' '' ' ' '' ' [ [[ [ ) )) ) T TT T j jj j n nn n ; ;; ;

VISA APPLICATION FORM OF THE PEOPLE'S REPUBLIC OF CHINA

1 // // // //Surname

/( /( /( /(Given name
2 '/( '/( '/( '/(Chinese Name If any


3 j( j( j( j(Former name If any

4 ] ] ] ] Date of birth
+ ++ +) )) )
vear month dav
5 j j j j Place of birth


6 ] ] ] ] Sex:

/M ( (( (/F
|) |) |) |)
Photo



7 | | | |Nationality


8 |]| |]| |]| |]|Former nationality

9 1 1 1 1Occupation

10 , , , ,Employer`s name


11 _|; _|; _|; _|; Home address


12 ||, ||, ||, ||, )|j )|j )|j )|j
Passport type Other travel document

_ _ _ _Number |_]= |_]= |_]= |_]=Valid until + ++ +) )) )
j| j| j| j|Issued by vear month dav

13 n;'j n;'j n;'j n;'jPurpose of journey to China


14 jj) jj) jj) jj)Places to visit

15 ;,({,;/( ;,({,;/( ;,({,;/( ;,({,;/( Name, address and phone of the company or person to be visited in China
({ ({ ({ ({//( /( /( /(Name

j; j; j; j;address:
] ] ] ]_phone No.

16 |'j] |'j] |'j] |'j]Intended date of entry + ++ +) )) )
vear month dav
17 |'j, |'j, |'j, |'j,Number of entries requested
, , , , Single , , , , Double , , , , Multiple
18 ),]j ),]j ),]j ),]j
Duration of each stay /days
19 |n;'j |n;'j |n;'j |n;'j? | || |
Have you ever applied for a Chinese visa before? Yes No
20 |j|'j |j|'j |j|'j |j|'j? Have you ever been declined for your Chinese visa application?
Yes | || |No
j|}[ j|}[ j|}[ j|}[ j) j) j) j)If ever declined , when and where

21 j|||[j| j|||[j| j|||[j| j|||[j|Accompanying persons included in passport
/( /( /( /(Full name ] ] ] ]Date of birth [n;_ [n;_ [n;_ [n;_Relationship to applicant




22 ]j)]j;Tjj)_]{ ]j)]j;Tjj)_]{ ]j)]j;Tjj)_]{ ]j)]j;Tjj)_]{ +]| +]| +]| +]|
I hereby declare that the information given above is true, correct and complete. I shall bear
the responsibility for the above information.

( ( ( (Signature + ++ +) )) )
vear month dav
)j )j )j )j )j )j )j )j For official use only






)j)|,}[ )j)|,}[ )j)|,}[ )j)|,}[
, , , ,
!"#$%&'()*+, !"#$%&'()*+, !"#$%&'()*+, !"#$%&'()*+,)) )) )) ))
























































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