Form 1 Brazilian Visa Application Form - Consulate General of Brazil (English/Portugese) - New York City

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Fillable Form
REPÚBLICA FEDERATIVA DO BRASIL
FORMULÁRIO DE PEDIDO DE VISTO
MINISTÉRIO DAS RELAÇÕES EXTERIORES
V1
VISA APPLICATION FORM –
CONSULADO-GERAL DO BRASIL EM NOVA YORK
Visto nº
1185 Avenue of the Americas, 21st Floor, New York, NY 10036
Tel: (917) 777-7777 - Fax: (212) 827-0225
Email:
visas@brazilny.org
-
www.brazilny.org
P
, i
. A
1
26 (
). I
. S
.
LEASE TYPE OR PRINT IN BLOCK LETTERS
N BLUE OR BLACK INK ONLY
NSWER ITEMS
THROUGH
FRONT AND BACK
NCOMPLETE FORMS WILL BE RETURNED
IGN AND DATE THE FORM
FAVOR GRAMPEAR FOTO
DADOS PESSOAIS / PERSONAL INFORMATION
TAMANHO 2 X 2 INCHES
01 - NOME COMPLETO (FIRST/MIDDLE/FAMILY NAME)
AQUI
PLEASE STAPLE A 2 X 2
INCHES PHOTO HERE
02 - NASCIDO EM (cidade/estado/país)
03 - DATA DE NASCIMENTO (d/m/a)
PLACE OF BIRTH (city/state/country)
DATE OF BIRTH (d/m/y)
• Fundo branco ou quase branco
• De frente – rosto completo
• Foto recente
• White or off-white
04 - NACIONALIDADE
05 - SEXO
06 - ESTADO CIVIL
NATIONALITY
SEX
MARITAL STATUS
background
• Front view, full face
Masculino/Male
• Must be a recent picture
Feminino/Female
07 – NÚMERO DOC. DE VIAGEM
08 - PAÍS EXPEDIDOR
09 - EXPIRAÇÃO (d/m/a)
PASSPORT NUMBER OR TRAVEL
ISSUING COUNTRY
EXPIRATION DATE (d/m/y)
DOCUMENT NUMBER
10 - NOME DOS PAIS / PARENT´S NAME / NACIONALIDADE / NATIONALITY
do pai - father’s:
____________________________________________________________________________________________
da mãe - mother’s ____________________________________________________________________________________________
11 - ENDEREÇO RESIDENCIAL / HOME ADDRESS
12 - TELEFONE Nº
13 - PROFISSÃO
TELEPHONE Nº
PROFESSION
14 - ENDEREÇO PROFISSIONAL / BUSINESS ADDRESS
15 - TELEFONE Nº
16 - EMPREGADOR
TELEPHONE Nº
EMPLOYER
PARA USO OFICIAL - FOR OFFICIAL USE ONLY
A - Consulta à SERE
B - Autorização da SERE
C - Tipo do Visto
____________Nº. _________
______________ Nº._________
_________________________
D -
E - Entradas
F - Prazo de Estada
G - Data
Concessão
Uma
______/______/_____
Denegação
_________anos/dias
Múltiplas
dia
mês
ano
Prorrogação
H - Observações
I - Assinaturas
Funcionário
Chefia
â
FAVOR CONTINUAR NO VERSO - PLEASE CONTINUE ON THE BACK
\Formularios \Setor Consular\Vistos \Formulário de Pedido de Visto
V1-6/3/2003
Fillable Form
REPÚBLICA FEDERATIVA DO BRASIL
FORMULÁRIO DE PEDIDO DE VISTO
MINISTÉRIO DAS RELAÇÕES EXTERIORES
V1
VISA APPLICATION FORM –
CONSULADO-GERAL DO BRASIL EM NOVA YORK
Visto nº
1185 Avenue of the Americas, 21st Floor, New York, NY 10036
Tel: (917) 777-7777 - Fax: (212) 827-0225
Email:
visas@brazilny.org
-
www.brazilny.org
P
, i
. A
1
26 (
). I
. S
.
