EMBASSY OF VIETNAM
1233 20
th
Street, NW, Suite 400
Washington, D.C. 20036
Tel: (202) 861-0694 & (202) 861-2293
Fax: (202) 861-1297
http://www.vietnamembassy-usa.org
VISA
APPLICATION
(FOR NON-VIETNAMESE
PASSPORT HOLDERS)
______
01
Photo
(2’x 2’)
1. Name (in block letters):
.................................................................................………………………………………….
First name Family name Middle name
2. Date of birth:..................................….…………
dd mm yy
3. Male:
Female
4. Place of birth:.......................................................
5. Nationality at birth:..............................................
Nationality at present:...........................................
6. Passport number:..................................................
Date of issue:...................Date of expiry:...........…
7. Profession:.............................................................
Place of employment:...........................................
Telephone (Office):…....….....................................
8. Present address: (P.O Box Not Accepted)
………….………………………………………….….
………………………………………………………...
Telephone (Home):............................................….
9. Accompanying children included in your same
passport (full name, date of birth, gender):
………………………………………………………..
...................................................................................
…...................…..................................................……
10. Purpose of visit to Vietnam:
.................................................................................
................................................…………………
11. Name, address of your contact in Vietnam:
(organization or individual)
................................................……………………
................................................................………...
................................................................................
………………………………………….………..
12. Proposed date of entry and exit Vietnam:
from................................to....…..….….……...
dd mm yy dd mm yy
13. Number of entries:
Single
Multiple
14. Port of arrival and departure:
All international ports of entry in Vietnam.
I solemnly declare that the statements made in this application are true and correct.
Place:………………………………………………………………..
Date:…………………………………………………………………
Signature: ....................................................................................….
Before submitting, make sure you have included:
Original Passport;
Completed Application with One Photo Attached;
Visa Fee
: Money Order (or Cashier’s Check); and
Self-addressed Pre-paid FedEx
Slip, (for mailing back issued visas).
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