APPLICATION FOR ENTRY VISA
Transcription
APPLICATION FOR ENTRY VISA
APPLICATION FOR ENTRY VISA EMBASSY OF THE REPUBLIC OF GHANA, ABIDJAN Before filling this form, carefully read all instructions on the next page Lire attentivement les instructions avant de remplir le formulaire FIRMLY AFFIX ONE (3.5x4.5) ID PHOTOGRAPH NOT OLDER THAN SIX MONTHS HERE COLLER ICI UNE PHOTO D’IDENTITÉ (3.5X4.5) DE MOINS DE SIX MOIS OFFICIAL USE/RESERVE AU SERVICE Visa No................................................................ Type of Visa......................................................... Date of issue........................................................ Charge (FCFA)...................................................... Signature of Issuing Officer................................. Please note: Four (4) copies of this form should be completed IN CAPITAL LETTERS and submitted together with 4 recent passport photographs. A votre attention: Ce formulaire doit être complété en 4 exemplaires EN LETTRES MAJUSCULES et soumis avec 4 photos d’identité récentes. 1. (a) Surname (Exactly as in passport) First name(s) (Exactly as in passport) Nom (Comme dans le passeport)……………………………………………………… Prénoms (Comme dans le passeport) ………………………………………………………… …………………………………………………………………………………………. ……………………………………………………………………………………………………. Previous Names (if applicable) Noms précédents (s’il y en a)………………………………………………………………………………………………………………………………………………………………………………….. (b) Date of Birth (c) Country & Place of Birth Date de naissance……………………………………………………………………… Pays et ville de naissance……………………………………………………………............ (d) Nationality (e) Former Nationality (if any) Nationalité…………………………………………………………………………………. Nationalité précédente (s’il y en a)……………………………………………………….. (f) Passport No. (g) Date of Issue Numéro du passeport………………………………………………………………… Date de délivrance……………………………………………………………………………….. (h) Place of Issue (i) Date of Expiry Lieu de délivrance……………………………………………………………………… Date d’expiration………………………………………………………………………………….. 2. Profession/Occupation Profession ou emploi……………………………………………………………………………………………………………………………………………………………………………………………… 3. (a) Business Address & Tel. No. Adresse et No. de Tel (Bureau)……………………………………………………………………………………………………………………………………………………………………………….. (b) Residential Address & Tel. No. Adresse et No. de Tel (Domicile)…………………………………………………………………………………………………………………………………………………………………………….. 4. Destination and Proposed Date of Departure for Ghana Destination et date prévue pour le départ au Ghana……………………………………………………………………………………………………………………………………………… 5. (a) Travelling by : By Air By Land By Sea Mode de voyage : Par avion En voiture En bateau (b) Type & Ticket No. (c) Vehicle/Boat Registration No. Type et No. Du billet……………………………………………………. Immatriculation de véhicule/Bateau…………………………………………………….. 6. Purpose of Journey : Business Official Employment Tourism Education Transit Motif du voyage: Affaires Officiel Emploi Tourisme Etudes Other (Please specify)/Autre (Précisez)………………………………………………………………………………………………………………….. 7. Financial means at Applicant’s disposal (please state amount) Moyens financiers du demandeur………………………………………………………………………………………………………………………………………………………………………….. 8. Names, Address and Tel. No. of two References in Ghana Noms et adresses de 2 répondants au Ghana (i) ………………………………………………………………………………………………………………………………………………………………………………………………………………………………. (ii) ………………………………………………………………………………………………………………………………………………………………………………………………………………………………. 9. If for Employment, Name & Address of Employer in Ghana En cas d’emploi, nom et adresse de l’employeur au Ghana……………………………………………………………………………………………………………………………………. 10. Duration of Stay in Ghana Durée du séjour au Ghana……………………………………………………………………………………………………………………………………………………………………………………… 11. Date of Last Visit to Ghana Date de la dernière visite au Ghana……………………………………………………………………………………………………………………………………………………………………….. 12. Date of Application Applicant’s Signature Date de la demande…………………………………………………………………………… Signature du demandeur……………………………………………………………..