V.

20133
Form V.201

Peoples Republic of China
Visa Application Form of the People
(For the Mainland of China only)

The applicant should fill in this form tru thful

truthful ly completely and clearly
thfully clearly.. Please type the answer in capital Englis
Englishh
letters in the space provided or tick () the relevant box to select. If some of the items do not apply, please type N/A or None.

Part 1: Personal Information

Last name AL-MADHAGI
1.1
Middle name ABDULWASEA
Full English name SAEED AHMED
as in passport
/Photo
/Photo
First name MOHAMMED Affix one recent color passport
photo (full face, front view,
1.2
1. 1.33
1. bareheaded
bareheadedandand against a plain
Name in Chinese N/A ame((s) N/A
Other name light colored background).

1.55
1.
yyyy-mm-dd)) 1991-01-01
1.44 Sex
1.
M F
DOBOB((yyyy-mm-dd
1.66
1.
1.7 Former nationality (ies) NONE
(ies) YEMENI
ationality(ies)
Current nationality
ationality(ies)
1.88 ((//))
1.
irth(ccity
Place of birth( ity,, province /s
province/s tate
/state ,c
tate,c ountry)) SANA'A,
ountry
,country YEMEN
1.99 //
1.
ID// Citizenship number 04010056440
Local ID

1.10 / Passport
1.10 /Travel document
Passport/Travel Diplomatic Service or Official
type
Ordinary (()) Other (Please specify)
specify)::

1.111
1.1 1.122
1.1
Passport number 07679695 Date of issue( yyyy-mm-dd)) 2016-11-23
yyyy-mm-dd
ssue(yyyy-mm-dd
1.133
1.1 1.144
1.1
Place of issue SANA'A yyyy-mm-dd)) 2022-11-23
xpiryy(yyyy-mm-dd
Date of expir
// Former/incumbent member of parliament
Business person
Businessperson
Position ________________________
Position________________________
Company employee
// Former/incumbent government
Entertainer
official
// Industrial/Agricultural worker
Position________________________
1.155
1.1 Student
Military personnel
Crew member
Position________________________
Current Self-employed
occupation(s) NGO staff
Unemployed
Religious personnel
Retired
Staff of media

(()) Other (Please specify):

1.16 Postgraduate
College
Education (()) Other (Please specify):

1.17 // Name SANA'A UNIVERSITY Phone number +967 01 464365
Employer/School

Address
SANA'A, YEMEN Zip Code N/A
1 4 / Page 1 of 4
1.18 1.19
Home address TELEVISION ST., SANA'A YEMEN Zip Code N/A
1.20 // 1.21
1.21
Home/mobile phone number 00967734232347
ALMADHEHAGI@YAHOO.COM
E-mail address
1.22 Marital status
1.22 Married
Single Other(Please specify):

Name Nationality Occupation Relationship

1.23
(
,,))
ABDULWASEA SAEED AHMED YEMENI GOVERNMENT EMPLOYEE FATHER
Major family
members spouse,
membersspouse,
AMT ALGAFOOR ANABH YEMENI HOUSE WIFE MOTHER
children,parents,et
c.,may type on MAZEN ABDULWASEA SAEED YEMENI STUDENT BROTHER
separate paper
paper

1.24
Name ASHRAF AL-MADHAGI Mobile phone number
0086181858515047

Emergency
Contact Relationship with the applicant FRIEND
1.25 Country or territory where the
applicant is located when applying for this visa OMAN

Part 2: Travel Information

Official Visit
iplomatcconsul or staff of internation
As resident diplomat al
international
Tourism
organization
Non-business visit As permanent re ressident
Business & Trade Work
As introduced talent As child in foster care
As crew member
crew
Transit

2.1
Short-term visit to Chinese citizen or 180 Family reunion for over
Major
purpose foreigner with Chinese permanent residence status 180 days with Chinese citizen or foreigner with
of your visit Chinese permanent residence status

