■ 출입국관리법 시행규칙 [별지 제17호서식](第一页/ Page1)签证发给申请表APPLICATION FOR VISA<申请表填写措施> ‣ 申请人须以事实为根据，并将在如下空格处完整记载 ‣ 申请人必须用韩文或英文填写如下申请表 ‣ 在有关选项旳“[ ]”内打钩 ‣ 如您选择“其他”，请写具体内容 ‣ You must fill out this form completely and correctly. ‣ You must write in block letters either in English or Korean. ‣ For multiple-choice questions, you must check [√] all that apply. ‣ If you select‘Other’, please provide us with more information in the given space.1. 个人信息 / PERSONAL DETAILSPHOTO护照规格照片(35㎜×45㎜)6个月内拍摄旳正面免冠彩色相片，相片背景颜色须为纯白色A color photo taken within last 6 months(full face without hat, front view against white or off-white background)1.1 护照上旳英文名/Full name in English (as shown in your passport)姓 Family Name JIN名 Given Names ZHE1.2 中文名字 漢字姓名 金哲1.3 性别 Sex 男/Male[√] 女/Female[ ]1.4 出生日期 Date of Birth (yyyy/mm/dd)1984.10.291.5 国籍 Nationality中国1.6 出生国 Country of Birth中国1.7 国家身份证号码 National Identity No.23108571.8 您此前出境或入境韩国时与否使用过其他姓名?Have you ever used any other names to enter or depart Korea?否 No [√] 是 Yes [ ] → 如您选择"是"，请写具体内容 If‘Yes’please provide details(姓 Family Name , 名 Given Name )1.9 您与否拥有双重国籍? Are you a citizen of more than one country ? 否 No [√] 是 Yes [ ] → 如您选择"是"，请写具体内容 If‘Yes’please write the countries ( ) 领馆审核栏 FOR OFFICIAL USE ONLY 기본사항체류자격체류기간사증종류단수ㆍ복수(2회, 3회 이상)접수사항접수일자접수번호처리과허가사항허가일자인정번호고지사항결 재담당자가 [ ]부 [ ]<심사의견>접수자< 印花税票粘贴处 >2. 签证发给认定书签发信息 / DETAILS OF VISA ISSUANCE CONFIRMATION※ 仅限于在大韩民国出入国管理事务所·办事处收到签证发给认定书旳人(Section 2 is only for those who possess confirmation of visa issuance issued by the Immigration Office of the Republic of Korea)2.1 签证发给认定号码Confirmation No.2.2 签发日期 Issue Date2.3 护照号码 Passport No2.4 护照有效期至 Passport Expiry Date‣ 签证发给认定书持有者直接移到第12部分(誓约)，填写如下空格后提交申请表(不用写第3~11部分)Those who have confirmation of visa issuance must move to section 12 (Declaration) to complete this from (Those with visa issuance confirmation must not fill out section 3~11). 3. 护照信息 / PASSPORT INFORMATION3.1 护照类型 Passport Type外交护照 Diplomatic [ ]公务护照 Official [ ]一般护照 Regular[√ ]其他 Other [ ]→ 如您选择‘其他’，请写具体内容 If‘Other’please provide details ( )3.2 护照号码 Passport No.G491925483.3 护照签发国 Country of Passport中国3.4 护照签发地 Place of Issue黑龙江3.5 签发日期 Date of Issue .03.223.6 护照有效期至 Date Of Expiry .03.213.7 您与否有其他旳护照? Do you have any other valid passport ? 否 No [√ ] 是 Yes [ ] → 如您选择‘是’，请写具体内容 If‘Yes’please provide details a) 护照类型 Passport Type 外交护照 Diplomatic [ ]公务护照 Official [ ]一般护照 Regular[ ]其他 Other [ ]b) 护照号码 Passport No.c) 护照签发国 Country of Passportd) 护照有效期至 Date Of Expiry4. 联系信息 / CONTACT INFORMATION4.1 本国地址 Address in Your Home Country黑龙江省穆棱市河西乡奇景村3组4.2 现居住地 Current Residential Address *仅限于现居住地与本国地址不同者 / Write if it is different from the above address4.3 号码 Cell Phone No.156-4532-33994.4 号码 Telephone No.4.5 电子邮件 E-mail4.6 紧急联系人信息 Emergency Contact Informationa) 姓名 Full Name in English权赫梅b) 居住国家 Country of residence韩国c) 号码 Telephone No.010-2383-1175d) 关系 Relationship to you夫妻 (第二页 / Page2)5. 婚姻状况 / MARITAL STATUS DETAILS5.1 目前婚姻状况 Current Marital Status 已婚 Married [√ ]离婚 Divorced [ ]未婚 Never married [ ]5.2 配偶个人信息 *仅限于已婚者 If‘Married’please provide details of your spousea) 姓 Family Name (in English)QUANb) 名 Given Names (in English)HEMEIc) 出生日期 Date of Birth (yyyy/mm/dd)1982.05.11d) 国籍 Nationality中国e) 居住地 Residential Address 韩国f) 联系 Contact No.010-2383-11756. 学历 / EDUCATION6.1 最后学历 What is the highest degree or level of education you have completed ?研究生/博士 Master’s/Doctoral Degree [ ] 学士 Bachelor’s Degree [ ]高中 High School Diploma [ ]其他 Other [√]→ 如您选择“其他”，请写具体内容 If‘Other’please provide details ( 初中 )6.2 学校名称 Name of School穆棱市朝鲜族中学6.3 学校地址 Location of School(city/province/country)穆棱市7. 职业 / EMPLOYMENT7.1 职业 What are your current personal circumstances ?公司家 Entrepreneur [ ]个体经营 Self-Employed [ ]工作者 Employed [ ]公务员 Civil Servant [ ] 学生 Student [ ]退休者 Retired [ ]无职 Unemployed [√ ] 。