FEDERAL REPUBLIC OF NIGERIA

RESIDENCY / STR VISA APPLICATION FORM

IMPORTANT NOTICE

1M M/22

VISA NO..................

Your application may be rejected if the form is incorrectly filled. If wrong information is
given, or if relevant sections are left incomplete.
1.Family Name (Mr/Mrs/Miss)..............................Other .mes...............................................
(in block letters)

2.Former Names (if married woman, insert maiden name) and Aliases .............................
3.Sex.....................................................................................................................................
4.Present Nationality........................................Have you had other nationality before? If so
state ................................................................
5.Place of birth (city, country)..............................................................................................
6.Date of birth (state date, month, year)..............................................................................
7.Residence Address (office, street, city, telephone)...........................................................
8.Official Address (office, street, city, telephone)...............................................................
'
9.Profession......................................................For how long have you been exercising this
profession?........................................................
10.State what branches of the Armed Forces of your country you have served in or are
serving.................................................................................................................................
(a)

Army, Navy, Airforce (b) Regiment

(c).................................................Duration of service.........from..........................to
(d)...........................................................Last rank before retirement or discharge

Colour of Hair

Colour of Eyes

Height

Complexion

12.Any visible mark of Identification?.................................................................................................................................

13.
Passport No.

Date of Issue

Date of Expiration

Place of Issue

Issuing Government

14.Type of visa required/visitors or Residence.....................................................................................................................

15.Date of last visit (if any) to Nigeria and address at which you stayed .............................................................................

16.Propose date of travel .....................................................................................................................................................

17.If you are taking up an employment please fill in this section:
Name of Employer and full business
address (P.O. Box not accepted)

Employment

Duration

18.Please give in the space below a full description of the job you will be handling ..........................................................

19. If you are joining spouse, parents or relatives, please give their names and particulars of their employment in Nigeria
including the full address of their residence..........................................................................................................................

20.If you are not visiting spouse, parents, or relatives, please indicate place of residence...................................................

21.Your reference in Nigeria (Names, addresses and positions) ..........................................................................................

22.Have you obtained his/her/their written permission to cite him/her/them as references' ) Show evidence ...........................

23.Sate where and approximately when you last applied for a Nigerian Visa / Entry Permit ....................................................

24.Indicate whether

visa was granted

rejected

n o re p l y

25.How long have you lived in the country where you are applying for a Visa / Entry Permit ..................................................
26. Give a list of the countries you have lived in for more than a year during the last five years
Countries

Cities

Dates

27.Which countries have you visited during the last twelve months?
Countries

Cities

Dates

I understand that I will be required to comply with the Immigration / Alien and other laws governing entry of immigrants
into the country for which I now apply for a Visa / Entry Permit.
Date.........................................................................

APPLICANT

Signature....................................................................

CHILDREN ENDORSED IN APPLICANTS PASSPORT

Photo

Photo

Date

Photo

Remarks (For Official Use Only)

FGP 01.1832