Short-term visit to foreigner residing in As accompanying family member of foreigner
China due to work, study or other reasons residing in China due to work, study or other reasons
Short-term study for less than 180 days
Long-term study for over 180 days
As journalist for temporary news As resident journalist
coverage
(()Other
)Other (Please specify)
specify)

(( 3 )) One entry valid for 3 months from the date of issue
2.2 (( 3-
3-66 )) Two entr ies valid for 3 to 6 months from the date of issue
entries
6 )) Multiple entr
Multiple ies valid for 6 months from the date of issue
entries
Intended number
of entries 1 )) Multiple entr
Multiple ies valid for 1 year from the date of issue
entries
Other
Other (Please specify)
specify)::

2.3 Are you applying for express service?

Note: Note: Express service needs approval of Yes
No
consular officials, and extra fees may apply.

2.4
yyyy-mm-dd))
Expected date of your first entry into China on this trip (yyyy-mm-dd 2017-08-23/2017-8-24
2 4 / Page 2 of 4
 2.55
2.
Longest intended stay in China among all entries 1095 Days

Date Detailed address

2.66
2.
,,

Itinerary in
timee
China (in tim
sequence
sequencemay may
type on separate
paper))
paper

2.77 Who will pay for your travel and

2.
Chinese Government Scholarships CSC
expenses during your stay in China?

Name HOHAI UNIVERSITY

2.8

Address 1 Xikang Rd, Nanjing 210098, P.R. China
Information of
inviter in China Phone number +86 25 8378 7955 / +86 25 8378 6244

Relationship with the applicant STUDENT
2.9 NONE
Have Have you ever been granted a Chinese visa? If applicable, plea se
please
specify the date and place of the last time you were granted the visa.

2.10 12 Other countries or territories NONE

you visited in the last 12 months

Part 3: Other Information

3.1 Have you ever overstayed your visa or
Yes
No
residence permit in China?
3.2 ,HaveHave you ever been refused a visa for China, or
Yes
No
been refused entry into China?
3.3 Do you have any criminal record in China or any other
Yes
No
country?
3.4 Are you experiencing any of the following conditions
conditions??
Serious mental dis order
isorder
Yes
No
Infectious pulmonary tuberculosis
Other infectious disease of public health hazards
3.5 30 Did Did you visit countries or territories affected
Yes
No
by infectious diseases in the last 30 days?
3.6 3.1 3.5
detailss below
If you select Yes to any questions from 3.1 to 3.5, please give detail below..

3 4 / Page 3 of 4
 3.7
If you have more information about your visa application other than the above to declare,please give details below or type on a
paper..
separate paper

3.8 If someone else travels and shar es

shares
the same passport with the applicant , please affix their photos and give their information below.

1 2 3
Person 1 Person 2 Person 3

Information
Affix Photo Affix Photo Affix Photo
here here here

Full name

Sex

DOB(yyyy-mm-dd)
OB(yyyy-mm-dd)

Part 4: Declaration & Signature

4.1
I hereby declare that I have read and understood all the questions in this application and shall be ar all the legal consequences for the
bear
provided..
authenticity of the information and materials I provided
4.2

I understand that whether to issue a visa, type of visa, number of entries, validity and duration of each stay will be determined by
consular official, and that any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into
China.
4.3
I understand that, according to Chinese law, applicant may be refused entry into China even if a visa is granted.

Applicants signature:
Applicant Date (yyyy-mm-dd ):
yyyy-mm-dd):

18 Note: The parent or guardian shall sign on behalf of a minor under 18 years of age
age..

Part 5 If the application form is completed by another person on the

applicant's behalf, please fill out the information of the one who completes the form
5.2 Relationship
5.1 Name
with the applicant

5.3 Address 5.4 Phone number

5.5 Declaration

I declare that I have assisted in the completion of this form at the request of the applicant and that the applicant understands and
agrees that the information provided is true and correct.

/Signature
/Signature
/Signature /Date
/Date (yyyy-mm-dd ):
yyyy-mm-dd):

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