VISA APPLICATION - vietnam-consulate.org.au

1 CONSULATE GENERAL OF VIET NAMPERTH AUSTRALIAL evel 8, 16 St Georges Terrace WA 6000 PO Box 3122, East Perth, WA 6892 (08) 9325 3642 - 9221 1158 visa APPLICATION 1. Full name (in CAPITALS): .. Family name Middle name First name 2. Date of birth ../../.. DD MM YYYY 3. Sex Male Female 4. Nationality: .. 5. Passport number: .. Date of expiry: ../../.. 6. Occupation: .. 7. Current contact (required): Address (NOT PO Box, please).

2 Email: .. Mobile phone: .. 8. Purpose to visit Viet Nam Tourism Business Other 9. Proposed first date of entry ../../.. DD MM YYYYP roposed last date of exit ../../.. DD MM YYYY 10. Type of visa requested: Single entry Multiple entries I hereby declare that the statements in this APPLICATION form are true and correct. Date: ../../..DD / MM / YYYY Signature.

3 Check list: Original passport (with at least 6 months validity from the date of exit) and 1 copy of main page This APPLICATION form visa fee (cash or bank cheque/money order only) (Optional) Prepaid envelop of Registered/Express Post with signature on delivery to return your passportDisclaimer: - Applicants are fully responsible for checking information on the visa . If any error found, please report immediately tothe Consulate General for correction. The Consulate General holds no responsibility for unreported In case of emergency, please call (+61) 434 520 536 Please include a copy of front page of your passport(no photo required) 1 month 3 months DD MM YYYY