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VISA APPLICATION / DEMANDE DE VISA

EMBASSY OF THE REPUBLIC AMBASSADE DE LA REPUBLIQUE. OF CAMEROON DU CAMEROUN. T l. : (202) 265-8790 2349 Massachusetts Avenue Fax : (202) 387-3826 Washington, DC 20008. Email: VISA APPLICATION / DEMANDE DE VISA. (WRITE IN CAPITAL LETTERS ONLY / ECRIRE EN LETTRES MAJUSCULES SEULEMENT). 1. TRAVELER'S IDENTITY / IDENTITE DU VOYAGEUR. Surname: Given Name(s): Nom de Famille Pr nom(s) Photograph Maiden Name (*): Date of Birth: / / (Staple or glue the photo). Nom de Jeune Fille Date de Naissance Day/Jour Month/Mois Year/Ann e Sex / Sexe: Male Female 2 inches X 2 inches Place of Birth: City: State: Country: Lieu de Naissance Ville Etat Pays Citizenship: Origin: Current: Photographie Nationalit Origine Actuelle (Agrafer ou coller la photo).

TRAVEL ITINERARY / ITINERAIRE DE VOYAGE Place of departure (City/State/Country): Date of departure (DD/MM/YYYY): Lieu de départ (Ville/Etat/Pays) Date de départ (JJ/MM/AAAA) Transiting through (List airports, cities and countries, and transit dates) / Transitant par (Citer les aéroports, villes et pays, et les dates de transit)

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