Form V.2011a - Visa Application Form Of The People'S Republic Of China Page 10
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13三、你在新西兰(或长期居住国)的家庭，工作或学习信息
Section 3. Your Family and Employment Details in New Zealand (or in your own country)
3.1 家庭住址
Residential address
3.2 家庭电话
3.3 手机号码
Telephone
Mobile phone number
3.4 电子信箱
Email address
3.5 工作单位或学校
名称 Name
Employer or School
联系地址 Address
联系电话 Telephone
3.6 家庭成员
关系
姓名
国籍
职业
Details of your immediate
Relationship to the
Name
Nationality
Occupation
family members
applicant
3.7 紧急情况下的联系人
3.8 紧急联系人电话
Contact person in case of
Emergency contact phone
emergency
number
四、其他情况 Section 4. Other Information
4.1 是否曾经访问过中国？如果是，请说明最近一次情况。
Have you ever visited China before? If yes, please specify date, places and purpose of the recent visit.
4.2 在过去的 12 个月里是否访问过其他国家或地区。如果是，请说明。
Have you ever visited other countries or territories in the last 12 months? If yes, please specify date, name of countries or territories and
purpose of the visits.
4.3 是否曾在中国超过签证或居留许可允许的期限停留？
□ 否 / No
□ 是/ Yes
Have you ever overstayed your visa or residence permit in China?
4.4 是否曾经被拒绝颁发中国签证或被拒绝进入中国？
□ 否 / No
□ 是/ Yes
Have you ever been refused a visa for China, or been refused entry into China?
4.5 是否在中国或其他国家有违法记录？
□ 否 / No
□ 是/ Yes
Do you have any criminal record in China or any other country?
4.6 是否患有以下任一种疾病?
Do you suffer from any of the following diseases?
① 严重精神病 Serious mental disorder
□ 否 / No
□ 是/ Yes
② 传染性肺结核病 Infectious pulmonary tuberculosis
③ 可能对公共卫生造成危害的其他传染病 Other infectious disease of public health hazards
4.7 近 30 日内是否前往国流行性疾病传染的国家或地区？
□ 否 / No
□ 是/ Yes
Did you visit countries or territories infected by infectious diseases in the last 30 days?
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