Type of Visa:
OTE:
If retired or currently unemployed, please state the
address and telephone number of last/previous
employer.
1. Personal Information
a. Surname /Last Name
b. First Name(s)
c. 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 $60.00
Multiple Entry $100.00
For Official Use Only
Visa No.:
Date of Issue:
Issuing Officer:
Charges:
ttach recen
assport size
hotograph here
ILL WITH BLACK INK ONL
1. The form must be completed in block/
capital letters and submitted together with
two(2) recent passport size photographs.
pplication for Ghana Entry Permit/Vis
Embassy of Ghana Washington DC.
2. Passport Information
O PERSONAL CHECK
EGULAR SERVICE
d. Middle Name