Offline Visa Application form for entry into Taiwan ...

1 Offline visa Application form for entry into Taiwan , Republic of China Please complete all sections in BLOCK LETTERS A. Which category visa are you applying for? 1. Visitor visa Resident visa Diplomatic visa Courtesy visa 2. entry : Single Multiple B. Applicants Details : name/s: name or other (if any): name (if any): : Nationality (if any): 7. Sex: Male Female 8. Marital Status: Single Married Widowed Separated Divorced Other 9. Date of birth (DD/MM/YYYY): of Birth: (City) (Country) 11. Occupation: 12: Name of employer or school: 13. Address and telephone number in Taiwan : 14. Permanent address and Telephone number in home country: C. Family Details Relation Name Surname Date of Birth City/Country of birth Father Mother Spouse D. Applicants Passport details Passport type: Diplomatic Official Regular Other, please specify.

2 Passport Number: Date of Expiry (DD/MM/YYYY): Date of Issue (DD/MM/YYYY): Place of issue: E. Journey to Taiwan , : Purpose of Travel: Tourism Business Study Employment Joining or visiting family Religion Other Proposed date of arrival (DD/MM/YYYY): Proposed date of departure (DD/MM/YYYY): Particulars of reference in Taiwan if applicable: Name: _____ Relationship to applicant:_____ ROC ID/ARC No. of your reference in Taiwan :_____ Personal Telephone Number:_____ Residential Address:_____ Business Telephone Number:_____ Business Address:_____ F. All applicants are required to read and check the appropriate box for each item: Yes No Do you have a criminal record within or outside the territory of the or have you ever been denied entry , order to leave or deported by the government? Have you ever entered Taiwan illegally? Have you ever had a communicable disease of public health significance, a dangerous physical or mental disorder, or been a drug abuser or addict?

3 Have you ever overstayed a visitor or resident visa or worked illegally in Taiwan ? Have you ever been a controlled substance (drug) trafficker? Have you ever been refused a visa by an mission board? Have you ever applied for an visa using a different name? Have you ever worked in Taiwan ? Attention: Answering YES does not necessarily mean you are ineligible for a visa . If you answered YES to any of the above questions or if you have any questions in this, please come to discuss the issue in person. G. Acknowledgment 1. I have read and understood and all the questions set forth in this Application and the answers I have provided are true and correct to the best of my knowledge 2. I understand that holding a Republic of China visa does not necessarily mean I will be allowed to enter the 3. I understand that any false or misleading statement may result in the refusal of a visa or denial of entry into the 4.

4 I also understand that the government of the Republic of China reserves the right to withhold disclosure of the reasons for rejecting my visa Application and to withhold fees deemed non-refundable 5. I understand that, once submitted, this Application form will become the property of the government of the and will not be returned to me. I am aware that citizens who have previously held household registration in Taiwan shall be subject to the laws of the Republic of China while in its jurisdiction. According to Article 14 of the Regulations of for Exit Draftees, a draftee who has maintained household registration in Taiwan and possesses dual citizenship shall enter and depart Taiwan by presenting his ROC passport. Any draftee age male who enters Taiwan by presenting a foreign passport shall be restricted from departing Taiwan . Please visit for the conscription law. WARNING: Drug trafficking is punishable by death according to the criminal law of the Republic of China.

5 Date of Application :_____ Applicant s signature:_____ Signature of the Applicants agent:_____ Relationship to applicant:_____ Agent s full name:_____ Telephone Number:_____ Address:_____