rQnlphOtoto4M6x6nmseenotesSeen02)su(Form)NA1BanhQnhk^mtheoth?ngt?s?04/2015/TT-BCA ngay05thangO1n?m2015T?KHAI??NGH?C?PTH?TH?CVI?TNAM(1)VIETNAMESEVISAAPPLICATIONFORM(Dungchong??in??cngoai-Forforeigners)1- H?ten(ch?inhoa): Fullname(incapitalletters)??2- Gi?itfnh:Nam Nd EJ3-Sinhngay thang n?m SexMale FemaleDateofbirth(Day,Month,Year)4-N?isinh: Placeofbirth???5-Qu?ct?chg?c: 6-Qu?ct?chhi?nnay: Nationalityatbirth Currentnationality7-T?ngiao: 8-Ngh?nghi?p: Religion Occupation9- N?ilamvi?c: Employerandbusinessaddress10- ??ach?th??ngtru: Permanentresidentialaddress S??i?ntho?i/Email: Telephone/Emailll-ThannhanFami7ymembers:Quanh?(3)RelationshipH?ten(ch?inhoa)Fullname(incapitalletters)Gi?it fnh SexNgaythangn?msin hDateofbirth (Day,Month,Year)Qu?ct?chNationality??ach?th??ngtruPermanentresidentiala ddress12-H?chi?u/gi?yt?cogiatr??i?iqu?ct?s?: lo?i(4):PassportorInternationalTravelDocumentnumber TypeC?quanc?p： cogiatr???nngay: / / Issuingauthority:Expirydate(Day,Month,Year)13- Ngaynh?pc?nhVi?tNamg?nnh?t(n?uco): DateofthepreviousentryintoVietNam(ifany)14-D?ki?nnh?pc?nhVi?tNamngay / / ;t?mtrU?Vi?tNam ngayintendeddateofentry(Day,Month,Year)IntendedlengthofstayinVietNamdays14- M?c?fchnh?pc?nh: Purposeofentry15- D?ki?n??ach?t?mtrU?Vi?tNam： IntendedtemporaryresidentialaddressinVietNam16- C?quan,t?ch?cho?ccanhant?iVi?tNamm?i,b?ol?nhHostingorganisation/individualinVietNamC?quan,t?ch?c: Nameofhostingorganisation??ach?: AddressCanhan(h?ten) Hostingindividual(fullname)??ach? AddressQuanh?v?ib?nthan Relationshiptotheapplicant17- ??ngh?c?pth?th?c: m?tl?n nQj?ul?n □ApplyingforavisaSingle Multiple t?ngay: / / ??nngay / / validfrom(Day,Month,Year)to(Day,Month,Year)18- ??ngh?khaclienquanvi?cc?pth?th?c(n?uco): Otherrequests(ifany)T?ixincam?oannh?ngn?idungtrenla?ungs?th?t.IdeclaretothebestofmyknowledgethatalltheaboveparticularsarecorrectLamt?i: ngay thang n?m Doneat date(Day,Month,Year)Ng??i??ngh?(ky,ghir?h?ten)Theapplicant'ssignatureandfullnameGhich6/Notes:(1) M?ing??ikhai01b?nkemh?chi?uho?cgi?yt?cogiatr??il?iqu?ct?,n?ptr?cti?pt?ic?quan??id i?nVi?tNam?n??cngoaiho?c??nv?ki?msoatxu?tnh?pc?nht?ic?akh?uqu?ct?n?inh?nth?th?c. SubmitinpersononecompletedapplicationformenclosedwithpassportorInternationalTravel DocumentattheVietnameseDiplomaticMissionabroadorattheinternationalbordercheckpoi ntimmigrationofficewherethevisaisissued.(2) KemO2?nhm?ich?p,c?4x6cm,ph?ngn?ntr?ng,m?tnhinth?ng,??u??tr?n,kh?ng?eokinhm? u(01?nhdanvaot?khai,01?nh??r?i).Enclose2recentlytakenphotosin4x6cmsize,withwhitebackground,frontview,barehead,with outsunglasses(oneontheformandtheotherseparate).(3) Ghir?b?,m?,v?,ch?ng,con,anh,ch?,emru?t(n?uc6).Stateclearlytheinformationaboutparents,spouse,childrenandsiblings(ifany).(4) Ghir?lo?ih?chi?uph?th?ng,c?ngv?,ngo?igiaoho?cgi?yt?c(giatr??il?iqu?ct?.SpecifytypeofpassportwhetheritisOrdinary,OfficialorDiplomaticorspecifynameoftheInterna tionalTravelDocument.。