Don Xin Nhap Canh Visa - Sfo
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Tæng l·nh sù qu¸n Céng hoµ XHCN ViÖt Nam
t¹i San Francisco - Hoa Kú
®¬n xin nhËp c¶nh ViÖt Nam (Dµnh cho ng!êi ViÖt Nam ®Þnh c! ë n!íc ngoµi)
1700 California Street, Suite 430 San Francisco, CA 94109 Tel: (415) 922-1577 Fax: (415) 922-1848
¶nh (4cm x 6cm)
www.vietnamconsulate-sf.org
1. Hä vµ tªn trong hé chiÕu/thÎ xanh (viÕt ch÷ in hoa):..............................................................Nam N÷ Hä vµ tªn khai sinh (viÕt ch÷ in hoa): ........................................................................................................... 2. Sinh ngµy...............th¸ng............. n¨m............ t¹i......................................................................................... 3. Chç ë hiÖn nay (kh«ng ghi ®Þa chØ lµ sè P.O.BOX) ...................................................................................... ....................................................................................................................................................................... ............................................................................................§iÖn tho¹i sè .................................................... 4. NghÒ nghiÖp .................................................................................................................................................. 5. N¬i lµm viÖc .................................................................................................................................................. ....................................................................................................................................................................... .......................................................................................... §iÖn tho¹i sè ...................................................... 6. Quèc tÞch hiÖn nay .......................................................Quèc tÞch gèc........................................................... 7. Sè hé chiÕu hoÆc sè thÎ xanh .................................................................................................................... cÊp ngµy....../...../….......cã gi¸ trÞ ®Õn ngµy ....../....../.......... C¬ quan cÊp.................................................... 8. Rêi ViÖt Nam ngµy......../....../ ................víi h×nh thøc ra ®i: b»ng thuyÒn Du häc ; Tr!íc 1975 ; ODP ;HO ; AC ;H×nh thøc kh¸c ; NÕu ®i hîp ph¸p ghi râ hé chiÕu (giÊy phÐp xuÊt c¶nh) sè …………..cÊp ngµy……/……/..………........ 9. Môc ®Ých nhËp c¶nh:…………. ……………………………………… …………………………............ 10 . Hä vµ tªn, ®Þa chØ th©n nh©n (ghi râ hä tªn, quan hÖ, ®Þa chØ th©n nh©n t¹i ViÖt Nam hoÆc tªn ®Þa chØ c¬ quan n¬i vÒ th¨m hoÆc lµm viÖc) ……………………………………………………………......... ………………………………………………………………………………………………..................... ………………………………………………………………………………………………..................... 11. Thêi gian dù kiÕn vÒ ViÖt Nam tõ ngµy…… th¸ng……. n¨m…….. ®Õn ngµy…….th¸ng…. n¨m……....... 12. Sè lÇn xin nhËp c¶nh: mét lÇn nhiÒu lÇn T«i xin cam ®oan nh÷ng lêi khai trªn ®©y lµ ®óng sù thËt, t«i vÒ ViÖt Nam theo ®óng môc ®Ých nhËp c¶nh vµ tu©n thñ luËt ph¸p ViÖt Nam. Lµm t¹i................................... ngµy….... th¸ng…….n¨m…………. Ng!êi xin thÞ thùc (ký vµ ghi râ hä tªn)
Chó ý cÇn nép: - 1 ®¬n - 2 ¶nh (1 ¶nh nÕu kÌm theo hé chiÕu gèc) - Hé chiÕu hoÆc Reentry Permit/copy thÎ xanh - 1 b× th! cã tem vµ ®Þa chØ nÕu göi tr¶ b»ng b!u ®iÖn
t¹i San Francisco - Hoa Kú
®¬n xin nhËp c¶nh ViÖt Nam (Dµnh cho ng!êi ViÖt Nam ®Þnh c! ë n!íc ngoµi)
1700 California Street, Suite 430 San Francisco, CA 94109 Tel: (415) 922-1577 Fax: (415) 922-1848
¶nh (4cm x 6cm)
www.vietnamconsulate-sf.org
1. Hä vµ tªn trong hé chiÕu/thÎ xanh (viÕt ch÷ in hoa):..............................................................Nam N÷ Hä vµ tªn khai sinh (viÕt ch÷ in hoa): ........................................................................................................... 2. Sinh ngµy...............th¸ng............. n¨m............ t¹i......................................................................................... 3. Chç ë hiÖn nay (kh«ng ghi ®Þa chØ lµ sè P.O.BOX) ...................................................................................... ....................................................................................................................................................................... ............................................................................................§iÖn tho¹i sè .................................................... 4. NghÒ nghiÖp .................................................................................................................................................. 5. N¬i lµm viÖc .................................................................................................................................................. ....................................................................................................................................................................... .......................................................................................... §iÖn tho¹i sè ...................................................... 6. Quèc tÞch hiÖn nay .......................................................Quèc tÞch gèc........................................................... 7. Sè hé chiÕu hoÆc sè thÎ xanh .................................................................................................................... cÊp ngµy....../...../….......cã gi¸ trÞ ®Õn ngµy ....../....../.......... C¬ quan cÊp.................................................... 8. Rêi ViÖt Nam ngµy......../....../ ................víi h×nh thøc ra ®i: b»ng thuyÒn Du häc ; Tr!íc 1975 ; ODP ;HO ; AC ;H×nh thøc kh¸c ; NÕu ®i hîp ph¸p ghi râ hé chiÕu (giÊy phÐp xuÊt c¶nh) sè …………..cÊp ngµy……/……/..………........ 9. Môc ®Ých nhËp c¶nh:…………. ……………………………………… …………………………............ 10 . Hä vµ tªn, ®Þa chØ th©n nh©n (ghi râ hä tªn, quan hÖ, ®Þa chØ th©n nh©n t¹i ViÖt Nam hoÆc tªn ®Þa chØ c¬ quan n¬i vÒ th¨m hoÆc lµm viÖc) ……………………………………………………………......... ………………………………………………………………………………………………..................... ………………………………………………………………………………………………..................... 11. Thêi gian dù kiÕn vÒ ViÖt Nam tõ ngµy…… th¸ng……. n¨m…….. ®Õn ngµy…….th¸ng…. n¨m……....... 12. Sè lÇn xin nhËp c¶nh: mét lÇn nhiÒu lÇn T«i xin cam ®oan nh÷ng lêi khai trªn ®©y lµ ®óng sù thËt, t«i vÒ ViÖt Nam theo ®óng môc ®Ých nhËp c¶nh vµ tu©n thñ luËt ph¸p ViÖt Nam. Lµm t¹i................................... ngµy….... th¸ng…….n¨m…………. Ng!êi xin thÞ thùc (ký vµ ghi râ hä tªn)
Chó ý cÇn nép: - 1 ®¬n - 2 ¶nh (1 ¶nh nÕu kÌm theo hé chiÕu gèc) - Hé chiÕu hoÆc Reentry Permit/copy thÎ xanh - 1 b× th! cã tem vµ ®Þa chØ nÕu göi tr¶ b»ng b!u ®iÖn
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