LEASE TYPE OR PRINT IN BLOCK LETTERS
N BLUE OR BLACK INK ONLY
NSWER ITEMS
THROUGH
FRONT AND BACK
NCOMPLETE FORMS WILL BE RETURNED
IGN AND DATE THE FORM
FAVOR GRAMPEAR FOTO
DADOS PESSOAIS / PERSONAL INFORMATION
TAMANHO 2 X 2 INCHES
01 - NOME COMPLETO (FIRST/MIDDLE/FAMILY NAME)
AQUI
PLEASE STAPLE A 2 X 2
INCHES PHOTO HERE
02 - NASCIDO EM (cidade/estado/país)
03 - DATA DE NASCIMENTO (d/m/a)
PLACE OF BIRTH (city/state/country)
DATE OF BIRTH (d/m/y)
• Fundo branco ou quase branco
• De frente – rosto completo
• Foto recente
• White or off-white
04 - NACIONALIDADE
05 - SEXO
06 - ESTADO CIVIL
NATIONALITY
SEX
MARITAL STATUS
background
• Front view, full face
Masculino/Male
• Must be a recent picture
Feminino/Female
07 – NÚMERO DOC. DE VIAGEM
08 - PAÍS EXPEDIDOR
09 - EXPIRAÇÃO (d/m/a)
PASSPORT NUMBER OR TRAVEL
ISSUING COUNTRY
EXPIRATION DATE (d/m/y)
DOCUMENT NUMBER
10 - NOME DOS PAIS / PARENT´S NAME / NACIONALIDADE / NATIONALITY
do pai - father’s:
____________________________________________________________________________________________
da mãe - mother’s ____________________________________________________________________________________________
11 - ENDEREÇO RESIDENCIAL / HOME ADDRESS
12 - TELEFONE Nº
13 - PROFISSÃO
TELEPHONE Nº
PROFESSION
14 - ENDEREÇO PROFISSIONAL / BUSINESS ADDRESS
15 - TELEFONE Nº
16 - EMPREGADOR
TELEPHONE Nº
EMPLOYER
PARA USO OFICIAL - FOR OFFICIAL USE ONLY
A - Consulta à SERE
B - Autorização da SERE
C - Tipo do Visto
____________Nº. _________
______________ Nº._________
_________________________
D -
E - Entradas
F - Prazo de Estada
G - Data
Concessão
Uma
______/______/_____
Denegação
_________anos/dias
Múltiplas
dia
mês
ano
Prorrogação
H - Observações
I - Assinaturas
Funcionário
Chefia
â
FAVOR CONTINUAR NO VERSO - PLEASE CONTINUE ON THE BACK
\Formularios \Setor Consular\Vistos \Formulário de Pedido de Visto
V1-6/3/2003
DADOS PESSOAIS / PERSONAL INFORMATION (CONT.)
17 - OBJETIVO DA VIAGEM AO BRASIL /PURPOSE OF VISIT TO BRAZIL (PLEASE CHECK AS APPROPRIATE) :
VIAGEM ESTRITAMENTE DE NATUREZA TURÍSTICA (ATIVIDADES REMUNERADAS PROIBIDAS)
MY VISIT WILL BE STRICTLY FOR TOURISM (NO PAID ACTIVITIES ARE ALLOWED).
VIAGEM DE NEGÓCIOS
I AM GOING TO BRAZIL ON BUSINESS.
VIAGEM DE TRÂNSITO
I AM IN TRANSIT.
PARTICIPAÇÃO EM SEMINÁRIOS OU CONFERÊNCIAS
I WILL PARTICIPATE IN SEMINARS OR CONFERENCES.
PARTICIPAÇÃO EM PROGRAMAS CULTURAIS/CIENTÍFICOS
I WILL TAKE PART IN A CULTURAL/SCIENTIFIC PROGRAM.
DESEMPENHO DE ATIVIDADES DE PESQUISA
I WILL DEVELOP RESEARCH ACTIVITIES.
TRABALHO EM ATIVIDADES DE ASSISTÊNCIA SOCIAL
I WILL ACCOMPANY A GROUP OF CHURCH VOLUNTEERS AND/OR TAKE PART IN COMMUNITY SOCIAL WORKS.
PARTICIPAÇÃO EM ATIVIDADES ESPORTIVAS E/OU ARTÍSTICAS
I INTEND TO PARTICIPATE SPORT AND/OR ARTISTIC ACTIVITIES.
TRABALHO COMO CORRESPONDENTE JORNALÍSTICO
I INTEND TO WORK AS A MEDIA CORRESPONDENT.
