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Visa Appication Form Of Yemen

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Visa Appication Form Of  Yemen Powered By Docstoc
					                                                                                                                            ‫ﺳﻔﺎرة اﻟﺠﻤﻬﻮریﺔ اﻟﻴﻤﻨﻴﺔ )واﺷﻨﻄﻦ(‬
                                                                                                                            ‫(‬               ‫اﻟﻘﻨﺼﻞ اﻟﻘﻨﺼﻠﻲ )‬
             ‫‪ATTACH‬‬                                                                                                          ‫‪Embassy of Yemen Republic‬‬
             ‫‪PHOTOS‬‬                                                                                                              ‫.‪Washington D.C‬‬
              ‫‪HERE‬‬                                                                                                                ‫‪Consular Section‬‬
                                                                                                                                ‫(‬                 ‫)‬
                                                                 ‫إﺳﺘﻤﺎرة ﻃﻠﺐ ﺗﺄﺷﻴﺮة دﺧﻮل‬
                                         ‫‪APPLICATION FORM FOR ENTRY VISA‬‬

‫:‪APPLICANT INFORMATION‬‬
‫:)اﻻﺳﻢ اﻟﻜﺎﻣﻞ واﻟﻠﻘﺐ( ‪1- Full name & Surname‬‬
‫:)اﻟﺠﻨﺴﻴﺔ( ‪2- Nationality‬‬                                                                         ‫:)اﻟﺠﻨﺲ( ‪3- Sex‬‬
‫:)ﻣﻜﺎن وﺗﺎریﺦ اﻟﻤﻴﻼد( ‪4- Place & Date of Birth‬‬
‫:)اﻟﺤﺎﻟﺔ اﻻﺝﺘﻤﺎﻋﻴﺔ( ‪5- Marital Status‬‬                                                             ‫:)اﻟﻤﻬﻨﺔ( ‪6- Profession‬‬
‫:)رﻗﻢ ﺝﻮاز اﻟﺴﻔﺮ( ‪7- Passport No‬‬                                                                   ‫:)اﻟﻨﻮع( ‪8- Type‬‬
‫:)ﻣﻜﺎن وﺗﺎریﺦ ﺻﺪورﻩ( ‪9- Place & Date of Issue‬‬                                                     ‫: )ﺗﺎریﺦ اﻥﺘﻬﺎء ﺻﻼﺡﻴﺘﻪ( ‪10- Expires on‬‬
‫:)أﻓﺮاد اﻷﺳﺮة اﻟﻤﺪرﺝﺔ أﺳﻤﺎﺋﻬﻢ ﺑﺎﻟﺠﻮاز( ‪11- Other names Shown in Passport‬‬
‫:)اﻟﻌﻨﻮان اﻟﺪاﺋﻢ( ‪12- Permanent Address‬‬
‫:) رﻗﻢ اﻟﻬﺎﺗﻒ ( ‪13- Phone Number‬‬
‫:)اﻟﻐﺮض ﻣﻦ اﻟﺴﻔﺮ( ‪14- Purpose of visit‬‬
‫:)ﻣﺪة اﻟﺘﺄﺷﻴﺮة اﻟﻤﻄﻠﻮﺑﺔ( ‪15- Duration of visa requested‬‬                                   ‫: )ﻋﺪد اﻟﺴﻔﺮات اﻟﻤﻄﻠﻮﺑﺔ( ‪16- No. of entries requested‬‬
‫:)ﻣﺪة اﻹﻗﺎﻣﺔ ﻓﻲ اﻟﻴﻤﻦ( ‪17- Period of stay in Yemen‬‬
‫:)اﻟﻌﻨﻮان ﻓﻲ اﻟﻴﻤﻦ( ‪18- Address in Yemen‬‬
‫:)اﻟﻤﺮﺝﻊ ﻓﻲ اﻟﻴﻤﻦ( ‪19- Reference in Yemen‬‬

