Visa Application Form
ADVERTISEMENT
1
2Protocol number
Visa number
REPÚBLICA FEDERATIVA DO BRASIL
MINISTÉRIO DAS RELAÇÕES EXTERIORES
VISA APPLICATION FORM
01 - Full name
(as per passport; do not abbreviate or omit any name)
First
Middle
Last
Attach photo here
02 - Place of birth (city/state/country)
03 - Date of birth
- size: 40 mm x 35mm
Day
Month
Year
(1 9/6 x 1 3/8 inches)
04 - Country of citizenship
05 - Sex
06 - Marital status
- white or off-white
male
female
background
07 - Passport #
08 - Issuing country
09 - Expiration date
- front view, full face
Day
Month
Year
- must be recent picture
10 - Parent’s full name (do not abbreviate or omit any name) and country of birth
Father’s:
Mother’s:
11 – Highest level of education (check only one box)
12 - Major/primary field of study
no diploma
high school diploma or the equivalent (e.g., GED)
13 - List any special skill and/or certificates
some college credit, but less than one year
more than one year of college, but no degree
14 - Job position (as per business card) or title
associate’s degree (e.g., AA, AS)
bachelor’s degree (e.g., BA, AB, BS)
master’s degree
15 - Employer (for students, name school/university)
professional degree (e.g., MD, DDS DVM, LLB,
JD)
16 – E-mail:
doctorate degree
17 - Business address
18 - Business telephone # (with area code)
19 - Home address
20 - Home telephone # (with area code)
FOR OFFICIAL USE ONLY
A - Consulta à SERE
B - Autorização da SERE
C - Tipo do Visto
___________________
OF
TEL
No. _______
DESP
DESPTEL
No. ______
F - Validade
G - Data
D -
Concessão
E -
Uma entrada
Denegação
Múltiplas entradas
_____________anos/dias
______/______/______
Impedimento
H - Observações
I - Assinaturas
Funcionário
Chefia
Consbras Houston/VisaForm.Doc
Updated: May 2001
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business