Form V.

201
V.20133

Visa Application Form of the People
Peoples Republic of China
(For the Mainland of China only)

The applicant should fill in this form tru

thful
ly completely and clearly
h

truthful
thfully
clearly.. Please type the answer in capital Englis
English
letters in the space provided or tick () the relevant box to select. If some of the items do not apply, please type N/A or None.

Part 1: Personal Information

Last name
1.1
Full English name
as in passport

ACHWANI

Middle name
First name

RAMESH

/Photo
/Photo

SANTOSH

1.
1.2
Name in Chinese
1.
1.44 Sex

Affix one recent color passport

photo (full face, front view,
and against a plain
bareheaded
bareheadedand
light colored background).

1.
1.33
Other name
ame((s)

1.
1.66
Current nationality
(ies)
ationality(ies)

INDIAN

1.
1.88 ((//))
/s
tate
,c
ountry
Place of birth(
irth(ccity
ity,, province
province/s
/state
tate,c
,country
ountry))

1985-11-22

1.
1.55
DOB
OB((yyyy-mm-dd
yyyy-mm-dd))

(ies)
1.7 Former nationality
ationality(ies)

INDIAN

ULHASNAGAR, THANE DIST., M.S., INDIA

1.
1.99 //
Local ID
ID// Citizenship number
10 / Passport
/Travel document
1.
1.10
Passport/Travel
type
1.1
1.111
Passport number
1.1
1.133
Place of issue

L9625544

Diplomatic

Service or Official

Ordinary

(()) Other (Please specify)

specify)::

1.1
1.122
yyyy-mm-dd
Date of issue(
ssue(yyyy-mm-dd
yyyy-mm-dd))

MUMBAI

1.1
1.144

Date of expir
xpiryy(yyyy-mm-dd
yyyy-mm-dd))

2024-05-18

// Former/incumbent member of parliament

person
Business
Businessperson
Company employee
Entertainer
// Industrial/Agricultural worker
1.1
1.155

Current
occupation(s)

2014-05-19

Student

________________________
Position
Position________________________
// Former/incumbent government
official
Position________________________
Military personnel

Crew member

Position________________________

Self-employed

NGO staff

Unemployed

Religious personnel

Retired

Staff of media

(()) Other (Please specify):

1.16
Education

1.17 //
Employer/School

Postgraduate
(()) Other (Please specify):

Name

College

DR. SHARMA'S CLINIC

Address F-10/35, KRISHNA NAGAR, DELHI, INDIA

1 4 / Page 1 of 4

Phone number +91

Zip Code

981 046 1358

110 051

110008

1.18
Home address 12/8, GROUND FLOOR, WEST PATEL NAGAR, NEW DELHI, INDIA

1.19
Zip Code

1.20 //
Home/mobile phone number

21
1.
1.21
SANTOSH_ACHWANI@YAHOO.COM
E-mail address

1.
22 Marital status
1.22

011 4246 6769

Married

Single

Other(Please specify):

Name

Nationality

Occupation

Relationship

RAMESH A. ACHWANI

INDIAN

BUSINESSMAN

FATHER

SANGITA R. ACHWANI

INDIAN

BUSINESSWOMAN

MOTHER

1.23
(
,,))
Major family
spouse,
members
membersspouse,
children,parents,et
c.,may type on
separate paper
paper

1.24

Emergency
Contact

Name

Relationship with the applicant

RAMESH A. ACHWANI

Mobile phone number

+91 9320273883

FATHER

1.25 Country or territory where the

applicant is located when applying for this visa

NEW DELHI, INDIA. PIN - 110 008

Part 2: Travel Information

Official Visit

Non-business visit

al
As resident diplomat
iplomatcconsul or staff of internation
international
organization
As permanent re
ressident

Business & Trade

Work

As introduced talent

As child in foster care

Tourism

ew member
As cr
crew
Transit
2.1
Major
purpose
of your visit

Short-term visit to Chinese citizen or
foreigner with Chinese permanent residence status

Short-term visit to foreigner residing in
China due to work, study or other reasons

180 Family reunion for over
180 days with Chinese citizen or foreigner with
Chinese permanent residence status

As accompanying family member of foreigner
residing in China due to work, study or other reasons

