Vize Başvuru Formunu İndir

DJIBOUTI EMBASSY
REPUBLIC OF DJIBOUTI
CİBUTİ BÜYÜKELÇİLİĞİ
CIBUTI CUMHURİYETİ
ANKARA
UNITE – EGALITE - PAIX
Photograph
VISA APPLICATION
Vize başvuru formu
ATTENTION:
RESIM
Fill out headings using CAPITAL LETTERS.
Your application shall not be processed in case of error or omission.
SURNAME / SOYADI
1.
NAME / ADI
2.
DATE & PLACE OF BIRTH/ DOĞUM TARİHİ
DATE/ MONTH/YEAR
CITY/ TOWN
COUNTRY /
ÜLKE
ŞEHİR
Gün / ay / yıl
....../........./.........
4. PERSONAL STATUS / MEDENİ HALİ
3. SEX / CİNSİYET
MALE / ERKEK
MARRIED / EVLI
FEMALE / KADIN
5. NATIONALITY: CURRENT NATIONALITY
BIRTH NATIONALITY / DOĞUM UYRUGU :
ŞİMDİKİ UYRUGU
6. TYPE OF PASSPORT / PASAPORT TÜRÜ:
NOT MARRIED /
EVLI DEĞIL
PASSPORT NO./ PASAPORT NO :
ISSUING AUTHORITY / VEREN MAKAM
Diplomatic Passport / diplomatik pasaport
Official Passport / Resmi pasaport
Service Passport / Hizmet pasaport
DATE OF ISSUE /
VERİLİŞ TARİHİ:
DATE OF EXPIRATION /
BİTİS TARİHİ
Ordinary Passport / Ulusal pasaport
....../........./.........
Other document / Diger seyahat belgesi
....../........./.........
7. PERMANENT ADDRESS / İkametgah adresi
8. TELEPHONE:
OFFICE / OFIS
9. PROFESSION / SU ANKİ MESLEGİNİZ :
HOME / EV
MOBILE / CEP TELEFON
10. EMPLOYER: (NAME/ ADDRESS/TEL.) /
CALİSİLAN SİRKETİN ADİ, ADRESİ VE TELEFON NUMARASİ
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11. ACCOMPANYING CHILDREN / REFAKAT EDILEN ÇOCUKLAR
NAME / ADI
SURNAME / SOYADI
DATE OF BIRTH/ DOĞUM TARİHİ
1.
2.
3.
4.
5.
12. DATE(S) OF EARLIER VISIT TO DJIBOUTI / İÇİN DAHA ÖNCE ZİYARET TARİHLERİ :
13. PURPOSE OF TRIP / Seyahat amaciniz :
DIPLOMATIC
OFFICIAL
BUSINESS
14. DURATION OF STAY / Öngörülen gezi
TRANSIT
OTHER
15. VISA REQUESTED FOR / Talep edilen giris sayisi :
Gün / ay / yıl
(DATE/ MONTH/YEAR)
....../........./.......
:
TOURIST
TO
......../......./.........
16. MEANS OF SUPPORT DURING YOUR STAY IN
DJIBOUTI / Geziniz boyunca seyahat ve genel
masraflariniz kim tarafindan karşılanacak ?
SINGLE ENTRY / Tek
MULTIPLE ENTRY /Cok girisli
17. SPONSOR OR HOST IN DJIBOUTI (NAME/ ADDRESS/ TEL.)
SPONSOR VEYA CİBUTİ’ DEKİ EV SAHİBİ
(ISIM/ADRES/TEL)
(CASH/ TRAVELLER’S CHECK/ CREDIT CARDS ETC.)
DATE :
........./........./...........
SIGNATURE :
FOR OFFICIAL USE ONLY/ RESERVE A L’ADMINISTRATION
NUMÉRO DU VISA
NATURE DU VISA
DATE DE DÉLIVRANCE
VALIDITÉ DU VISA
DURÉE DU VISA
DU
AU
....../....../...........
AVIS OU DÉCISION DES AUTORITÉS
NOMBRE D’ENTRÉE(S)
SIMPLE O
....../....../...........
MULTIPLE
O
Refusé
Délivré
İlkbahar Mah. Galip Erdem Caddesi, 613. Sok, no: 6 Yıldız - Çankaya - Ankara
Tel : 00 90 312 491 95 13/14 – Fax: 00 90 312 491 95 10
E-mail: [email protected]
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