Form 5a - Visa Requirements South Sudan Visa Application Form Page 7
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12E-mail Address:. …………………………………………………………
Next of Kin Details
Surname: …………………………………………………………
Given Names: ……………………………………………………
Permanent Address:
………………………………………………………………………….…………………………………………
……………………………………………………………………………………………
Phone No: ……………………………………………Mobile No……………………………….……….
E-mail Address: ………………………………………………………………
8. Have you ever:
a) Been convicted of a crime or offence in any country?
Yes
No
b) Been deported or removed from South Sudan or any country for overstaying your visa or violating any
law or regulation?
Yes
No
c) Been convicted and sentenced for a drug offence in any country in violation
of law concerning narcotics, marijuana, opium, stimulants or psychotropic
substances?
Yes
No
d) Committed trafficking in persons or incited or aided another to commit such an offence?
Yes
No
e) Are you suffering from tuberculosis, any other infectious or contagious disease
Yes
No
If you answer yes to any of the questions above, provide explanation below:
………………………………………………………………………….
……………………………………………………………………………….
Address of Place of Stay / Hotel:
………………………………………………………………………………….……
………………………………………………………………………………………
Funds Available For My Stay ………………………..
9. Guarantor or references in South Sudan:
Name: ……………………………………Telephone No.: ………………………………
Visa
A pplication
F orm
( Form
5 A)
Page
3
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