PERSONAL DETAILS FORM
SECTION 1
Surname: …………….………………… First Name: …………….………………Middle Name: ……………………………...
Date of Birth: …………………………………… Place of Birth: …………………………………………..
Marital Status: …………………………………………… Mobile No: ................................................................................ E-Mail:
…………………………………………………………..
SECTION 2
Passport No: …………………………………………… Date of Issue: ……………………………………………………………
Date of Expiry: ………………………………….......... Place of Issue: …………………………………………………………..
Nationality: ….………………………………
SECTION 3
Resident Address: ……………………………..………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………
……………………………………………………Kindly Indicate if house is: Rented( ) Owned ( )…….No of Years lived
in………………………………….
SECTION 4
Father’s Surname: …………………………………….. Father’s Given Names: ……………………………………………..
Father’s Date of Birth: ………………………………………
Mother’s Surname: ………………………………… Mother’s Given Names: …………………………………………………
Mother’s Date of Birth: ………………………………………..
Spouse Surname: ……………………………… Spouse Given Names: ……………………………………………………….
Spouse Date of Birth: ……………………………….
Is anyone sponsoring this trip ....................................................................... Amount to be paid by
Sponsor…………………………………………………..Dependent(s)…………………………………………………………………
SECTION 5
Occupation : ……………………………………………………………………………………………………………………………..
Name of Company: …………………………………………………………………………………………………………………....
Company’s Address: ………………………………………………………………………………………………………………….
Phone No: ……………………………………………………. E-Mail: ………………………………………………………………
Date of Employment: ………………………………… Monthly Salary: …………………………………………….
SECTION 6
Tertiary Institution Attended: ……………………………………………………………………………………………………….
Attendance Dates: …………………………………………………………………………………………………………………….
Course Studied: ………………………………………………………………………………………………………………………..
SECTION 7
Date of Intended Travel: ……………………………………. Duration: ………………………………………………………….
Contact Person: ………………………………………………………………………………………………………………………..
Contact Address: ………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
Contact’s Residence Status: ………………………………………………………………………………………………………..
Contact Phone No: …………………………………………………………………………………………………………………….
Contact Mailing Address: …………………………………………………………………………………………………………….
Relationship to You: …………………………………………………………………………………………………………………...
Purpose of Travelling…………………………………………………………………………………………………………………….
SECTION 8
Have you ever been refused a Visa? ………………………………………………………………………………………
If Yes State Reason: …………………………………………………………………………………………………………
Have you ever been issued a visa before? ………………………………………………………………………………..
Previous Visa No. (If Available): ………………………………………………………………………...........................
Have u visited any country in the past 10 years…………………………………………………………………………….
List Countries and Dates:
………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………….
Indemnity; by signing this form, I certify that the information given in this form is true and accurate and I have granted p ermission to
Travels R’us (or its representative) to process and submit my visa application according to the information given. I confirm that I have paid
a non-refundable fee for the service requested and accept that Travel R’us does not have control of the outcome of the visa service request
as the final decision to grant or refuse any visa application is at the behest of the embassy/consulate.
Name & Signature of Applicant: ……………………………………………………………………………….
Date: ………………………………………………………………………………..
