Mu (Form) N1

nh - photo T KHAI NGH CP TH THC VIT NAM

in 4x6 cm Application for a Vietnamese Visa
(1)
See note

1- H tn (ch in hoa) : ...............................................

Full name (in capital letters)
Tn khc (nu c): .........................................................................................................
Other name (if any)
2- Sinh ngy ... thng .... nm .......... 3- Gii tnh: Nam N
Date of birth (day, month, year) Sex Male Female
4- Ni sinh : .................................................................................................
Place of birth
5- Quc tch gc : . 6- Quc tch hin nay:.................
Nationality at birth Current nationality
7- Tn gio: .......................................................................................................................
Religion
8- Ngh nghip: .. . 9- Ni lm vic : ...........
Current occupation/Profession Employer and employers address
10- a ch thng tr: .................................
Permanent address
......................................................................S in thoi/Email: ..........
Telephone/Email
11- Thn nhn (Family members):
Quan h H tn Ngy sinh Quc tch a ch thng tr
Relationship Full name Date of birth Nationality Permanent address
B (Father)
M (Mother)
V/ chng
(Spouse)
Con (Children)
Con (Children)

12- H chiu s/ giy t c gi tr thay h chiu s: loi (2): ..

Number of passport/ Document in lieu of a passport Type of passport
C quan cp: . c gi tr n ngy .
Issuing authority: Expiry date (day, month, year)
13- Ngy nhp xut cnh Vit Nam gn nht (nu c): .....................................................
Date of the latest entry into Viet Nam (if any)
14- D kin nhp cnh Vit Nam ngy ..........................; tm tr Vit Nam .......ngy
Proposed date of entry: Proposed length of stay in Viet Nam: days
15- Mc ch nhp cnh: .
Purpose of entry
Ca khu Xut Nhp cnh Vit Nam: .
Port of arrival and departure
16- D kin a ch tm tr:..
 Proposed temporary address in Viet Nam

17- C quan, t chc hoc c nhn ti Vit Nam mi, bo lnh (nu c):
Hosting organization or individual in Viet Nam (if any)
- C quan, t chc: tn ..................................................................................................
Name of hosting organization
a ch: ........................................................................................................................
Address
- C nhn: h tn ............................................................................................................
Hosting individual (full name)
a ch..........................................................................................................................
Address
Quan h vi bn thn ..................................................................................................
Relationship to the applicant
18- Ngi di 14 tui i cng (nu c): nh - photo nh - photo
Accompanying child(ren) under 14 years old (if any) in 4x6 cm in 4x6 cm
(under 14 years (under 14
old) years old)
(1) (1)
See note See note

S H v tn Ngy sinh Quc tch S h chiu Quan h vi

TT Full name Date of birth Nationality Passport bn thn
Item number Relationship
s to the
applicant

19- ngh cp th thc: mt ln nhiu ln

Entries requested: Single Multiple
20- ngh khc lin quan vic cp th thc (nu c):.....................................................
Other requests (if any)
......................................................................................................................................
Ti xin cam oan nhng ni dung trn y l ng s tht.
I swear that the above declarations are true and correct to the best of my knowledge and belief.

Lm ti: ............... ngy .... thng .nm ..

Done at date (day, month, year)
Ngi ngh k, ghi r h tn
Signature and full name of the applicant

Ghi ch/Note:
(1) Mi ngi khai 01 bn, dn nh mi chp, c 4x6cm, phng nn trng, mt nhn thng, u trn, khng eo knh mu.
Each applicant completes one form, stick a recent (4x6) photo on a white background, straight looking, without hat or sunglasses.
(2) Nu l h chiu th ghi r ph thng, cng v hay ngoi giao; nu l giy t thay h chiu th ghi r tn giy t .

2
 If document is a passport, please specify its type: Ordinary, Official/Service or Diplomatic; for document in lieu of passport,
please specify its name.