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1、 State of Israel 以色列国以色列国 Application for entry visa to Israel 签证申请表签证申请表 申请表填写说明申请表填写说明: : Instructions for completing application form： 1. 请附一张近期护照照片. 1. Please attach a recent ID photograph.。 2. 如申请不是为了访问以色列，请详述申请 原因，并递交相关材料. 2. If application is not for the purpose of visit, specify reasons and
2、supply documentation. 3. 请用希伯来文或英文填写表格. 3. Please fill in following details in Hebrew or English. Family name 姓 Given name 名 Fathers name 父亲姓名 Mothers name 母亲姓名 Previous family name 曾用名 Place of birth 出生地点 Date of birth 出生日期 Occupation 职业 Present nationality 现国籍 Previous nationality 曾有国籍 Family stat
3、us 家庭状况 Passport 护照 Laissez passer 临时护照 married 已婚 single 未婚 widowed 丧偶 divorced 离异 Number 号码 Issued at 签发地点 Issued on 签发时间 valid until 有效期至 In English 英文 Purpose of entry into Israel 进入以色列的目的 If you hold a Laissez-Passer issued by the State of your permanent residence, state whether you have a retu
4、rn visa and indicate its validity.若 持永久居留国签发的临时护照，请说明是否具有回程签证及有效期。 permanent address abroad 中国/他国永久地址 Country 国家 Province/City 省/市 Street and house no. 街道及房号 telephone no. 电话 Address in Israel 在以色列地址 Anticipated date and place of entry to Israel 入境日期及地点 Approximate duration of stay 拟停留期限 Countries o
5、f transit 中转国 申请人随行家属详细情况申请人随行家属详细情况 particulars of dependants included in the application family name given name maiden name fathers name place of birth Date of birth Dates of previous stays in Israel 曾在以色列停留日期 Category of previous residence permit in Israel (visitor, student, tourist, temporary re
6、sident, resident, immigrant, work)曾在以色列 居留许可类型（访问者、学生签证、旅游签证、临时居民、居 民、移民、工作签证） 配偶配偶 Spouse Photo 照片 照姓 名 婚前姓名 父亲姓名 出生地点 出生日期 18 岁以下儿童岁以下儿童 Children under the age of 18 Given name 姓名 Place of birth 出生地点 Date of birth 出生日期 1 . 以色列联系人以色列联系人/亲属亲属 Relation/references in Israel Name 姓名 Relationship 关系 Add
7、ress 地址 1 . 声明声明 Declaration I declare that the particulars contained in this application are correct and have been made in awareness of the fact that they are to serve as basis for the consideration of my application. I also declare that I have not committed any criminal offence or any act directed
8、 against the Jewish people or the security of the state of Israel and that I am not affected with any illness which might endanger public health. There is no judicial warrant against me and I am not wanted by the police of any country. 我声明，本申请表中所填内容属实，并将作为审核我申请的依据。我还声明， 我无犯罪记录也没有针对犹太 人或以色列国安全的任何行为。我
9、无任何危害公众健康的疾病。我没有受到司法缉捕，也未被任何国家警方 通缉。 I hereby declare that I have not been issued with a restraining order. Furthermore, I have not been denied entry into Israel. I am aware that if a preventive order of this kind has been issued against me, I will be denied entry into Israel, and will be sent back
10、to my country of origin. 我声明，我没有受到出行限制，也未曾被以色列拒签入境。我知道，如对我有此类限制令，我将会被以色列 拒签入境，并被遣送回原籍国。 I am also aware that the receipt of a visa does not in any way invalidate the right of the Israel Ministry of the Interior to deny my entry into the territory of the State of Israel, if it becomes clear that the visa was issued on the basis of false information. 我知道，如查明发给我的签证是基于虚假信息，以色列内务部仍将有权拒绝我进入以色列国领土。 Place 地点 Date 日期 Applicants signature 申请人签名 /
