Visa Application Form - iranconsulate.org.hk

1 For Office Use Only/ : : : : Consulate General of Islamic Republic of Iran Hong Kong Visa Application Form No. 101- 2004/ - Page 1 of 2/ PLEASE Type in and Answer all Questions in Full. Incomplete applications Will Not Be Processed.. 1. First Name: . : 5. Sex: Male Female : . 2. Surname: . : 6.

2 Date of Birth :(yyyy/mm/dd) . ): / / ( 3. Former Names : : . 7. Place of Birth: : City Province Country 4. Father's Name: . : 8. Occupation: : . 9. Ancestral Name* : : . * * (Obligatory for Na ionals of Arab Countries or Other Naionals of Arab Origin) (.)

3 * tt10. Education (For Statistical Purposes) ( ) . University/ Post Secondary/ Secondary/ Primary/ 11. Nationality: : . a) Present: b) Former: c) Other(Optional): ( ) 12. Passport: : . Number: Type: Date of Issue: Place of Issue: Date of Expiry: (At Least With Six Months Validity) ) ( 13. Marital Status: Married* Single Divorced Separated Widowed.

4 *If Married, Name and Nationality of the Spouse: * Name: Surname: Nationality: This Section ONLY If Dependants Included in Your Passport Are Traveling With You: (If Any) .. Sex Full Name Date of Birth Relationship Remarks M/ F/ M/ F/ M/ F/ M/ F/.

5 15. What is The Purpose of Your Trip to Iran? : . 16. Have You Ever Been in Iran? If Yes, When and Why? ..17. Has Your Visa Application to Iran Ever Been Rejected? If Yes, When and Where? No/ Yes/ 18. What Countries Have You Traveled Before? . Photo Form No. 101/ Page 2 of 2/ 19. Have you stayed in a country more than six months?.

6 Country:/ Date:/ Reason:/ 20. Have You Ever Been Infected With Any Contagious Disease? (Name) . ) ( No/ Yes/ 21. Who will be Your Host in Iran? Please Give Complete Name: .. Ministry/ Organization/ Institution / Foundation/ Company/ Travel Agency/ Individual (s)/ Others/ Name, Title and Tel: : 22.

7 Type of Visa requested:* * . *Please check One Box From Each Section (A&B) * ) ( . A/ Entry/ Tourist/ Pilgrimage/ Journalist/ Diplomat/ Work Permit/ Transit/ Student/ Service / Other/ ** B/ Single / Double / Multiple / . 23.

8 If You Are Passing Through Iran on Transit, Have You Obtained Entry Visa For Your Next Destination Country? Yes/ No/ . 24. Who Will Cover Your Expenses While Staying in Iran? 25. How Much Currency in US Dollar Do You Intend to Have With You? . 26. What Places or Cities Will You Be Visiting in Iran? . 27. Approximate Date of Entry to Iran: 28. Duration of Stay in Iran: 29. Port Of Entry to Iran: . ) (.

9 : . : 30. Residential Address . : Address: : Tel: : Fax: : E-Mail: : 31.

10 Business Address . Name and Address: : Tel: : Fax.