EMBASSY OF ETHIOPIA EMBASSY OF ETHIOPIA
CONSULAR OFFICE
VISA APPLICATION FORM 3506 INTERNATIONAL DRIVE, N.W.
WASHINGTON, D.C. 20008
PASSPORT AND VISA SERVICES
(202)364-1200
PLEASE TYPE OR PRINT YOUR ANSWER IN THE SPACE PROVIDED BELOW EACH ITEM.
MIDDLE NAME ............................................................. NAME .................................................................
FIRST NAME ................................................................... LAST
SEX • MALE • FEMALE DATE OF BIRTH COUNTRY OF BIRTH
D ........................... /M ................ /YY...............
CURRENT NATIONALITY ................................................................... ORIGINAL NATIONALITY (NATIONALITY AT BIRTH)
PASSPORT TYPE • ORDINARY • SERVICE • DIPLOMATIC • TRAVEL DOCUMENT • OTHER
PASSPORT NUMBER ISSUE DATE D................................. /M ................ /YY .................. EXPIRA ............................. /M .............. /YY ............
HOME/MAILING ADDRESS
................................................................................................................................................................................................................................................
CrrY/TOWN STATE/REGION , --------------------------------- ZIP/POSTAL COUNTRY .......................................
D ........................................
DAY TEL. EVENING TEL. FAX E-MALI,
CURRENT OCCUPATION
PURPOSE OF TRAVEL • TOURISM/FAMILY VISIT • BUSINESS • OFFICIAL • T' ' 1p I 4 THER ..........................................................................................
DATE OF DEPARTURE FROM USA ............................................... DATE OF ARRIVAL IN EMI IA .................................... BORDER OF FIRST ENTRY ......................................
DURATION OF STAY IN ETHIOPIA ENTRIES: • SINGLE • DOUBLE • MULTIPLE
ADDRESS IN ETHIOPIA HOTEL: HOTEL NAME
HOTEL TELEPHONE NUMBER
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CONTACT PERSON IN ETHIOPIA
TELEPHONE NUMBER ..................................................................................................................... ATTACH ONE
PASSPORT SIZE
FAMILY CITY REGION PHOTOGRAPH.
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WRITE YOURNAME ON
ACCOMMODATION: THE BACKOFTHE
ZONE ................................................................................... K. KETEMA (WOREDA) ......................................... PHOTOGRAPH.
KEBELE ............................................................................... HOUSE NO..........................................................
TELEPHONE ....................................................................
CHILDREN/DEPENDENTS AME PASSPORT
FIRST NAME i MIDDLE NAME LAST NAME SEX BIRTH DATE BIRTH PLACE
(D/M/YY)
1'
3
4
5: ld;g;r
I, THE , DECLARE THAT ALL THE ABOVE-MENTIONED STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE.
APPLICANT'S NAME.............................................................................. APPLICANT'S SIGNATURE ................................................................... DATE ..............................
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VISA DATE
VISA NUMBER ---------------------------------------- TYPE --------------------------------------- OF ISSUE --------------------------------------------- EXPIRATION DATE ------------------------
PROCESSED BY NAME ............................................................................ SIGNATURE ........................................................................... DATE ..............................
APPROVED BY NAME ............................................................................ SIGNATURE ........................................................................... DATE ..............................
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