申請用紙 | 旅行関連事業 | ATC

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EM B A S S Y O F TU R K M EN IS TA N – CO N S U LA R S ECTIO N

2-6-14, Higashi, Shibuya-ku, Tokyo 150-0011, Japan

tel: 03-5766-1150; fax: 03-5766-1151; e-mail: [email protected] I M PORTAN T!Implementation of the following few additional steps is essential in order to process quickly your Application. Please read instructions carefully and make changes as necessary before submitting to the Embassy. The information provided with the forms will be reflected in your visa and any corrections/changes afterwards may be highly time, effort and resource consuming. It may also lead to total decline of your Application or in certain cases to deportation upon arrival and annulment of your visa. 1 Application per Applicant! Please do not fold or otherwise deteriorate the Application Form as it will not be admitted for processing. Form must be filled in duly, without corrections, preferably typed or printed, all fields must be answered (enter “n/a” where applicable). Recent photo of max. 6 months old must be glued to each Application Form. No staples!!! Fees must be of exact amount in USD, unless waived. All dates in dd/mm/yyyy format only!

D o n o t w r it e o r m a r k in t h is a r e a !

Resmileşdirilen wizanyň:

№ Senesi: Möhleti:

1

V is a A p p lic a t io n Fo r m

1

Surname/Last Name:

₂

Name, Given Name(s):

3

Any Other Name(s) used before:(e.g. before

m arriage)

4

Date of Birth: (dd-m m -y y y y )

5

Place of Birth:

6

Current Citizenship:

7

Citizenship at Birth:

₈

Sex:

₉

Family Status:

(e.g. sin gle, m arried, w idow ed, separated, div orced)

10

Type of Passport:

(e.g. diplom atic; official/ serv ice; ordinary )

11

Other Travel Document if none in #10 is applicable:

(in accordance w ith 1951 Conv ention)

12

Passport #:

₁₃

Valid from: to:

(dd-m m -y y y y )

14

Issuing Authority/Agency:

Children/Dependents included on your passport and traveling with you: Full N am e as w ritten in Passport Date of Birth:

(dd-m m -y y y y )

Place Birth

1 2 3 4

15

5

Type of Visa:(check a ll appropriate boxes) Indiv idual: Group:

a

Diplom atic

f

Student

17

Number of Entries and Duration of Stay:

b

Official (serv ice)

g

Tourist

a

Sin gle

e

N um ber of day s

c

Business

_h

M edical

_b

Double

_f

N um ber of m on ths

d

Private

_i

Driv er

_c

Triple

_g

N um ber of y ears

16 e

Transit

j

Other

d

M ultiple

18

Date of Entry: (dd-m m -y y y y )

₁₉

Date of Exit: ( dd-m m -y y y y )

Rev. – 2009, July 05

PH OTO

Please glue,

do n ot

staple!

Maxim um Size 1.5 x 2 in .

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2 Page 2

Your Full Name Here:

____________________________________ Rev. – 2009, July 05

20

Mean(s)/Type(s) of Transportation

(e.g. airplan e, car, train , ferry , com bination of all or som e, other)

21

Number of Previous Trips to Turkmenistan:

If any, provide Date(s):

a

Current Employment: (Job Title, Position, Profession)

_b

_{Employed since:} ( m m -y y y y )

c

Affiliation: (com plete n am e & postal address)

22 d

Tel., Fax, E-mail, Webpage, etc.:

a

Permanent Residence Address in full :

23 b

Tel., Fax, E-mail, Webpage, etc.:

24

Annual income (in USD)

25

Amount & Type of Funds Available for This Trip: (cash, trav elers checks, etc.)

26

Who will pay for this trip?

Where will you stay in Turkmenistan? (com plete postal address)

27

Tel. Fax:

₂₉

28

Name(s) of Host/Sponsor/Contact:

His/Her Citizenship:

30

Additional information, if any, related to you or your trip that you think may be useful in consideration of your application:

31

D e c la r a t io n :

- I con firm that all in form ation provided in this Application Form is correct to the best of m y kn owledge. - I am aware that an y false statem en t(s) can lead to den ial to enter/ deportation from Turkm en istan even

if I have valid visa.

- In case of m y/ accom pan yin g m e person ’s den ial to en ter/ deportation from Turkm en istan , I/ we have n o claim (s) to com pen sation .

- I am aware that an y false or in com plete statem ent(s) will lead to den ial to obtain visa in future an d m ay also ren der m e liable to prosecution un der the local law.

- I do realize that m yself an d person (s) accom pan yin g m e are to leave Turkm en istan upon expiration of m y/ our visa.

- I have read these provision s of Turkm en istan ’s Foreign Visitors Act govern ing the en tran ce, stay and leave by foreign n ation als an d under its pen alty I un dertake to follow them .

32

Signature:

33

Date: ( dd-m m -y y y y )

Ch e c k lis t : 1-On e (1) Visa Application ; 2 - Passport an d copy of its fron t page carry in g y our photo; 3 - On e

(1) passport size photo glued to the Application ; 4 – Fees;

5 - Certified Letter of Inv itation.