EMBASSY OF VIETNAM
1233, 20th St. NW, Suite 400
Washington DC, 20036
Tel. (202) 861 0694
Fax (202) 861 1297

  APPLICATION
FOR ENTRY AND EXIT VISA
(For foreigners)

Photo
(4cm x 6cm)

 

1. Name and surname: .......................................................................................................... ...................................................
(in block letters)

2. Date of birth:........../.........../.............
(dd/mm/yy)
3.Male/Female …………………….…………..…….
4. Place of birth............................................................
5. Nationality at birth...................................................
Nationality at present.........................................….....
6. Passport number:.....................................................
Issued by......................................................................
Date of issue................................................................
Date of expiry..............................................................
7. Profession.................................................................
Place of employment...................................................
Office telephone number.............................................
8. Present address:.........………………………….....
……………………………………………………........
Home telephone number:............................................
9. Accompanying children:
(Full name/Date of birth/Relationship)
......................................................................................
......................................................................................
......................................................................................
......................................................................................
......................................................................................
10. Purpose of visit to Vietnam........…..............
............................................................................
11. Name, address of your contact (office, organization or individual) in Vietnam:
............................................................................
.............................................................................
.............................................................................
12. Proposed date of entry into and exit
from Vietnam
From........./......./............to......./...…/….....
(dd/mm/yy)
13. Number of entries:
Single .....……..Double...........Multiple.............
14. Port of arrival and departure....................
……………………………………………..

I solemnly declare that the statements made
in this application are true and correct.

Done at..................................................................
on ........./.........../...........
(dd/mm/yy)
 

Signature

Please submit the following documents:
Two copies of application form with two passport photos.
Original passport.
Visa fee (Please call Visa Information for current fees) 		Official use only:
Fax # :
Date of fax:
Visa # :