N
OTE:
I
f retired or currently unemployed, please state th
e
address and telephone number of last/previous
employer.
1. Personal Information
a. Surname /Last Name
b. First Name(s)
d. Previous Name (if applicable)
e. Date of Birth f. Place of Birth
g. Nationality
h. Former Nationality (if any)
a. Passport Number b. Date of Issue
c. Place of Issue e. Date of Expiry
a. Profession/Occupation
e. Home Phone No.:
f. Cell Phone No.
:
4. Residential Address
a. Street/ Mailing Address:
b. City: c. State d. Zip Code:
g. Emergency Contact Person: (Full Name)
h. Contact Person's Phone No. i. Relationship
3. Name and Address of Employer/School (USA)
b. Street/Mailing Address:
c. City
d. State: e. Zip Code:
f. Telephone Number:
Your Email Address
Applicant's intended date of travel Is applicant in possesion of roundtrip
ticket?
If (yes) Indicate ticket number: Amount of money Applicant is travelling
with
Traveling by:
Air Sea Land
Page One of Two
Single Entry Rush $100.00
Multiple Entry Rush $200.00
For Official Use Only
Visa No.:
Type of Visa:
Date of Issue:
Issuing Officer:
Charges:
A
ttach recen
t
p
assport size
p
hotograph here
F
ILL WITH BLACK INK ONL
Y
The form must be completed in block/capital
letters and submitted together with two(2)
recent passport size photographs.
A
pplication for Ghana Entry Permit/Vis
a
Embassy of Ghana Washington DC.
2. Passport Information
N
O PERSONAL CHECK
S
USH SERVICE
c. Middle Name
Purpose of Journey:
Business Tourism Employment Official Transit
Student
5. Name, Address and Telephone Number of Lodging place/Contact Person/s in Ghana
a. Name of Hotel/Guest House in Ghana
b. Street (Mailing address)
c. City/Town d. Region
e. Telephone Number
f. Contact Person in Ghana, Name and Address
g. Street(Mailing address)
h. City/Town i. Region
j
. Tel. Number:
6. If you select employment, indicate name and address of employer in Ghana
a. Name of Employer
c. City/Town d. Region
b. Address/P .O Box:
e. Telephone Number
7. Duration of stay in Ghana 8. Date of last visit to Ghana
Other
Applicant's Signature: Date of Application:
Page Two of Two
A
pplication for Ghana Entry Permit/Vis
a
Embassy of Ghana Washington DC
Visa Processing Center(RUSH SERVICE)
E
mbass
y
o
f
Ghana
3512 International Drive NW
Washington DC. 20008
For mailing:.. Use Address Below:....
9. For Tourism, list at least two(2) areas of interest, or indicate in writing purpose of journey if
you selected Other