Ghana form - Réseau Espaces Volontariats

For Official Use
V is a N o . . . . . , . . . . .
Type of Visa. . .. .
Dateoflssue.. ...
Cha r g e s . . . . . . . . . . .
Signature of Issuing Officer
AppHcationfor GhanaEntry Permit/Visa
PARIS MISSION
withinatleasttlrree(3)-daysbeforetheintendeddateofdeparture& rempliren@@[girylggyjoindrequatre(4)photosd'identitdetdiposer
2.
3.
4
5.
trois (3) jours avant la date prevwte pour le vayage.
Full names and Addresses ofreferences in Ghana should be stated (iflcluding Telephone Numer, 1f avanlable/ Noms et adressesde deux
rdf€reces au Ghana (numero de tdlqhone, si disponible)
Any information stated on the From and subsequently found to be incorrect may render Entry Permit/Visa void,/Ez cas defausse diclaration'
le visa d'entrde/de sdjour s'ovirera nul et niant.
Travellers to Ghana must be in possession of an intemational Health Certificate for Yellorar F ever/ Tout vayageur est prier de se munir d'tm
certificat intemational de vaccination, contre lafievre iaune.
Apilicants applying by post should provide Self-addressed stamped envel opes/Tout demandeur par courrier doit obligatorement fournir des
enveloppes tirnbrdes d son nom et adresse
(a) Surname/Noz
Previous Name (if appli
.(b)PlaceofBitNLteudeNaissance........
(blDate ofBirth/DatedeNaissance........
(e)Na tion al it y / ' lr af onalit 6. . . . . . . . . . . . ' ' . . . . ' . ' ( f) F o r m e r N a t i o n a 1 i t y ( i f a n y ) / N a t i o n a l i t d
(g)PassportN" lN"dePasseport
... ... ... .. ...(h)Dateof Issue/Datedediliwance.
(i)Placeo fIs s t t elLieudeddliwanc e' . . . . ' . ' . . ' ' . f ) D a t e o f E x p i r y / D a t e d 'e x p i r a t i o ''', . ''. ''. . '. . . . '.
2.
Profession/Occup
3.
(a)Business Address & Tel. NolAdresse& N" de tdldphonedu lieu
4.
5.
ProposeddateofDeparture forGhana/Dateprewepourledipart
E Anl,lvion
(a) Travellirrg byl Moym de transport
(b) Is applicantin possessionof return ticket ?.. ... ....
Le demsndeurdiswset-il d un billet alle/retour?
flseal&ateau
ELand/Route
" 'Ticket No" "
N" du Billet
(c) Financial meansat Applicant's disposal
du demandeurou sesmoyensd'existencependantsonsdjoursu Ghana
Ressources
6.
7.
purposeof JovrneylMotifduvoyage g Business/,4ft;rasg
Tourisme/Tour.kme g^Employment/Emptoi
Names and Addresses ofTwo ref,erencern Chana/Noms& Adressesde deuxre|erencesou Ghana
If for Employment, Name & Address of Employer in Ghana/S;pour emploi,nom& adressede I'employeurau Ghana
9.
Duration of Stay in Ghan
10.
dedemiervoyageou Ghana....-................
Date of Last Visit to Gharm.lDate
11.
Applicant's Signab*elsignature
12.
(e) de (enfants
Accompanied by (childten)lAccompagnd
........Date of Application/Oate
g
OfficiaUfficiel