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01 Photo

(2 inches x 2 inches)

APPLICATION FORM

Glued photo here

FOR ENTRY AND EXIT VISA

and

01 additional photo

stapled to this form for a

CONSULATE GENERAL OF VIETNAM

loose -leaf visa request

IN SAN FRANCISCO, US

1700 California Street, Suite 580

San Francisco, CA 94109

Tel: 415 922 1707; 415 922 8588

1. Full name (in BLOCK letters):

..................................................................................................................................................................

Family name

First name

Middle name

Date of birth:

Gender:

Male

Female

..............

.......................

........................

Date

Month

Year

2. Place of birth:

…...............................………………………..

8. Name, address of your contact (organization or

individual) in Vietnam

(if any):

3. Nationality at birth :

..................................….........………

.............................................................................................................................

Nationality at present:

...........…………………...…......

.............................................................................................................................

4. Passport number:

......................................……........…...…

..............................................................................................................................

Date of expiry:

............................……………………….......

9. Proposed DATE OF ENTRY into and EXIT from

Vietnam:

5. Employer:

................................................................................

6. Mailing address:

-From:

...............................................….…….....

..................

...................

.....................

Date

Month

Year

..........................………………………...........................…..…..….

-To:

.............

....................

......................

Contact number:

........................……………...................

Date

Month

Year

7. Purpose of visit to Vietnam

10. Requesting a visa good for:

Business

Tourist

Visit Relatives

-Number of entries:

Single

Multiple

or other:

................................................................................

-Total length of stay:

01Month

03Months

________________________________________

Please submit the following documents:

06 Months

One-Year (U.S passport only)

One copy of application form with one passport photo

Original passport (for visa sticker) or Copy of passport

I solemnly declare that the statements made in this

(for loose-leaf visa)

application are true and correct.

Visa fee (please call Visa section: 415-922-8588; 415- 922-

1707 Ext 101 / 102 / 108/ 118 for current fees)

If apply by mail, pls. enclose a prepaid self-addressed

Signature:

return envelope and retain one copy of the application

form for enquiry about visa status

* Visa will be valid from the DATE OF ENTRY (shown on the visa). You can enter Viet Nam on or after the DATE OF ENTRY and must leave before the

end of expiration date.

* The Vietnam Customs and Border Protection at the port of entry determines the period of each authorized stay for travelers with one-year visas.

* Please double check all information on visa issued by the Consulate. In case of mistake(s), please contact the Consulate immediately for correction,

Phone number: 415-922-8588; 415-922-1707 Ext 101/102/108/118 (office hours) or Hotline 415-533-0156, or Email: .