Formulaire Visa Canada

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					                                                REPUBLICA DE CUBA
                      PERSONAL VISA APPLICATION / FORMULAIRE POUR VISA PERSONNEL

Last Name / Nom                    First name / Prenom                       Middle name / Second Prenom




Birth date / Date de naissance     Country of birth / Pays de naissance       Sex       Marital status / Etat civil
 Year       Month           Day




Passport No. / Passeport No.       Issue Date / Date de deliverance          Expiry date / Date de expiracion
                                         Year      Month          Day            Year             Month               Day



Citizenship / Citoyenneté          Indicate relationship / Relation avec la personne a visiter:




Full name and address of the person you will visit in Cuba / Nom et prenom de la personne a visiter a Cuba




Length of stay / Durée de sejour   Date of departure / Date de depart        Departure airport / Aeroport de depart

                                      Year         Month          Day



Full permanent Address / Adresse




Telephone                          Fax                                       E-mail




Any additional information / Observations




Signature                                                     Date

				
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