Ministry Of Foreign Affairs Of The Republic Of Tajikistan Visa Application Form Page 2

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27. Ha

you ever been refused a visa? If «YES»:

When:

Where:

What was you purpose of visit:

For how long requested:

28. Do you intend to work in Tajikistan? If «YES», indicate name and address of

29. Do you intend to study in Tajikistan? If «YES», indicate name and address of

employer:

the Institution or University:

30. Please indicate the information about your relatives in the Republic of Tajikistan (father, mother, sister/brother, children, adopted children, spouse, fiancée

etc):

31. IMPORTANT: AFTER HAVING READ THE LISTED BELOW QUESTIONS ATTENTIVELY, PLEASE MARK THE “YES” OR “NO”:

- have you ever been arrested or convicted for any offence of crime within the

YES

territory of the Republic of Tajikistan? If answer «YES», please describe it in

the separate page

- have you ever been a member of terrorist or extremist group or organization,

human trafficking, weapons and ammunition, illegal drug trafficking and their

YES

precursors, illegal immigration?

- do you have a criminal record for felony in the territory of the Republic of

YES

Tajikistan or in any other foreign country?

- have you ever been subject of pardon or amnesty?

YES

- did you or do you have infections (contagious) of diseases harmful for the

YES

health surrounding society?

32. Was this application prepared by another person (organization)? If «YES», then:

YES

The inviting side is informed that according to the legislation of the Republic of Tajikistan, bears responsibility for authenticity of data indicated in the application as well as for the timely preparation

of the documents of the invited foreign citizen for the right of: stay in the Republic of Tajikistan, movement within the territory and for exit from the Republic of Tajikistan upon expiring their defined

term of stay.

who:

relation with applicant:

full address and telephone number:

date and signature (organization putting a

stamp):

33.

I, hereby certify that after having read the questions listed in the application, I acknowledged the full responsibility for my answers. I am well aware that the false or misleading statement may result

in their permanent refusal of a visa. I understood that possession of a visa does not automatically entitle the bearer to enter the Republic of Tajikistan upon arrival at a point of entry.

Applicant`s signature _________________________________________________

Date _______________________________________________________________

Барои истифодаи хизматї

Аз љониби корманди консулї пур карда мешавад

Раводиди тањти раќами

Категорияи (ба таври пурра)

Ба мўњлати (аз кай то кай)

Аз љониби (ному насаб, имзо

ва мўњри Консул)

Санаи судури раводид