A²S „íXqV
STATE OF ERITREA
‹ÏDï „ïLð´Sa}} sò´{q}
DEPT. OF IMMIGRATION & NATIONALITY
KIqq }K†ogñ kzïš
APPLICATION FORM FOR ENTRY VISA
ÐXM cë B62.3
Form No.
cëÃöU KDD§ „ïLð´Sa}
IMMIGRATION IDENTITY No.
2 Ãp/SEX
MDê† ]M (‰M Ò]ÔXq)
FULL NAME (AS IN PASSPORT)
1
ol
MALE
…{
FEMALE
3 …chªïKé ›{kS ‘§ ŠF† ]M (›oÊD¢)
FORMER/OTHER NAME (If different from above)
4 np F©q
PLACE OF
BIRTH
‰oL
CITY OR TOWN
—Dq F©q
DATE OF BIRTH
—Dq
DATE
PRESENT NATIONALITY
PERMANENT ADDRESS:
]VI
OCCUPATION
PASSPORT TYPE & No.
Ò]ÔXq ›ogBkDê —Dq
DATE OF ISSUE OF PASSAPORT
Ò]ÔXq ›ogBkDê np
PLACE OF ISSUE OF
PASSPORT
9 cgLð …©öV`
5
–Kq
YEAR
7 –§{q} cëÃöU} Ò]ÔXq
6 BFgñ sò´{q
8
‘XGï
MONTH
—Dq
DATE
‰oL CITY OR TOWN
A²X/COUNTRY
10 …©öV` …mk „íXqV
DATE OF EXPIRY OF PASSAPORT
—Dq
DATE
–Kq
YEAR
‘XGï
MONTH
µ©|} cëÃöU ²š}
STREET AND NUMBER
–Kq
YEAR
cë. oõDíÐ}
TEL. No.
µ©|} cëÃöU ²š}
STREET AND NUMBER
‰oL CITY OR TOWN
ADDRESS IN ERITREA
‘XGï
MONTH
8.1 Ò]ÔXq ›‘©öcDê —Dq
cë. oõDíÐ}
TEL. No.
11 mkš—l Hpo/q ›Iqq [mk/…ŠF
REFERENCE IN ERITREA
…©öV`
ADDRESS
12
‰oL
CITY OR TOWN
PURPOSE OF ENTRY
13 ›©öD K†ogñ
ENTRY DESIRED
µ©|} cëÃöU ²š}
STREET AND NUMBER
cë. oõDíÐ}
TEL. No.
•ê©q
TOURISM
‘´–gñ
OFFICIAL
g{ð}
BUSINESS
qMBXoñ
STUDENT
sK©ö MmkÄI
FAMILY VISIT
ŠF†
OTHER
}ÃöF
SINGLE
]VI
EMPLOYMENT
14 ›Ã}HDê ´sò
mksêI
MULTIPLE
PERIOD OF STAY:
15 …]Lq mkH© [{©ö ›²_ì
PERSONS TRAVELLING ON THE SAME PASSPORT:
]M
NAME
o.cë
No.
Åp
SEX
—Dq
DATE
—Do F©q
DATE OF BIRTH
‘XGï
–Kq
YEAR
MONTH
np F©q
PLACE OF BIRTH
16 …{
I
CORRECT AND COMPLETE
np
PLACE
17
DECLARE THAT THE INFORMATION GIVEN ABOVE IS
—Dq
DATE
‹pM
SIGNATURE
}k–F Ksï ¹V§ ›MF‰q / FOR OFFICIAL USE ONLY
›o‘]© ‘é\{ó
DECISION TAKEN
cë. K†ogñ kzïš
ENTRY PERMIT No.
X†§r
REMARKS
—Dq
DATE
]M k–F Ksï
NAME OF AUTHORITY
‹pM k–F Ksï / SIGNATURE OF AUTHORITY
Download

Visa Formular (PDF)