TRABALHO COM CONTRATO NO BRASIL
I INTEND TO HOLD A POSITION UNDER AN EMPLOYMENT CONTRACT IN BRAZIL.
TRABALHO COMO MISSIONÁRIO RELIGIOSO NO BRASIL
I INTEND TO WORK AS A RELIGIOUS MISSIONARY
ATIVIDADE EM ÁREAS HABITADAS POR POPULAÇÕES INDÍGENAS
I INTEND TO VISIT AREAS INHABITED BY INDIGENOUS POPULATIONS.
CURSOS ESCOLARES NO BRASIL
I WILL ATTEND SCHOOL IN BRAZIL.
VIAGEM EM MISSÃO OFICIAL
I WILL TRAVEL IN AN OFFICIAL MISSION.
ACOMPAN HAMENTO DE PESSOAS EM MISSÃO OFICIAL
I WILL ACCOMPANY MEMBERS OF AN OFFICIAL MISSION.
SOLICITAÇÃO DE VISTO PERMANENTE
I AM APPLYING FOR A PERMANENT VISA
OUTROS (INDICAR)
OTHER (EXPLAIN)
18 - NOME E ENDEREÇO DA PESSOA, ENTIDADE OU EMPRESA DE CONTATO NO BRASIL
NAME AND ADDRESS OF PERSON, INSTITUTION OR COMPANY WHERE YOU CAN BE CONTACTED IN BRAZIL
19 - ENDEREÇO NO BRASIL
20 - TELEFONE Nº
ADDRESS IN BRAZIL
TELEPHONE Nº
21 - LOCAL E DATA DE DESEMBARQUE NO BRASIL
22 - DESTINO
23 - PERÍODO DA ESTADA
PLACE AND DATE OF ARRIVAL IN BRAZIL
DESTINATION
LENGTH OF INTENDED
STAY
24 - JÁ ESTEVE NO BRASIL?
25 - EM CASO AFIRMATIVO, FAVOR INDICAR QUANDO,/LOCAL E DURAÇÃO
HAVE YOU EVER BEEN IN BRAZIL?
DA ÚLTIMA ESTADA
IF YES, PLEASE INDICATE WHEN, PLACE AND LENGTH OF LAST STAY
SIM/YES
NÃO/NO
TERMO DE RESPONSABILIDADE / FORMAL STATEMENT
26 - DECLARO SEREM VERDADEIRAS E COMPLETAS AS INFORMAÇÕES CONTIDAS NO PRESENTE DOCUMENTO.
I HEREBY DECLARE THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE.
NOME /NAME
DATA /DATE DD/MM/YY
ASSINATURA /SIGNATURE
ü
\Formularios \Setor Consular\Vistos \Formulário de Pedido de Visto
V1-6/3/2003
Consulate General of Brazil in New York
1185 Avenue of the Americas, 21st Floor
New York, NY 10036 - Tel.: (917) 777-7624/26/27/28/52/58 - Fax: (212) 827-0225
http://www.brazilny.org - e-mail: visas@brazilny.org
TOURISM AND BUSINESS VISA REQUIREMENTS
OFFICE HOURS: 10AM TO 12PM, MONDAY THROUGH FRIDAY
NO VISA WILL BE PROCESSED BY MAIL OR COURIER
SERVICE.
a) Children of Brazilian citizens born outside Brazil;
b) Children born in Brazil to foreign parents; and
c) Brazilian citizens who acquired another nationality by naturalization.
Passport or USA "Permit to Reenter" valid for a minimum of six (6) months,
from date of intended arrival in Brazil;
THE CONSULAR FEES ARE ( US Post Office money order only):
Alien USA Registration Card (Green or Pink Card) for permanent resident
or, if you are planning to return to the USA and you are not a permanent
COUNTRY OF CITIZENSHIP
PRICE IN U.S. DOLLAR
resident, your USA visa must be valid for reentry to the USA, for a
UNITED STATES
130.00 *
minimum of six (6) months (multiple entries) when you apply for a
CANADA
65.00
Brazilian Visa;
NORTH KOREA
30.00
JAPAN
50.00
One (1) visa application form, for each applicant, provided by this
NIGERIA
40.00
Consulate, duly filled out and signed by the person in whose name the
MEXICO
30.00
passport was issued (bearer);
RUSSIA
50.00
AUSTRALIA
35.00
One (1) passport-type photograph (2x2 inches), recently taken, in color or
black and white. Vending machine prints and tinted photographs are not
OTHER COUNTRIES
20.00
accepted;
FOR BUSINESS VISA - US$ 60.00
THERE IS A HANDLING FEE OF US$ 10.00, WHENEVER THE
Round trip ticket to Brazil or ticket in transit, with flight numbers, dates, or
BEARER OF THE PASSPORT DOES NOT SUBMIT APPLICATION
itinerary, must be presented. In lieu of the ticket the Consulate will also
PERSONALLY.
