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7eIhv'0=;y-k -njG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD lt4kogvdvad7t]af4tm6f I6[ ok,ltd5oG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD (It's Easy)

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7eIhv'0=;y-k
APPLICATION FOR VISA
I6[
PHOTOGRAPH
2" x 2"
Embassy of the Lao PDR
2222 S Street, N.W.
Washington, DC 20008
Tel: (202) 667-0076
Fax: (202) 332-4923
lt4kogvdvad7t]af4tm6f
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Lao People's Democratic Republic
Peace Independence Democracy Unity Prosperity
-njG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
FIRST NAME (IN BLOCK LETTER)
;aoF gfnvoF xugdufG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
DATE OF BIRTH
lao-kfG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
NATIONALITY
soa'lnzCkocfos,kpg]dG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
PASSPORT No.
vvd.sh;aomuG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
DATE OF ISSUE
muj16Cxt95[aoG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
]6d8yf8k,muj.-hsoa'lnzjkocfofP;daoG
CHILDREN TRAVELING WITH
THE SAME PASSPORT
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PURPOSE OF THE TRIP
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fCkog0Qkg,nv'G DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
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DATE OF ARRIVAL IN THE LAO PDR
PORT OF ENTRY
ok,ltd5oG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
lt4komujgdufG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
vk-u[G DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
vvd.shmujG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
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3m]tla[G DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
FAMILY NAME (IN BLOCK LETTER)
PLACE OF BIRTH
OCCUPATION
PLACE OF ISSUE
EXPIRATION
TEL.
!D -nj (NAME) DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
@D -nj (NAME) DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
#D -nj (NAME) DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
vkp5 (AGE) DDDDDDDDDDDDDDDDDDD
vkp5 (AGE) DDDDDDDDDDDDDDDDDDD
vkp5 (AGE) DDDDDDDDDDDDDDDDDDD
-nj (NAME)G DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD 3m]tla[ (TEL.)G DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
muj16C (ADDRESS)G DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
95fgfuomk's^a'9kddko1hP,1k, lxx ]k;G DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
NEXT DESTINATION AFTER YOUR VISIT TO THE LAO PDR
;aomuG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD ]kpg-aoG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
DATE SIGNATURE
7egsao0v'lt4kom6f (OFFICIAL USE ONLY)
;y-kg]dmuG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD ]q';aomuG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
HOME
ADDRESS
REFERENCE IN
THE LAO PDR
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MEANS OF TRANSPORTATION
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DURATION OF STAY IN THE LAO PDR DAYS
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7eIhv'0=;y-k -njG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD lt4kogvdvad7taf4tm6f I6 ok,ltd5oG DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD (It's Easy)

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Completed 25 July 2021

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