Form 5A "Sudan Visa Application Form" - Sudan

Form 5A or the "Sudan Visa Application Form" is a form issued by the Sudan Ministry of Interior.

A PDF of the latest Form 5A can be downloaded below or found on the Sudan Ministry of Interior Forms and Publications website.

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Download Form 5A "Sudan Visa Application Form" - Sudan

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Republic   o f   S outh   S udan  
 
Ministry   o f   I nterior
 
Directorate   o f   N ationality,   P assports   a nd   I mmigration  
 
Visa   A pplication   F orm  
Form   5 A  
(FILL   O UT   I N   C APITAL   L ETTERS   O NLY)  
Warning: giving false information is considered a crime in accordance with the Passport and Immigration Act, 2011. Visa fees are
non-refundable. Visa is not transferable and attempt to do so is considered a crime.
Place of Application
Date:
/
/20
Have you Previously Applied for South Sudan Visa. Yes
No
If yes, Previous visa No:. ……………………………..…. Date of Issue……………………………..….Place
of Issue……………………………..….Date of Arrival in south Sudan……………………………..….Point of
Entry……………………………..…point of Exit……………………………..….
1. Visa Type Requested: Single:
Multiple:
Transit:
Other:
(Specify)
Purpose of visit: Visit
Education
Tourism
Medical treatment
Official
Other
(Specify)
…………………………..….
Duration
of
Intended
Stay……………………………..….Date
of
Intended
Arrival
in
South
Sudan……………………………..….
Mode of Transport: Air
Road/Trail
River
2. Personal Details (As in Passport)
Surname: ………………………………………………………………………………………
Given Names: …………………………………………………………………………………
Date of Birth (Day/Month/Year): ……/……../……….
Place of Birth: ………………………….Country of Birth………………………….…
Sex:
Male
Female
Marital Status: Single
Married
Divorced
Widowed
Visa   A pplication   F orm   ( Form   5 A)  
Page   1  
 
Republic   o f   S outh   S udan  
 
Ministry   o f   I nterior
 
Directorate   o f   N ationality,   P assports   a nd   I mmigration  
 
Visa   A pplication   F orm  
Form   5 A  
(FILL   O UT   I N   C APITAL   L ETTERS   O NLY)  
Warning: giving false information is considered a crime in accordance with the Passport and Immigration Act, 2011. Visa fees are
non-refundable. Visa is not transferable and attempt to do so is considered a crime.
Place of Application
Date:
/
/20
Have you Previously Applied for South Sudan Visa. Yes
No
If yes, Previous visa No:. ……………………………..…. Date of Issue……………………………..….Place
of Issue……………………………..….Date of Arrival in south Sudan……………………………..….Point of
Entry……………………………..…point of Exit……………………………..….
1. Visa Type Requested: Single:
Multiple:
Transit:
Other:
(Specify)
Purpose of visit: Visit
Education
Tourism
Medical treatment
Official
Other
(Specify)
…………………………..….
Duration
of
Intended
Stay……………………………..….Date
of
Intended
Arrival
in
South
Sudan……………………………..….
Mode of Transport: Air
Road/Trail
River
2. Personal Details (As in Passport)
Surname: ………………………………………………………………………………………
Given Names: …………………………………………………………………………………
Date of Birth (Day/Month/Year): ……/……../……….
Place of Birth: ………………………….Country of Birth………………………….…
Sex:
Male
Female
Marital Status: Single
Married
Divorced
Widowed
Visa   A pplication   F orm   ( Form   5 A)  
Page   1  
 
Nationality / Citizenship:
………………………………………………………………………………………………..
(If dual, give both)
3. Passport Details:
4. Passport Type:
Regular
Diplomatic
Special
Business
Other
(specify)
Passport No: …………………………Date of Issue (Day/Month/Year): ……/……/……
Country of Issue: ……………………Date of Expiry (Day/Month/Year): ……/……/………Place of Issue:
……………………………….
5. Professional / Occupation Details:
Present Occupation: .……………………….................. Title: ……………….…………………
Employer Name: ….………………………………….………………………………………….
Employer Address:
…………………………………….……………………………………………………………
……………………………………………………… Phone No: ….……..……………………
E-mail: ….……..…………………………….
6. Applicant’s Contact Details:
Present Address:
.……………………………………………………………………………………………………………
……………………………………………………………………………………………………………………
………….……….
Permanent Country of Origin Address:
………………………………………………………………………….…………………………………………
……………………………………………………………………………………………
Phone No: ……………………………………………
Mobile No: . ……..…………………………….
E-mail Address: …………………………………………………………
7. Family Details:
Spouse Details
Surname: …………………………………………………………
Given Names: ……………………………………………………
Permanent Address:
………………………………………………………………………….…………………………………………
……………………………………………………………………………………………
Phone No: ……………………………………………Mobile No……………………………….……….
Visa   A pplication   F orm   ( Form   5 A)  
Page   2  
 
E-mail Address:. …………………………………………………………
Next of Kin Details
Surname: …………………………………………………………
Given Names: ……………………………………………………
Permanent Address:
………………………………………………………………………….…………………………………………
……………………………………………………………………………………………
Phone No: ……………………………………………Mobile No……………………………….……….
E-mail Address: ………………………………………………………………
8. Have you ever:
a) Been convicted of a crime or offence in any country?
Yes
No
b) Been deported or removed from South Sudan or any country for overstaying your visa or violating any
law or regulation?
Yes
No
c) Been convicted and sentenced for a drug offence in any country in violation
of law concerning narcotics, marijuana, opium, stimulants or psychotropic
substances?
Yes
No
d) Committed trafficking in persons or incited or aided another to commit such an offence?
Yes
No
e) Are you suffering from tuberculosis, any other infectious or contagious disease
Yes
No
If you answer yes to any of the questions above, provide explanation below:
………………………………………………………………………….
……………………………………………………………………………….
Address of Place of Stay / Hotel:
………………………………………………………………………………….……
………………………………………………………………………………………
Funds Available For My Stay ………………………..
9. Guarantor or references in South Sudan:
Name: ……………………………………Telephone No.: ………………………………
Visa   A pplication   F orm   ( Form   5 A)  
Page   3  
 
Address………………………………………………………………………………………
Date of Birth (Day/Month/Year) : ….…../…………/……..… Sex: Male
Female
Relationship to Applicant:
…………………………………………………………………………………………..
Profession/occupation: …………………………………………………………………….
Nationality and Immigration Status: ………………………………………………………………………….
10.
Declaration:
I declare that the information provided in this form is true and accurate.
Signature of the applicant (Sign below here)
Date (Write below here)
………………………….……….
: ….…../…………/……..…
FOR OFFICIAL USE
Approving Authority:
Officer Name: ……………………………………………. Title: ……………………………………
Entry Type: Single
Multiple
Period of stay …………………………………..
Officer’s Signature: ……………………………………… Date (Day/Month/Year):
….…../…………/…….….…....
Comments:
………………………………………………………………………………………………………………………
……………
Fees
Amount: …………………………………………………………………..
Date of Receipt: ……………………………………… Receipt No: ……………………………….
Designated Officer’s Name: ………………………………Title: ……………………………………
Signature and stamp ………………………………………………………………
Visa Number: ……………………………………………………………………
Visa   A pplication   F orm   ( Form   5 A)  
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