Form 22 Kenyan Visa Application Form - Embassy of the Republic of Kenya - Washington, D.C.

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EMBASSY OF THE REPUBLIC OF KENYA
FORM 22 (REVISED 2012)
2249 R STREET, N.W.
WASHINGTON, D.C. 20008
Tel: (202) 387-6101
Fax: (202) 462-3829
APPLICATION FORM FOR A VISA
(To be completed in Block Letters)
1. Visa required (specify)
2. (a) Surname/Family Name …………………………………………………………………………………………………
(b) Other Names in Full ………………………………………………………………………………………………………
(c) Sex
(d) Full Names of Parent(s)/spouse(s) …………………………………………………………………………………
3. (a) Date of Birth
(b) Country and Place of Birth ………………………………………………………………………………………….
(c) Profession/occupation ……………………………………………………………………………………………….
4. (a) Nationality at Birth ……………………………………………………………………………………………………..
(b) Present Nationality, if different …………………………………………………………………………………..
(c) Country of Residence ………………………………………………………………………………………………..
(d) Contact Address in the Country of Residence (Physical address)
………………………………………………………………………………………………………………………………….
Telephone……………………………………………….
E‐mail ……………………………………………………
5. Passport/Travel Document held:
(a) No. ……………………………………………………………………………………………………………………………
(b) Place of Issue ……………………………………………………………………………………………………………
(c) Date of Issue …………………………………………………………………………………………………………….
(d) Expiry date ……………………………………………………………………………………………………………….
(e) Issued by ………………………………………………………………………………………………………………….
6. (a) Specify reasons for Entry ……………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………
(b) Proposed Date of Entry …………………………………………………………………………………………………
(c) Duration of stay …………………………………………………………………………………………………………….
EMBASSY OF THE REPUBLIC OF KENYA
FORM 22 (REVISED 2012)
2249 R STREET, N.W.
WASHINGTON, D.C. 20008
Tel: (202) 387-6101
Fax: (202) 462-3829
APPLICATION FORM FOR A VISA
(To be completed in Block Letters)
1. Visa required (specify)
2. (a) Surname/Family Name …………………………………………………………………………………………………
(b) Other Names in Full ………………………………………………………………………………………………………
(c) Sex
(d) Full Names of Parent(s)/spouse(s) …………………………………………………………………………………
3. (a) Date of Birth
(b) Country and Place of Birth ………………………………………………………………………………………….
(c) Profession/occupation ……………………………………………………………………………………………….
4. (a) Nationality at Birth ……………………………………………………………………………………………………..
(b) Present Nationality, if different …………………………………………………………………………………..
(c) Country of Residence ………………………………………………………………………………………………..
(d) Contact Address in the Country of Residence (Physical address)
………………………………………………………………………………………………………………………………….
Telephone……………………………………………….
E‐mail ……………………………………………………
5. Passport/Travel Document held:
(a) No. ……………………………………………………………………………………………………………………………
(b) Place of Issue ……………………………………………………………………………………………………………
(c) Date of Issue …………………………………………………………………………………………………………….
(d) Expiry date ……………………………………………………………………………………………………………….
(e) Issued by ………………………………………………………………………………………………………………….
6. (a) Specify reasons for Entry ……………………………………………………………………………………………..
………………………………………………………………………………………………………………………………………
(b) Proposed Date of Entry …………………………………………………………………………………………………
(c) Duration of stay …………………………………………………………………………………………………………….
7. Full names and addresses of Hotels/Places/Firms/Friends or Relatives to be visited in Kenya
(Physical address)
Telephone/Cell no. ……………………………………………….
E‐mail ……………………………………………………
8. Dates and Duration of previous visits to Kenya …………………………………………………………………
……………………………………………………………………………………………………………………………………………
9. Will you be returning to your Country of Residence/Domicile?. ......................................
10. Have you been previously denied entry into Kenya? If yes state when and reasons given.
…………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………………….
11. Have you ever been convicted of any offence under any system of law? If yes give offence
and penalty?.
……………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
I, ……………………………………………………………………………………………………………………
(insert name)
understand that if any of the particulars furnished above are found to be incorrect or if any
relevant information is found to be withheld or suppressed, the visa is liable to be cancelled.
(Signature of applicant)……………………………………..Date………………………………………….
NOTE:
(a) The possession of a visa is not the final authority to enter the Republic of Kenya
(b) Engaging in any form of business or employment without a requisite permit or pass
is an offence.
FOR OFFICIAL USE

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