20111006005

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					Application for the official invitation for a short-term visa:
Please, fill in this form, answering ALL questions, and send it back to
infocent@tspu.edu.ru or fax it to +7 3822 522066 with well-readable scanned page of the
passport (identification page and amendments or extension pages, if applicable). Use
LATIN letters only, no signs such as: Ç Ñ Æ Ø Ü
Incomplete forms can NOT be processed.

Surname as in passport
First and Middle names as in passport
Date of birth (day/month/year)
Citizenship
Sex
Place of birth (country, city,
state/province)
Place of permanent residency
(country, city, state/province)
The place of the Russian diplomatic
mission in the country of your
residence where the visa will be
applied for. E.g. Russian consulate in
Seattle/USA, Russian Consulate in
Bonn/Germany…
Place of employment/school (full Hiroshima University
name)
Address of employment/school with Student Plaza 1-7-1 Kagamiyama,
phone and fax number                    Higashi-Hiroshima,
                                        Japan 739-8514
                                        Phone:+81-82-424-6188
                                        F a x:+81-82-424-4545
Present occupation or position
Passport number
Passport issued on
Passport expires on
Supposed date of entry
Supposed date of departure
Places of stay in Russia (besides N/A
Tomsk)
E-mail address where a scanned copy
of the invitation should be mailed)
Mailing address where the original
(hard copy) of the invitation should be
shipped.

				
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