2024年4月24日发(作者：)

CONSUL DIVISION OF THE EMBASSY OF THE KYRGYZ REPUBLIC

TO THE PEOPLE’S REPUBLIC OF CHINA

吉尔吉斯共和国驻华大使馆领事处

Affix the

photo here

VISA APPLICATION FORM / 签证申请表

Application form should be filled in fully and accurately in capital letters, submitted

with passport, which is valid. Please, ensure that the photograph is attached.

请准确、完整地填写申请表并提交护照及其复印件和照片.

近三个月免冠

1. Full name / 姓名

(as in passport) (pinyin)

2. Nationality: 3. Sex: 4. Marital status:

国籍: 性别: 婚姻状况:

5. Date of birth: Y M D 6. Place of birth:

出生日期: 年 月 日 出生地点:

7. Passport No.: 8. Issued by: 9. Expiration date: Y M D

护照号码: 护照签发单位: 护照有效期至: 年 月 日

10. Permanent home address / 家庭地址

Country: City/Province: Street/Village:

国家: __________________________, 省/市:____________________________, 街道/乡村:________________________________,

Apartment No.: Telephone: Mobile: E-mail address:

楼, 房号: 电话: 手机: 电子信箱:

11. ID card No.: Place of issue:

身份证编号: 身份证签发单位:

12. Name of employer: Occupation:

工作单位名称:______________________________________________________, 申请者职务:____________________________,

Address: Telephone:

单位地址: 单位电话:

13. Purpose of trip: 14. Type of visa requested:

旅行目的: 申请签证类型:

15. Date of Entry: Y M D 16. Date of Exit: Y M D

入境日期: 年 月 日 离开日期: 年 月 日

17. Places to be visited: 18. Do you intend to work in Kyrgyzstan?

计划访问那些地方: 是否打算在吉尔吉斯共和国工作?

19. Name of host company in Kyrgyzstan: Name of contact person in host company:

在吉国接待单位名称:____________________________________________, 接待单位联系人姓名:___________________________,

Address: Tel./ Fax number:

单位地址: 电话 / 传真:

20. Number of previous trips to Kyrgyzstan? 21. Date of the latest trip? Y M D

访问吉尔吉斯共和国次数? 最后次访问吉尔吉斯共和国日期? 年 月 日

22. If permission to visit to Kyrgyzstan or extend stay in Kyrgyzstan has been refused previously?

在办理签证或者签证延期时，是否有过被拒绝? When: Where:

_____________ 何时: 何地:

23. If any children accompanying applicant are included in his/her passport, give the details / 如有孩子同行, 请写明:

Full name: Sex:

姓名:________________________________________________________, 性别: _____________________,

Date of birth: Place of birth:

出生日期: 出生地点:

24. Was this application prepared by another person on your behalf, if so / 如果该申请表由他人代为填写，请注明填写下列信息：

Full name: Relationship to Applicant: Occupation:

代办人姓名:___________________________, 与签证申请人的关系: ________________________, 职业:_______________________,

Address: Telephone / Mobile: Signature:

联系地址: 电话 / 手机: 代办人签字:

25. I hereby declare that the information given above is true, correct and complete. I understand that any false or misleading statement

may result in the permanent refusal of a visa or denial of entry into the Kyrgyz Republic.

我确认，以上填写内容真实、完整。我明白，任何虚假内容或者误导都可导致永久拒签。

Date / 填表日期: Applicant’s Signature / 申请人签字:

FOR OFFICIAL USE ONLY / 工作人员填写

Виза №:

Дата выдачи:

201__г.

Дип. Служ. Обык.

Инвест. Тур. Трудоустр.

Част. Учеб. Транз.

Сроком с:

201__ г.

Сроком до:

Одн. Двукр. Многокр.

201__ г.