Visa Application Form
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1EMBASSY OF THE KYRGYZ REPUBLIC
TO THE USA AND CANADA
2360 Massachusetts Ave., NW,
Washington, D.C. 20008
Tel.: (202) 449-9822 ;Fax: (202) 386-7550
E-mail:
Photo
VISA APPLICATION FORM
Personal information
Citizenship
Passport number
Expiration date
Type
Last name
First name
Middle name
Date of birth
Place of birth
Name of spouse
Resident address
Occupation, office address
_______________________________________
________________________________________________
_______________________________________
_________________________________________________
Phone#_________________________________
Phone #__________________________________________
Do you have any citizenship
Have you been to the Kyrgyz Republic?
before or currently?
(Dates of all previous visits )_______________________________________________
(If yes, which country)
__________________
______________________________________________________________________
Information for a visa
Purpose of trip
First intended duration of stay
Business
o
Tourist
From ____/____/_______ until_____/_____/______
o
Private
o
Period of requested
Inviting organization or private host in the Kyrgyz Republic (name, address, phone)
visa
________________________________________________________________
1 month
o
3-months
_________________________________________________________________
o
5-years
o
(only for US
_________________________________________________________________
citizens)
Number of entries
Type of visa
Multiple
Diplomatic
Business
Tourist
Transit
o
o
o
o
o
Single
Official
Study
Private
o
o
o
o
I declare that the information provided above is correct and comprehensive.
Sign____________________________________________________________Data_____________________
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