accept a signed letter from the carrier or travel agent, on company
letterhead, with the name of the passenger, flight numbers, or name of
* FOR U.S. CITIZENS THERE IS A PROCESSING FEE OF US$
vessel, itinerary, dates of arrival and departure, in and from Brazil;
130.00 IN RECIPROCITY FOR IDENTICAL FEE PAID BY
BRAZILIAN CITIZENS WHO APPLY FOR A VISA TO THE
Airline employees or standbys with open tickets must present ticket with
UNITED STATES OF AMERICA.
itinerary and an airline ID card, or a signed letter from the airline, on
company letterhead, with the name of the employee and his/her itinerary;
INCOMPLETE OR IMPROPERLY FILLED OUT APPLICATIONS
FOR BUSINESS VISA ONLY: A letter on company letterhead addressed
will cause delay and/or cancellation of the required visa.
to the Consulate, signed by an authorized representative (other than the
TOURIST TRIP ONLY: visa requirements have been waived for citizens
candidate for the visa), stating the specific nature of business in Brazil,
itinerary, business contacts, dates of arrival and departure in and from
of the following countries:
Brazil. The same letter should also state that the company assumes all
Andorra
Guiana
Portugal
financial and moral responsibility while the applicant is in Brazil
Argentina
Honduras
Romania
ALL APPLICANTS UNDER 18 YEARS OF AGE MUST PRESENT:
Austria
Hungary
San Marino
a. A Birth Certificate (original or photocopy), with names of both parents.
Bahamas
Iceland
Slovakia
This document must be in English or Portuguese. If in another language,
Barbados
Ireland
Slovenia
an official translation in one of the above mentioned languages must also
Belgium
Israel, Italy
Spain
be presented.
Bermuda
Liechtenstein
Surinam
b. Proof of parents' country of birth and present nationality.
Bolivia
Luxembourg
Sweden
c. If traveling alone, a letter, signed by both parents, duly notarized, giving
Bulgaria
Macau
Switzerland
permission for the minor to travel. It should also state the name and
Chile
Malaysia
South Africa
address of the person(s) responsible for the child while in Brazil.
Colombia
Morocco
South Korea
d. If traveling with only one parent, the same type of letter with the above
Costa Rica
Monaco
Thailand
("c") information, signed by the other parent, duly notarized
Croatia
Namibia
Trinidad and Tobago
e. A certificate of vaccination against polio, stating kind and dosages of
Czech Republic
Netherlands
Turkey
vaccine, is necessary for children between the ages of 3 months and 6
Denmark
New Zealand
United Kingdom
years.
Ecuador
Norway
Uruguay
JURISDICTION: If you are a resident of the states of New York, New
Finland
Panama
Vatican
Jersey, Connecticut, Delaware, Pennsylvania, or Bermuda, you must obtain
your visa at the Consulate General of Brazil in New York.
France
Paraguay
Venezuela
Germany
Peru
TOURIST AND BUSINESS VISAS must be used within ninety (90)
Guatemala
Philippines
days from date of issuance. An extension for an additional period of
three months may be requested from the Immigration Authorities in Brazil,
Greece
Poland
prior to the expiration of the visa.
THE FOLLOWING SITUATIONS MUST BE CHECKED WITH THE
Visa requirements and other information in this list are subject to
BRAZILIAN CONSULATE BEFORE REQUESTING A VISA:
change without notice. Visit us on the Internet to obtain our Visa Form.
Este formulário é gratuito e distribuído pelo Consulado-Geral da República Federativa do Brasil em Nova York.
J:\Formularios\Setor Consular\Vistos\Requerimento de Vistos - Informações.doc
8/20/2008

Download Form 1 Brazilian Visa Application Form - Consulate General of Brazil (English/Portugese) - New York City

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