"Vietnam Visa Application Form - Embassy of Vietnam" - Washington, D.C.

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Download "Vietnam Visa Application Form - Embassy of Vietnam" - Washington, D.C.

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Visa Approval/Reference Number (if any):
01
Photo
EMBASSY OF VIETNAM
VISA
th
(2 inches x 2 inches)
1233 20
Street, NW, Suite 400
APPLICATION
Glued photo here
Washington, D.C. 20036
01 additional photo
(FOR NON-VIETNAMESE
stapled to this form for a
Tel: (202) 861-0737 & (202) 861-2293
PASSPORT HOLDERS)
loose -leaf visa request
Fax: (202) 861-0917
______
http://www.vietnamembassy.us
1. Name (in block letters):
.................................................................................………………………………………….
Family name
First name
Middle name
2. Date of birth:.................../............./….… …
10. Name, address of your contact (sponsor, host,
hotel…) in Vietnam (if any)
Date / Month / Year
................................................………………
3. Male:
Female
................................................................……
4. Place of birth:..............................................
.........................................................................
5. Nationality at birth:......................................
.........................................................................
Nationality at present:..................................
.........................................................................
Passport number
6.
:........................................
..………………………………………….…
Date of issue:................ ........... ........... .........
11. Proposed date of entry:
Date of expiry:........... ........... ........... ...........
.......... …./…............/........
. .....
7. Profession:......................................................
Date
/ Month
/ Year
Place of employment:.....................................
Proposed date of exit:
.................................... ......................... ....
....… … /…………/……...
.....
……….…………………………………………
Date
/ Month
/ Year
Telephone (Office):…....…....................... .....
12. Requesting a visa good for:
8. Present mailing address: (P.O Box Not
 Times of entries:
Accepted for USPS express mail)
………….………………………………………
- Single (one time) visit
…………………………………………………
- Multiple visits
…………………………………………………
 Length of stay:
…………………………………………………
- One month
* Email :………………………….
* Telephone :.......................................
- 03 months
9. Purpose of visit to Vietnam:
- 0
6 Months
…………………………………………………
- 12 Months (US passport only)
…………………………………………………
…………………………………………………
I solemnly declare that the statements made in this application are true and correct.
Date:…………………………………………………
Signature of Applicant ...............................................
Check list: Before submitting, make sure you have included:
 Original Passport (for a visa sticker request);
or  Passport copy (front photo page, for a loose-leaf visa request)
 Completed and signed Application with One Photo glued or stapled;
 Visa Fee: Money Order (or Cashier’s Check); and
 Prepaid USPS Express Mail or FedEx Slip, (if you want your visa be returned by mail).
* Required for further contact
Visa Approval/Reference Number (if any):
01
Photo
EMBASSY OF VIETNAM
VISA
th
(2 inches x 2 inches)
1233 20
Street, NW, Suite 400
APPLICATION
Glued photo here
Washington, D.C. 20036
01 additional photo
(FOR NON-VIETNAMESE
stapled to this form for a
Tel: (202) 861-0737 & (202) 861-2293
PASSPORT HOLDERS)
loose -leaf visa request
Fax: (202) 861-0917
______
http://www.vietnamembassy.us
1. Name (in block letters):
.................................................................................………………………………………….
Family name
First name
Middle name
2. Date of birth:.................../............./….… …
10. Name, address of your contact (sponsor, host,
hotel…) in Vietnam (if any)
Date / Month / Year
................................................………………
3. Male:
Female
................................................................……
4. Place of birth:..............................................
.........................................................................
5. Nationality at birth:......................................
.........................................................................
Nationality at present:..................................
.........................................................................
Passport number
6.
:........................................
..………………………………………….…
Date of issue:................ ........... ........... .........
11. Proposed date of entry:
Date of expiry:........... ........... ........... ...........
.......... …./…............/........
. .....
7. Profession:......................................................
Date
/ Month
/ Year
Place of employment:.....................................
Proposed date of exit:
.................................... ......................... ....
....… … /…………/……...
.....
……….…………………………………………
Date
/ Month
/ Year
Telephone (Office):…....…....................... .....
12. Requesting a visa good for:
8. Present mailing address: (P.O Box Not
 Times of entries:
Accepted for USPS express mail)
………….………………………………………
- Single (one time) visit
…………………………………………………
- Multiple visits
…………………………………………………
 Length of stay:
…………………………………………………
- One month
* Email :………………………….
* Telephone :.......................................
- 03 months
9. Purpose of visit to Vietnam:
- 0
6 Months
…………………………………………………
- 12 Months (US passport only)
…………………………………………………
…………………………………………………
I solemnly declare that the statements made in this application are true and correct.
Date:…………………………………………………
Signature of Applicant ...............................................
Check list: Before submitting, make sure you have included:
 Original Passport (for a visa sticker request);
or  Passport copy (front photo page, for a loose-leaf visa request)
 Completed and signed Application with One Photo glued or stapled;
 Visa Fee: Money Order (or Cashier’s Check); and
 Prepaid USPS Express Mail or FedEx Slip, (if you want your visa be returned by mail).
* Required for further contact
o Applicant is responsible for checking accurate information on visa being issued by
the Embassy. In case of mistakes, please contact the Embassy immidiately for
correction. Otherwise, applicant is fully responsible for the mistakes.
o In case of emmergency, pls call: (202)- 716 - 8666 or (202) - 739 - 1666
* Required for further contact
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