"Visa Application Form" - Tajikistan

This Tajikistan-specific printable "Visa Application Form" is a part of the legal paperwork issued by the Tajikistan Minister of Foreign Affairs.

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Annex 2

MINISTRY OF FOREIGN AFFAIRS OF THE REPUBLIC OF TAJIKISTAN

to the Governmental Decree of

the Republic of Tajikistan

VISA APPLICATION FORM

#122 from 27.02.2009

Fill out the application form with capital letters (marked with black type)

1. Passport number

2. Place of issue: country

City (town)

District

3. Citizenship

4. Date of issue

5. Date of Expire

Place for color photo

6. Surname (Last name)

Size 3x4 cm

7. First name

8. Middle (other) name

9. Date of Birth

10. Place of Birth: District

City (town)

Country

11.Nationality

12. Sex

13. Marital status:

Married

Single

Male

Female

Divorced

14. Permanent address (country, city (town), street, house or apartment`s number, zip code):

15. Telephone number: Office

Fax:

Mobile:

E-mail address:

16. Name and address your office, institution or type of activity: Name

Address:

17. Position (if you are a student write “student” if retired, write “retried”). Describe your work (activity):

18. Date of arrival to Tajikistan

19. Date of departure from Tajikistan.

20. Number of entries: (single, double, multiple,

(for extension of visa, indicate the duration of

exit visa)

stay)

21. PURPOSE OF VISIT (the category of visa will be identified according to the purpose of visit; therefore, indicate the exact and complete purpose of your visit).

22. Place of stay in the Republic of Tajikistan (name and full address of the hotel. If it is a diplomatic representation, private house, state agency or other place, indicate

the full address):

23. Telephone number of the

place of your stay: Office:

Fax:

Mobile:

E-mail address:

24. Who will pay for your trip (is case of need, consular officer may request

25. Have you visited Tajikistan previously? Date and duration of your previous stay

prove of availability of funds, necessary to stay in the Republic of Tajikistan)

in the Republic of Tajikistan?

26. Ha

you ever been issued a Tajik visa

? If

«YES»:

When:

Where:

What type (category):

For how long:

Annex 2

MINISTRY OF FOREIGN AFFAIRS OF THE REPUBLIC OF TAJIKISTAN

to the Governmental Decree of

the Republic of Tajikistan

VISA APPLICATION FORM

#122 from 27.02.2009

Fill out the application form with capital letters (marked with black type)

1. Passport number

2. Place of issue: country

City (town)

District

3. Citizenship

4. Date of issue

5. Date of Expire

Place for color photo

6. Surname (Last name)

Size 3x4 cm

7. First name

8. Middle (other) name

9. Date of Birth

10. Place of Birth: District

City (town)

Country

11.Nationality

12. Sex

13. Marital status:

Married

Single

Male

Female

Divorced

14. Permanent address (country, city (town), street, house or apartment`s number, zip code):

15. Telephone number: Office

Fax:

Mobile:

E-mail address:

16. Name and address your office, institution or type of activity: Name

Address:

17. Position (if you are a student write “student” if retired, write “retried”). Describe your work (activity):

18. Date of arrival to Tajikistan

19. Date of departure from Tajikistan.

20. Number of entries: (single, double, multiple,

(for extension of visa, indicate the duration of

exit visa)

stay)

21. PURPOSE OF VISIT (the category of visa will be identified according to the purpose of visit; therefore, indicate the exact and complete purpose of your visit).

22. Place of stay in the Republic of Tajikistan (name and full address of the hotel. If it is a diplomatic representation, private house, state agency or other place, indicate

the full address):

23. Telephone number of the

place of your stay: Office:

Fax:

Mobile:

E-mail address:

24. Who will pay for your trip (is case of need, consular officer may request

25. Have you visited Tajikistan previously? Date and duration of your previous stay

prove of availability of funds, necessary to stay in the Republic of Tajikistan)

in the Republic of Tajikistan?

26. Ha

you ever been issued a Tajik visa

? If

«YES»:

When:

Where:

What type (category):

For how long:

27. Ha

you ever been refused a visa? If «YES»:

When:

Where:

What was you purpose of visit:

For how long requested:

28. Do you intend to work in Tajikistan? If «YES», indicate name and address of

29. Do you intend to study in Tajikistan? If «YES», indicate name and address of

employer:

the Institution or University:

30. Please indicate the information about your relatives in the Republic of Tajikistan (father, mother, sister/brother, children, adopted children, spouse, fiancée

etc):

31. IMPORTANT: AFTER HAVING READ THE LISTED BELOW QUESTIONS ATTENTIVELY, PLEASE MARK THE “YES” OR “NO”:

- have you ever been arrested or convicted for any offence of crime within the

YES

territory of the Republic of Tajikistan? If answer «YES», please describe it in

the separate page

- have you ever been a member of terrorist or extremist group or organization,

human trafficking, weapons and ammunition, illegal drug trafficking and their

YES

precursors, illegal immigration?

- do you have a criminal record for felony in the territory of the Republic of

YES

Tajikistan or in any other foreign country?

- have you ever been subject of pardon or amnesty?

YES

- did you or do you have infections (contagious) of diseases harmful for the

YES

health surrounding society?

32. Was this application prepared by another person (organization)? If «YES», then:

YES

The inviting side is informed that according to the legislation of the Republic of Tajikistan, bears responsibility for authenticity of data indicated in the application as well as for the timely preparation

of the documents of the invited foreign citizen for the right of: stay in the Republic of Tajikistan, movement within the territory and for exit from the Republic of Tajikistan upon expiring their defined

term of stay.

who:

relation with applicant:

full address and telephone number:

date and signature (organization putting a

stamp):

33.

I, hereby certify that after having read the questions listed in the application, I acknowledged the full responsibility for my answers. I am well aware that the false or misleading statement may result

in their permanent refusal of a visa. I understood that possession of a visa does not automatically entitle the bearer to enter the Republic of Tajikistan upon arrival at a point of entry.

Applicant`s signature _________________________________________________

Date _______________________________________________________________

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Раводиди тањти раќами

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Ба мўњлати (аз кай то кай)

Аз љониби (ному насаб, имзо

ва мўњри Консул)

Санаи судури раводид