Application For Re-Entry Visa
ADVERTISEMENT
1
2Éire
Ireland
Application for Re-Entry Visa
Official Use Only
3
Fee ______
Receipt No: _________
Category _______________
For Official Use Only
Valid to _____________
Single
Multi
Documents
Checked by _______________
Date __________________
Please complete this form in BLOCK LETTERS. Please see overleaf for information on documentation to accompany this application form.
Surname/Family Name (as in passport)
Forenames (as in passport)
D D M M Y Y Y Y
Date of Birth:
Gender:
Male
Female
Country of Nationality
Personal Status: Single
Married
Widowed
Divorced
Separated
Unmarried Partner
Civil Partnership
Type of Visa Required: Single Journey
Multiple Journey
Passport/Travel Document Number:
D D M M Y Y Y Y
D D M M Y Y Y Y
Date of issue:
Date of expiry:
Issuing Authority:
Your address in Ireland:
Daytime telephone number
GNIB Number
(as on your Certificate of Registration Card issued by the Garda National Immigration Bureau)
6 9 /
/
Dept of Justice Number
I declare that all of the information I have given in this form is true and correct.
I agree that the data in my application may be disclosed to other Irish Government Departments as well as to public authorities of the member states
of the European Union/EEA.
Signed: _________________________________________________
Date:___________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal