Transcription of SRI LANKA IMMIGRATION AND EMIGRATION
1 Application No 1. Details Of Passport i. Passport No ii. Place of issue Day Month Year Day Month Year iii. Date of issue iv. Date of expiry 2. Name in full as Shown in passport 3. Nationality 4. Gender i. Male ii. Female Day Month Year 5. Date of Birth i. Place of Birth ii. Country 6. Occupation 7. Civil status i. Single ii. Married iii. Divorced iv. Widowed 8. If Married Sri Lankan i. Full Name of Spouse ii. Passport Number ii.
2 Personal ID Number 9. Address in the Country of Domicile 10. Address in Sri LANKA 11. Contact Details i. Telephone Number ii. Mobile iii. Fax iv. E-Mail Day Month Year 12. Date of arrival Day Month Year 13. Date of expiry of visa / landing Endorsement 14. Extension of visa Months Required for PHOTOGRAPH SRI LANKA IMMIGRATION AND EMIGRATION APPLICATION FOR EXTENSION OF VISIT VISA NE 15. Exchange brought in i. Type of currency ii. Amount iii. Amount cashed v. Credit card available Yes No 16. Details of previous visit to Sri LANKA within immediate six months if any, i.
3 Date of arrivals ii. Date of departure iii. Duration iv. Total 17. Whether you are in possession of a return ticket Yes No 18. Reasons for extension i. Holiday ii. Visit Relations iii. Business iv. Other , Specify v. Documents annexed in support to the above reason 1 2 3 4 I hereby declare that to the best of my knowledge and belief the foregoing statements are true, that I shall not engage myself in any employment paid or unpaid , or in any business or trade on arrival or during my stay in Sri LANKA and that I shall leave Sri LANKA before the date of expiry of the period of my authorized stay. I also undertake to notify the Controller of IMMIGRATION & EMIGRATION , Colombo, immediately any change of my address, while in Sri LANKA , occurs.
4 Signature of applicant & Date D/A D/E Cashed RT Remarks Visa Fee (Rs) Tax (Rs) Penalty (Rs) Amount (Rs) Date Processing Officer For Controller General/Controller/Deputy Controller /Assistant Controller FOR OFFICE USE ONLY NOTE.
