"Rwanda Visa Application Form - Embassy of the Republic of Rwanda in the Netherlands" - The Hague, South Holland, Netherlands

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REPUBLIC OF RWANDA
EMBASSY OF THE REPUBLIC OF RWANDA IN THE NETHERLANDS
PHOTO
VISA APPLICATION FORM
1. Family name (as in passport)
2. Middle name
FOR OFFICIAL
USE ONLY
Date of application:
3. First name(s) (as in passport)
4. Date of birth (year-month-day)
5. ID-number
6. Sex
! Male
! Female
7. Place of birth
8. Marital status:
City :……………….……………………….……..
! Single
! Married ! Divorced
! Widowed ! Never married ! Other
Country……………………………………………
9. Citizenship at birth
10. Current citizenship
11. Father’s full name
12. Mother’s full name
13. Type of passport
! Travel Document (1951 Convention)
! Ordinary Passport
! Alien’s passport
Supporting
documents:
! Diplomatic Passport
! Other (please specify)…………………………………….
! Valid passport
! Service Passport
! Invitation letter
! Hotel booking
! Recommendation
letter
14. Passport number
15. Issue and expiry date
16. Place of issue
! Copy of hosts ID
! Itinerary
Other:
17. If you are resident in a country other than your country of origin, have you permission to
return to that country?
! No
! Yes, (number and validity) …………………………………………………………..
18. Current profession
Current occupation
Johan van Oldenbarneveltlaan 9-B, 2582 NE The Hague Tel +31 703926571, FAX +31 704275326
E-mail:
ambalahaye@minaffet.gov.rw
Page 1 of 3
REPUBLIC OF RWANDA
EMBASSY OF THE REPUBLIC OF RWANDA IN THE NETHERLANDS
PHOTO
VISA APPLICATION FORM
1. Family name (as in passport)
2. Middle name
FOR OFFICIAL
USE ONLY
Date of application:
3. First name(s) (as in passport)
4. Date of birth (year-month-day)
5. ID-number
6. Sex
! Male
! Female
7. Place of birth
8. Marital status:
City :……………….……………………….……..
! Single
! Married ! Divorced
! Widowed ! Never married ! Other
Country……………………………………………
9. Citizenship at birth
10. Current citizenship
11. Father’s full name
12. Mother’s full name
13. Type of passport
! Travel Document (1951 Convention)
! Ordinary Passport
! Alien’s passport
Supporting
documents:
! Diplomatic Passport
! Other (please specify)…………………………………….
! Valid passport
! Service Passport
! Invitation letter
! Hotel booking
! Recommendation
letter
14. Passport number
15. Issue and expiry date
16. Place of issue
! Copy of hosts ID
! Itinerary
Other:
17. If you are resident in a country other than your country of origin, have you permission to
return to that country?
! No
! Yes, (number and validity) …………………………………………………………..
18. Current profession
Current occupation
Johan van Oldenbarneveltlaan 9-B, 2582 NE The Hague Tel +31 703926571, FAX +31 704275326
E-mail:
ambalahaye@minaffet.gov.rw
Page 1 of 3
19. Present work address
Telephone/ Fax Number
E-mail address
20. Applicant’s home address
Telephone number
E-mail address
21. Type of Visa:
22. Number of entries requested
! Transit ! Short stay ! Long stay
! Single Entry ! Multiple entry
23. Duration of stay (Number days):.................... days
Type of Visa:
24. Have you ever been denied a visa to Rwanda or anyother African country?
! No
! Single Entry
! Yes - When……………………………….. Where………………………………………
! Transit
! Tourist
! Business
25. Have you ever been deported from or requested to leave Rwanda or anyother African
! Work
country ?
! Education
! No
! Other
! Yes - When…………………………….. Where…………………………………………
………………………
………………..……
26. In the case of transit, have you an entry permit for the final country of destination?
…………..
! No ! Yes, valid until: ……/………/………Issuing Authority:……..................……….…
27. Purpose of travel
! Official
! Tourism
! Business
! Cultural/Sports
! Private visit (family or friends) ! Medical reasons
Visa:
! Refused
! Other (please specify)
! Granted
! Pending
..................................................................................................................................................
..................................................................................................................................................
Valid
28. Date of arrival
29. Date of departure
From:................
……./……/……
……./……/……
30. Point of first entry or transit route
31. Means of transport
To:....................
32. Who is paying for your trip and costs of living during your stay in Rwanda?
! Myself ! Host person(s) ! Company
(State who and how)
...........................................................................................................................
...........................................................................................................................
33. Name and contacts of host or company in Rwanda. If not applicable, give name of hotel
or temporary address in Rwanda.
Names…………………………………………………….……
Physical address………………………………………………
Telephone………………………………………………………
Johan van Oldenbarneveltlaan 9-B, 2582 NE The Hague Tel +31 703926571, FAX +31 704275326
E-mail:
ambalahaye@minaffet.gov.rw
Page 2 of 3
E-mail address…………………………………………………
34. Means of support during your stay
! Cash ! Traveller’s Cheque ! Credit cards ! Accomodation
! Other:..............................................
! Travel and/or health insurance. (optional) Valid until:............................................
35. Spouse (If applicable)
Family name
Nationality
Middle name
Date of birth
First name
Place of birth
36. Accompanying children (Application must be submitted seperately for each passport)
Family Name
First name
Date of birth
1
2
3
4
37. I certify that I have read and understood all the questions set forth in this application
form and the answers I have furnished on this form are true and correct to the best of my
knowledge and belief. I uderstand that possession of a visa does not automatically entitle
me to enter the Republic of Rwanda.
38. Place and date
39. Signature (for minors, signature of
custodian /guardian)
Johan van Oldenbarneveltlaan 9-B, 2582 NE The Hague Tel +31 703926571, FAX +31 704275326
E-mail:
ambalahaye@minaffet.gov.rw
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