Department of Foreign Affairs

and Trade
APPLICATION FOR JENTRY PERMIT
INSTRUCTIONS OFFICE USE ONLY
1. Please read the notes on the rear of this form before Date Received; By:
completing the form.
2. A separate form is required for each person seeking entry to Fiie No:
PNG who is travelling on their own passport. Where the
application is in respect of a child under 16 years of age. both
parents must sign the application.
3. Piease write legibly or use a typewriter and answer all
questions as fully as possible,
4 The completed form and the applicant's passport should be Decision:
sent to one of the addresses on the reverse of this form. Applicant Notified on;
TtCK THE PURPOSE AND CIRCLE A DESCRIPTION^OF YOUR VISIT TO PNG:
r
Q Visitor Q Working Resident
Tourist - Tour Package Journalist Businessperson/investor Short-term Employment !
Tourist - Own Itinerary Yachtsperson Employment Consultant/Specialist 1
\
Visiting Relative Working Dependant Dependant of Citizen
i
UH Business LJ Student \
Short-term Multiple Entry Forma! Education Occupational Trainee

1
LI Entertainer >J Special Exemption Meianesian Spearhead i
Commerical: Foreign Official Diplomat i
1
Film-maker Comedian Musician Aid Wofker/Volunteef Researcher/ Academic
Charity: Film-maker (Non- commercial) Religious Worker 1
Gospel Group Cultural Exchange Emergency Relief Worker Sportsperson j
Medical Domestic Worker 1
1
U Accompanying another applicant as a dependant on my own passport j
j
V . -

Days: Months: Years:

HOW LONG DO YOU WISH TO STAY IN PNG: ; ! or : £?< \r ;

PERSONAL DETAILS:

Family Name Given Names

Date of Birth Sex Marital Status

Q Maie LJI Never Married LJ Married LJ De facto

Day Month
LJ Female LJI 'Widowed LJ Divorced

Country of Brrth Nationality

Passport Number Expiry Date Occupation

Day Month

Passport Issue Dote Passport Issuing Place Passport issuing Authority

TRAVEL ARRANGEMENTS:
Name of Vessel/Flight Departure to PNG Arrival m PNG
Port: Port:
Date: Date:
uay Month
 For entry for the purposes of employment: For ail other types of entry:
Please attach copies of the following documents: ; How will you he funding your
; stay in PNG?
;<J A letter of offer of employment from your PNG sponsor,
Q Salary
»J The letter of approval of your work permit, including the work permit
ST"
U«l Company sponsor
number, position number and expiry date.

'—J A certificate of good health from a registered doctor, a recent chest X-- LJ Own funds
ray, and the results ot a recent HIV test.
LJi Family
'«Ji A statement of your good cnaracter from your focal police authorities.

If you have ever changed your name, are known by an alias, or own another passport, please provide details:
PREVIOUS NAME/ALIAS DETAILS:
Family Name Given Names Date of Birth Sex Marital Status
; t ' I I

I i : I i-

OTHER PASSPORTS:
Country of issue Passport Number Passport Expiry Date

ORGANISATIONAL SPONSOR:

Organisation Name _ Agent

Contact Address Number and Street

Suburb/Town_ _ _ _ _ State/Province __ Postcode

Country Business Telephone

:NfegL.

Have you visited PNG before: LJ Yes LJ No

If yes, please give details of your last visit
,
Date „ . : _-,„,„ .*.,...--, .
_Purpose of visit
«..v --..;... , • ---- - ,
Duration of visit _
_-._,.. -~..-*~...,^. , -_
Address during stay
p -.-, - " — .—.. , - — : .,.-~«f~,

i - I 1 !
Day Month Year

Have you been convicted of a criminal offence: LJ Yes *J No

If yes, please give details of the date, nature of offence, place of conviction and the penajty imposed.

Have you been deported from, or refused entry to Papua New Guinea, or any other country: LJI Yes LJ No
if yes, please give details.

Have you been a patient in a mental home/institution, or do you suffer from a disease which may constitute a health

risk to Papua New Guinea: WJJ Yes HJ No

ADDRESSES:
RESIDENTIAL:
Number and Street

Suburb/Town _ ___ _ %lie/pn_^3'_t{i ____ _p?st?9_tje

. ___ _ ..,._____ i i _ .„ i (
Country Home Telephone Business Telephone
"-••••— - j j7 p ~^^2I] (T~T

PNG:
Number and Street __

TowivVHtatje Province

?°lsl?L^^[r,e5s
[ £0 J&OV^

EMERGENCY CONTACT:

Family name _ _ _ .^'^H (^^H?^ _ ~

[IIIIILZIZILII] ! Ill _ _! I _
Contact Address Number andJStreet
p-~,,.,^~-,~— :•-.. ^........ — ,.— •».. .-.*. W*,.,.^— .-,_-_.,-.-.,
_ ^~ - -

r Suburb/Town
—— ,...-- . ^ - , ^-.«.^,J-,. , ~~—— _- ^ _ _ - _- _ _ _
~ -.--. ^H^^^^il00 ~ i-...PP-^iE^'i
: > ; i i

Country _ __ Home Telephone Businei

r~" ~ " ~" ~ " ] fl ~_ ) "2" "".'.J [Ell

DECLARATION:

f
By signinc] this form, i,,.,.,.,, declare that the information provided on the form is true
and correct, and that I have disclosed all information that may be relevant to determining whether i sbouid be granted
an entry permit to travel to and stay in Papua New Guinea.

PHOTOGRAPH

Signature of Applicant/Parents/Guardian
Date: