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1、REQUEST FOR ENTRY VISA TO MOZAMBIQUE莫桑比克入境申请书RECIBO N.oTO BE FILLED IN LEGIBLE LETTERS请用清晰字体填写For official useVISTO N.oDATA DE EMISSO. / . /20.Temporary临时入境. / . /20.Single entry单次入境VALIDADE. / . /20.Multiple entries多次入境. / . /20.Surname姓Full name全名Maiden name婚前姓名Country and place of birth出生地、国家Date
2、 of birth出生日期Sex性别Marital status婚姻状况 Single Married未婚 已婚Nationality国籍Passport number护照号码Date of issue发照日期./ ./20 .Validity有效期./ . /20 .P.te nationality护照国籍Profession / Occupation职业Position you hold职位Institution, organization or firm you work你工作的机构、组织或公司Address of the permanent residence固定住所地址Have yo
3、u ever before been in Mozambique? 是否曾经到过莫桑比克？ Yes是No否Have you ever been a resident in Mozambique?是否曾经在莫桑比克居住过？Yes是No否No否Why did you leave Mozambique? Date of exit因何种原因离开莫桑比克？ 离境日期 ./ . / . ./ . / .Mention the institutions and firms to which you were attached列出你曾经隶属过的机构和公司INCOMPLETE OR INCORRECT FILL
4、ING IN OF THIS FORM MAY RESULT IN DELAY DEVOLUTION OR REJECTION表格中不完整或错误可能导致延迟或拒签In detail give reasons for your entry in Mozambique详细列明访莫缘由 Tourism Explore business opportunity Visit relatives or friends Others_旅游 寻找商业机会 拜访亲戚或朋友 其 他_Length of stay in Mozambique驻莫时长Date of entry入境日期./ . /20 .Date of
5、 exit离境日期. /. /20.Entry border入境地点Exit border出境地点Address of residence in Mozambique在莫桑比克的住所地址Province省District区City市Avenue/ Street大街/街道House No门牌号Relatives, friends living in Mozambique在莫桑比克的亲戚、朋友Full name全名Nationality国籍Relationship关系Address地址Reserved for stamps . /./20. .Signature of applicant or of the applying entity申请人或申请单位的签名ASSINATURA RECONHECIDA POR SEMELHANA EXISTENTE NO .N.o . EMITIDO A . / . / . . EM.RESERVADO AOS SERVIOSDATA DA RECEPO. / . /20 .Assinatura do FuncionrioDATA DE ENTREGADATA DE ENTREGADate 日期2
