kyrgyz Republic Page 2
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2CONSULATE OF THE KYRGYZ REPUBLIC
Embassy of the Kyrgyz Republic
affix the
2360 Massachusetts Ave., N.W., Washington, DC 20008
photo here
Tel: (202) 449-9822; Fax: (202) 386-7550
Е-мail:
Internet:
VISA APPLICATION FORM
(Application form must be typed or written in block letters)
Citizenship:
Passport number:
Expiration date:
Type:
Last name (in capital letters)
First
Middle name(s)
Date of Birth:
Place of Birth:
Sex:
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
Multiple entry (1 year)
Intended duration
From:
Until:
(For official use only)
day
month year
day month year
Номер:
Occupation, office address:
Permanent address:
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.
……… дней
……… мес
Signature
Date
……… год
Примечание:
№
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