Republica De Cuba Business Visa Application Form

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REPUBLICA DE CUBA
BUSINESS VISA APPLICATION FORM - FORMULAIRE POUR VISA DES AFFAIRES
Last Name / Nom
First name / Prenom
Middle name / Second Prenom
Country of birth /
Sex
Marital status / Etat civil
Birth date / Date de naissance
Pays de naissance
Year
Month
Day
Passport No. / Passeport No.
Issue Date / Date de deliverance
Expiry date / Date de expiracion
Year
Month
Day
Year
Month
Day
Citizenship / Citoyenneté
Name of the Cuban company you will contact in Cuba /
Nom de l’enterprisse a Cuba:
Business telephone /
Name of employer / Nom de l’employoir
Telephone des affaires
Reasons for the trip / Motives de votre voyage
Address or hotel in Cuba / Adresse ou hotel a Cuba
Length of stay / Durée de sejour
Date of departure /
Departure airport /
Date de depart
Aeroport de depart
Year
Month
Day
Full permanent Address / Adresse
Telephone
Fax
E-mail
Additional information / Observations
Signature ______________________________
Date:___________________________________

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