 ‫‪I hereby declare that the above information is‬‬                                                  ‫أﻗ ﺮ ﺑ ﺼﺤﺔ اﻟﺒﻴﺎﻥ ﺎت اﻟﻤﺪوﻥ ﺔ أﻋ ﻼﻩ وأﺗﻌﻬ ﺪ‬
 ‫‪accurate, and that I will fulfill and obey the laws and‬‬
 ‫.‪regulations of the Republic of Yemen‬‬
                                                                                                       ‫ﺑﺈﺡﺘﺮام ﻗﻮاﻥﻴﻦ وأﻥﻈﻤﺔ اﻟﺠﻤﻬﻮریﺔ اﻟﻴﻤﻨﻴﺔ‬


                       ‫)اﻟﺘﻮﻗﻴﻊ( ‪Signature‬‬                                                                                    ‫)اﻟﺘﺎریﺦ( ‪Date‬‬
‫‪OFFICIAL USE ONLY‬‬
                                                       ‫ﻣﻨﺤﺖ ﻟﻠﻄﺎﻟﺐ ﺗﺄﺷﻴﺮة ﻣﺮور : دﺑﻠﻮﻣﺎﺳﻴﺔ / ﺧﺎﺻﺔ / ﻟﻤﻬﻤﺔ / ﻟﻠﺰیﺎرة / ﻟﻠﺴﻴﺎﺡﺔ / ﻟﻠﺘﺠﺎرة / ﻟﻠﻌﻤﻞ / ﻟﻠﺪراﺳﺔ / ﻟﻠﻤﺮاﻓﻘﺔ‬
                                                   ‫ﺻﺎﻟﺢ ﻟﻐﺎیﺔ :‬                                      ‫ﺑﺘﺎریﺦ :‬                                                   ‫ﺑﺮﻗﻢ:‬
                                         ‫وﻣﺪة اﻟﺒﻘﺎء ﻓﻲ اﻟﻴﻤﻦ :‬                                                                                              ‫ﻟﻐﺮض :‬
                                    ‫أو ﻣﺠﺎﻥﺎ :‬                                    ‫رﻗﻢ ﺳﻨﺪ اﻟﺘﺤﺼﻴﻞ :‬                                             ‫واﻟﺮﺳﻢ اﻟﻤﺤﺼﻞ ﻗﺪرﻩ :‬
                                                                                                                                                ‫أﺳﺎس ﺻﺮف اﻟﺘﺄﺷﻴﺮة :‬

       ‫ﺧﺘﻢ اﻟﻘﻨﺼﻠﻴﺔ‬                                                ‫إﺳﻢ وﺗﻮﻗﻴﻊ اﻟﻘﻨﺼﻞ اﻟﻌﺎم‬                                             ‫ﺗﻮﻗﻴﻊ اﻟﻤﻮﻇﻒ اﻟﻤﺨﺘﺺ‬




      ‫‪THE FOLLOWING ATTACHEMENTS MUST BE SUBMITTED WITH THIS FORM FOR PROCESSING‬‬
                                                            ‫)ﻣﺮﻓﻘﺎت یﺠﺐ ﺗﻘﺪیﻤﻬﺎ ﻣﻊ اﻻﺳﺘﻤﺎرة(‬
‫‪VALID PASSPORT‬‬                                                                                                                           ‫ﺟﻮاز اﻟﺴﻔﺮ ﺳﺎري اﻟﻤﻔﻌﻮل‬
‫‪TWO (2) PASSPORT PHOTOS‬‬                                                                                                               ‫ﺻﻮرﺗﻴﻦ ﺷﻤﺴﻴﺘﻴﻦ ﻡﻘﺎس 4‪6x‬‬
‫‪COPY OF RETURN TICKET or ITINERARY‬‬                                                                                                          ‫ﺗﺬآﺮة ﺳﻔﺮ ذهﺎب وإیﺎب‬
‫‪HEALTH CERTIFICATE or DOCTOR’S NOTE‬‬                                                                                                                  ‫ﺷﻬﺎدة ﺻﺤﻴﺔ‬