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30. Please indicate the information about your relatives in the Republic of Tajikistan (father, mother, sister/brother, children, adopted children, spouse, fiancée etc):

31. IMPORTANT: AFTER HAVING READ THE LISTED BELOW QUESTIONS ATTENTIVELY, PLEASE MARK THE “YES” OR “NO” BOXES:

- have you ever been arrested or convicted for any offence of crime within the

YES

territory of the Republic of Tajikistan? If answer «YES», please describe it in the

separate page

- have you ever been a member of terrorist or extremist group or organization,

human trafficking, weapons and ammunition, illegal drug trafficking and their

YES

precursors, illegal immigration?

- do you have a criminal record for felony in the territory of the Republic of

YES

Tajikistan or in any other foreign country?

- have you ever been subject of pardon or amnesty?

YES

- do you intend to work or other entrepreneurial activities in territory of Republic of

YES

Tajikistan after receiving a visa?

- did you or do you have infections (contagious) of diseases harmful for the health

YES

surrounding society?

32. Was this application prepared by another person (organization)? If «YES», then:

YES

The inviting side is informed that according to the legislation of the Republic of Tajikistan, bears responsibility for authenticity of data indicated in the application as well as for the timely preparation of the

documents of the invited foreign citizen for the right of: stay in the Republic of Tajikistan, movement within the territory and for exit from the Republic of Tajikistan upon expiring their defined term of stay.

who:

relation with applicant:

full address and telephone number:

date and signature (organization putting

a stamp):

33.

I, hereby certify that after having read the questions listed in the application, I acknowledged the full responsibility for my answers. I am well aware that the false or misleading statement may result in their

permanent refusal of a visa. I understood that possession of a visa does not automatically entitle the bearer to enter the Republic of Tajikistan upon arrival at a point of entry.

Applicant`s

signature

Date _______________________________________________________________

_________________________________________________

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Раводиди тањти раќами

Категорияи (ба таври пурра)

Ба мўњлати (аз кай то кай)

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ва мўњри Консул)

Санаи судури раводид