Short-term study for less than 180 days

Long-term study for over 180 days

As journalist for temporary news

coverage
)Other (Please specify)
(()Other
specify)

As resident journalist

(( 3 )) One entry valid for 3 months from the date of issue

2.2

Intended number
of entries

ies valid for 3 to 6 months from the date of issue

(( 33-66 )) Two entr
entries
ple entr
ies valid for 6 months from the date of issue
6 )) Multi
Multiple
entries

ple entr
ies valid for 1 year from the date of issue

1 )) Multi
Multiple
entries

Other (Please specify)

Other
specify)::
2.3 Are you applying for express service?
Note: Express service needs approval of
Note:
consular officials, and extra fees may apply.

2.4
Expected date of your first entry into China on this trip (yyyy-mm-dd
yyyy-mm-dd))
2 4 / Page 2 of 4

Yes

No

2014-09-15

2.
2.55
Longest intended stay in China among all entries

Days

Date

Detailed address

2014-09-15

2.
2.66
,,

Itinerary in
China (in tim
timee
may
sequence
sequencemay
type on separate
paper
paper))

2.
2.77 Who will pay for your travel and
expenses during your stay in China?

Name
2.8

Information of
inviter in China

SANTOSH R. ACHWANI (MYSELF)

12/8, GROUND FLOOR, WEST PATEL NAGAR, NEW DELHI, INDIA. PIN - 110 008
Address

+91 844 766 8149

Relationship with the applicant MYSELF

Phone number

2.9
Have you ever been granted a Chinese visa? If applicable, plea
se
Have
please
specify the date and place of the last time you were granted the visa.
2.10 12 Other countries or territories
you visited in the last 12 months

AUSTRALIA AND SINGAPORE

Part 3: Other Information

3.1 Have you ever overstayed your visa or
residence permit in China?

Yes

No

Have you ever been refused a visa for China, or

3.2 ,Have
been refused entry into China?

Yes

No

Yes

No

Yes

No

Yes

No

3.3 Do you have any criminal record in China or any other

country?
3.4 Are you experiencing any of the following conditions
conditions??
order
Serious mental dis
isorder
Infectious pulmonary tuberculosis
Other infectious disease of public health hazards
Did you visit countries or territories affected
3.5 30 Did
by infectious diseases in the last 30 days?
3.6 3.1 3.5
If you select Yes to any questions from 3.1 to 3.5, please give detail
detailss below
below..

3 4 / Page 3 of 4

3.7
If you have more information about your visa application other than the above to declare,please give details below or type on a
separate paper
paper..

I INTEND TO TRAVEL A COUPLE OF TIMES DURING THE UPCOMING YEAR TO AUSTRALIA VIA
HONGKONG, EACH TIME TAKING A BREAK AT HONG KONG FOR THE PURPOSE OF TOURISM.
ALSO PLAN TO VISIT

es
3.8 If someone else travels and shar
shares
the same passport with the applicant , please affix their photos and give their information below.

Information

1
Person 1

2
Person 2

3
Person 3

Affix Photo
here

Affix Photo
here

Affix Photo
here

Full name

Sex

(yyyy-mm-dd)
DOB
OB(yyyy-mm-dd)

Part 4: Declaration & Signature

4.1
ar all the legal consequences for the
I hereby declare that I have read and understood all the questions in this application and shall be
bear
authenticity of the information and materials I provided
provided..
4.2

I understand that whether to issue a visa, type of visa, number of entries, validity and duration of each stay will be determined by
consular official, and that any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into
China.
4.3
I understand that, according to Chinese law, applicant may be refused entry into China even if a visa is granted.

Applicant
Applicants signature:

):
Date (yyyy-mm-dd
yyyy-mm-dd):

18 Note: The parent or guardian shall sign on behalf of a minor under 18 years of age
age..

Part 5 If the application form is completed by another person on the

applicant's behalf, please fill out the information of the one who completes the form
5.1 Name

5.2 Relationship
with the applicant

5.3 Address

5.4 Phone number

5.5 Declaration

I declare that I have assisted in the completion of this form at the request of the applicant and that the applicant understands and
agrees that the information provided is true and correct.
/Signature
/Signature
/Signature

/Date (yyyy-mm-dd
):
/Date
yyyy-mm-dd):

4 4 / Page 4 of 4