CONSULATE OF THE KYRGYZ REPUBLIC
Embassy of the Kyrgyz Republic
2360 Massachusetts Ave., N.W., Washington, DC 20008 affix the
Tel: (202) 449-9822; Fax: (202) 386-7550 photo here
Е-мail:
[email protected] Internet: http://www.kgembassy.org
VISA APPLICATION FORM
(Application form must be typed or written in block letters)
Citizenship: Passport number: Expiration date: Type:
Last name (in capital letters) First Middle name(s)
Date of Birth: Place of Birth: Sex:
Male Female
day month year
Name of spouse: Contact organization or private host in Kyrgyzstan, including address and tel.:
Purpose of trip:
Business Pleasure
Specific purpose of visit
Type of visa requested:
Transit Single entry Tourist Double-entry Multiple entry (1 year)
Intended duration
From: Until: (For official use only)
day month year day month year
Номер:
Occupation, office address: Permanent address:
Дата поступления:
Дата выдачи:
Сроком с:
Сроком до:
Tel: Tel:
Категория:
Dates of all previous visits to the Kyrgyz Republic: Дип Служ Обыкн Тур
Вид:
I declare that the data given in this application are correct and comprehensive. Транз Одн Двукр Многокр
……… дней
……… мес
Signature Date ……… год
Примечание:
№