Professional Documents
Culture Documents
2011A
Visa Application Form of the Peoples Republic of China
cdd
qrqrddApplicant should fill out this form truthfully and completely
on a computer and print out. Please type your answer in capital English letters in the space provided or cross the appropriate box to
select. Please state N/A or None if a section does not apply to you. If there is additional information to declare, please type on a
separate sheet.
(Form V.2011B)
Please also complete the Supplementary Visa Application Form (Form V.2011B) if you are not a U.S. citizen, or if you are applying
for work visa or student visa, or if you will be accompanied by anyone who shares the same passport with you.
1.2
Sex
Smith
Given name
M
F
Photo requirements
1.3
Name in Chinese character ( if applicable)
None
1.4
Other name or previous name
if applicable
None
1.5
Name in native language
Front-facing
Hatless
Light-colored
background
1.6
Current nationality
USA
1.7
Former nationality
1.8
Concurrent nationality
None
1.9
Date of birth (yyyy-mm-dd)
1.10 c
Place of birth (city,
province/state, country)
1.12
Marital status
Married
Widowed
1.13
Current
occupation(s)
Businessman
Company employee
Teacher
Student
Housewife
Unemployed
1.11
U.S. ID card number
None
1960-08-01
Driver Lic: MV6354868
Never Married
Divorced
OtherPlease specify:
Government official
Staff of media
Religious worker
Active duty military personnel
Member of national parliament
Crew member
Retired
Other (Please specify):
1.14
Passport type
1.15
Passport number
1.17
Place of issue (city, province/state,
country)
123456789
US Department of State
1.19
Please select pick-up day (Extra fee is charged for express pick-up)
1.16
Date of issue (yyyy-mm-dd)
2011-07-02
1.18
Expiry date (yyyy-mm-dd)
2021-07-01
1 4 / Page 1 of 4
Form V.2011A
c Section 2: Details of travel to China
2.1
Major
purpose(s) of
your visit(s) to
China
Tourism
As resident journalist
Family visit
Visiting friends
Business trip
Commercial performance
Meeting
As crew member
Transit
Study
Employment
Official visit
None
2.3
Intended date of your first entry (yyyy-mm-dd)
2011-10-01
2.4
Your longest intended duration of stay
15
Days
Beijing, Shenzhen
2.5 i) c
Please list cities and provinces to visit in China in a time sequence
2.5 ii)
Please list residence(s) and phone number(s) during your stay in China in a time sequence
Detailed address
City
Province
Phone number
Beijing
N/A
8610-8516
2888
Shenzhen
Guangdong
86755-83689999
2.6
Who will pay for your trip to China?
Myself Inviter
Parent(s) or guardian(s)
Other (Please specify):
Yes
No
None
None
2 4 / Page 2 of 4
Form V.2011A
ccSection 3: Information about your family, work or study
3.1
Address
Current home address
10 Madison Ave
3.2
Home phone number
3.5 c
c
Name, phone number and
address of your current
employer or school
Province/State
New York
NY
3.3
Mobile phone
number
(212) 000-0000
3.4
Email address
City
Zip code
10050
(201) 000-0000
jsmith0000@yahooo.com
Name
None (retired)
Address
City
N/A
N/A
Province/State
N/A
Phone number
N/A
Zip code
N/A
Name
Nationality
Occupation
Relationship
Mary E Smith
USA
Homemaker
Wife
3.8
Contact persons
phone number
(212) 000-0000
3.6
Major family members
3.7
Contact person in case of
emergency
Mary E Smith
No
4.3
Have you ever overstayed your visa or residence permit in China?
Yes
No
4.4
Have you ever been refused a visa for China, or been refused entry into China?
Yes
No
4.5
Do you have any criminal record in China or any other country?
Yes
No
Yes
No
4.7 30
Did you visit countries or territories infected by infectious diseases in the past 30 days?
Yes
No
3 4 / Page 3 of 4
Form V.2011A
N/A
None
c Section 6: Signature
6.1 ddI have read and understood all the
questions in this application. I declare that the information provided above is true and accurate. I shall take all responsibilities for any false
information.
6.2 cccc
dI understand that the decision on whether to issue a visa, validity/ type of visa, number of entries, and duration
of each stay will be decided by consular officers, and that any false, misleading or incomplete information may result in the refusal of a visa or denial of
entry into China.
2011-08-01
Date (yyyy-mm-dd):
.
Applicants signature:
dNote: Parent or guardian may sign on behalf of an applicant aged under 18.
cSection 7If the application form is completed by another person on the applicants behalf, please fill out
the following:
7.1
7.2
Name of the person completing
Relationship to the
this form on the applicants behalf
applicant
7.3
Address
7.4
Phone number
7.5
7.6
Type of ID document
Number of ID
7.7 Declaration
I declare that I have assisted in the completion of this form at the request of the applicant, and the applicant understands and confirms that the
information provided is true and correct.
/Date (yyyy-mm-dd):
/Signature
Official use only
4 4 / Page 4 of 4