FormV.

2013

VisaApplicationFormofthePeoplesRepublicofChina
(FortheMainlandofChinaonly)

Theapplicantshouldfillinthisformtruthfully

completelyandclear.PleaseytypetheanswerincapitalEnglish
lettersinthespaceprovidedortick()therelevanboxtoselectIfsome.oftheitemsdonotapply,pleasetypeN/AorNone.

Part1:PersonalInformation
Lastname
1. 1
FullEnglishname
asinpassport

Middlename

Firstname

Affixonerecentcolorpasspor

12.
NameinChinese
14. Sex M

16.
Currenationalityt(ies)

/Photo

photo(fullface,frontview,

13.
Othername(s)
15.
DOB(yyyy-mm)-dd

bareheadedandagainstaplain
lightcoloredbackground)

1. 7 Formernationality(ies)

18. ( / )
Placeofbirth(city,province/state,country)
19. /
LocalID/Citizenshipnumber
110. / Passport/Traveldocume
type

Diplomatic ServiceorOfficial
Ordinary ( )Other(Pleasspecify):

1.31

1.21

Dateofissue(yyyy-mm)-dd
1.41

Placeofissue

Dateofexpiry(yyyy-mm)-dd

1.11
Passportnumber

Businessperson
Companyemployee
Entertainer
/ Industrial/Agricultworker
1.51

Current
occupation(s)

Student
Crewmember
Self-employed
Unemployed
Retired

/ Former/incumbentemberofparliam
Position________________________
/ Former/incumbgovernmentnt
official
Position____________________
M ilitarypersonnel
Position____________________
NGO staff
Religiouspersonnel
Stafofmedia

( )Other(Pleasspecify):
1.16
Education

Postgraduate
( )Other(Pleasspecify):

1.17 /

Name

Phonenumber

Address

ZipCode

Employer/Sch

College

 1 4 /Page1
of4

1.18
Homeaddress

1.19
ZipCode

1.20 /
Home/mobilephonenumber

121.
E-mailaddress

122. Maritalstatus Married Single Other(Pleasespecify):

1.23
(
, )
Majorfamily
member spous
children,pa
c.,matypeon
separatepaper

Name

National

1.24

Name
Emergency

Contact
Relationshipwiththeapplicant
1.25 Countryorterritorywherethe
applicantislocatedwhenapplyingforthisvisa

Occupation

Relationsh

Mobilephonenumber

Part2:TravelInformation
OfficVisital

Non-businessvisit

Asresidentdiplomatconsulorstafofintern alt
organization
Aspermanentresident

Business&Trade

Work

Asintroducedtalent

Aschildinfostercare

Tourism

Ascrewm ember

2.1
Major
purpose
ofyourvisit

Transit

Short-termvisittoChinesecitizeor 180 Familyreunionforove

foreignerwithChineseprmanentresidencestat
180dayswithChinesecitizenorforeignerwit
Chinesepermanentresidencestatus

Short-termvisittoforeignresidrin As accompanyingfamilymemberof foreig

Chinaduetowork,studyorotherreasons
residinginChinaduetowork,studyorotherreaso

2.2

Intendednumber
ofentries

Short-termstudyforlessthan180day

Long-termstudyforover180days

Asjournalistfortemporarynew
coverage
( )Other(Pleasspecify)

Asresidentjournal

( 3 )Oneentryvalidfor3monthsfromthedateofissue

(
3-6
)Twoentriesvalidfor3to6monthsfromthedateofissue
6 )Multiplentriesvalidfor6monthsfromthedateofissue
1 )Multiplentriesvalidfor1yearfromthedateofissue
Other(Pleasspecify):

2.3 Areyouapplyingforexpressservice?

Note:Expressservicneedsapprovalof
consularofficials,andextrafeesmayapply.

Yes

No

2.4
ExpecteddateofyourfirstentryintoChinaonthistrip(yyyy-mm)-dd
2 4 /Page2
of4

25.
LongesintendedstayinChinaamongallentries

Days

Date

Detaileaddress

26.
,

Itineraryin
China(intime
sequencemay
typeonsepara
paper)

27.
Who willpayforyourtraveland
expensesduringyourstayinChina?

Name
2. 8

Address

Informationof

inviterinChina

Phonenumber

Relationshipwiththeapplicant

2.9
HaveyoueverbeengrantedaChinesevisa?Ifapplicablepleas
specifythedateandplaceofthelasttimeyouweregrantedthevisa.
2.10 12 Othercountriesorterrit
youvisitedinthelast12months

Part3:OtherInformation
3.1
residencepermintChina?

Yes

No

3.2 , HaveyoueverbeenrefusedavisaforChina,or
beenrefusedentryintoChina?

Yes

No

3.3 Do youhaveanycriminalrecordinChinaoranyothe
country?
3.4 Areyouexperiencinganyofthefollowingconditions?
Seriousmentaldisorder
Infectiouspulmonarytuberculosis
Otherinfectiousdiseaseofpublichealthhazards

Yes

No

Yes

No

3.5 30 Didyouvisitcountriesorterritoriaffecs
byinfectiousdiseasesinthelast30days?
3.6 3.1 3.5
IfyouselectYestoanyquestionsfrom3.1to3.5,pleasegivedetailsbelow.

Yes

No

Haveyoueveroverstayedyourvisaor

3 4 /Page3
of4

3.7
Ifyouhavemoreinformatiaboutnyourvisaapplicationotherthantheabovetodeclare,pleasegivedetailsbelowortypeona
separatepaper.

3. 8 Ifsomeoneelsetravelsandshares
thesamepassporwiththeapplicant,pleaseaffixtheirphotosandgivetheinformationrbelow.

Information

1
Person1

2
Person2

3
Person3

AffixPhoto
here

AffixPhoto
here

AffixPhoto
here

Fullname

Sex

DOB(yyyy-mm-dd

Part4:Declaration&Signature
4.1
IherebydeclarethatIhavereadandunderstoodallthequestionsinthisapplicationandshallbearallthelegalconsequencesforthe
authenticityoftheinformationandmaterialsIprovided.
4. 2

Iunderstandthatwhethertoissueavisa,typeofvisa,numberofentries,validityanddurationofeachstaywillbedetermineby
consularofficial,andthatanyfalse,misleadingorincompletestatementmayresulintherefusalofavisaforordenialofentryint
China.
4.3
Iunderstandthat,accordingtoChineselaw,applicantmayberefusedentryintoChinaevenifavisaisgranted.

Applicantssignature:

Date(yyyy-mm)-d:d

18 Note:Theparentorguardianshallsignonbehalofaminorunder18yearsofage.

Part5 Iftheapplicationformiscompletedbyanotherpers onthe

applicant'sbehalf,pleasefilloutheinformationoftheonewhocompletheesform
5.1 Name

5.2
withtheapplicant

5.3 Addre

5.4 Phonenumber

Relation

5.5 Declaration

IdeclarethatIhaveassistedinthecompletionofthisformattherequesoftheapplicanandthattheapplicantunderst and
agreesthattheinformatiprovidednistrueandcorrect.
/Signature

/Date(yyyy-mm):-dd
4 4 /Page4
of4