Visa Application Form - High Commission Of The Republic Of Uganda Page 2
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2Serial No: ………. ……
VISA APPLICATION FORM
High Commission of the Republic of Uganda, 1210-350 Sparks Street, Ottawa ON K1R 7S8
Telephone: (613) 789 7797 Fax: (613) 789 8909
Visa fee received:
Passport size
Visa No:
Recorded delivery No:
photograph
here
Date of dispatch:
Remarks:
Authorizing Officer
:
Please read the information on Page 2 carefully and fill the form in block letters.
Surname: ..........................................
Other Names......................................................
Former Names: ..................................
Gender..............................................................
Telephone: .........................................
Email: ...............................................................
Passport No: .......................... Place of Issue: ........................ Date of Issue......................
Type of Passport: ................................
Date of expiry: ..................................................
Date of Birth: ....................................
Place of Birth: ....................................................
Nationality: .......................................
Former: ............................................................
Current Occupation: ...........................
Previous Occupation: ..........................................
Work or School Address: ................................................................................................
Home Address: ............................................................................................................
Telephone No: Day/Work: ...................
Evening: ...........................................................
Marital Status: Married / Single/ Divorced / Widowed / Separated*
*Delete whichever does not apply
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Details of children, only if included on the passport and traveling with the applicant
Name
Date and Place of Birth
Sex
Relationship to applicant
1: ...............................................................................................................................
2: ...............................................................................................................................
Visa applied for: Single Entry/ Transit
Purpose of Entry: ...........................................................................................................
Date of arrival ...............
Duration of stay ............. Dates of previous visits ........................
If in transit, final destination ..........................................................................................
Have you obtained a visa for country of destination? Yes / No / Not necessary
Full name, address and telephone number of contact in Canada and Uganda
In Canada: ..................................................................................................................
Telephone: ..................................................................................................................
In Uganda: ..................................................................................................................
Telephone: ..................................................................................................................
I understand by signing below that the processing fee is non-refundable.
Date: .................................... Applicant’s Signature: ...................................................
Tel: (613) 789-7797 Fax: (613) 789-8909 E-mail:
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