Vietnamembassy-usa.org



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|EMBASSY OF VIETNAM | |

|1233 20th Street, NW, Suite 400 |visa |

|Washington, D.C. 20036 |APPLICATION |

| |______ |

| | | |

|1. |Name: | |

| |(Family name - First name - Middle name) | |

|2. |Date of birth: | |

|3. |Gender: | |

|4. |Place of birth: | |

|5. |Nationality at birth: | |

|6. |Nationality at present: | |

|7. |Passport number: | |

| |Date of expiry: | |

|8. |Profession: | |

|9. |Present mailing address: | |

| |(P.O Box Not Accepted) | |

|10. |Email : | |

|11. |Cell phone : | |

|12. |Purpose of visit to Vietnam: | |

|13. |Name, address of your contact (sponsor, host, | |

| |hotel…) in Vietnam (if any): | |

|14. |Proposed date of entry: | |

| |(DD/MM-in word/YYYY) | |

| |Example: 01 January 2018 | |

|15. |Proposed date of exit: | |

| |(DD/MM-in word/YYYY) | |

| |Example: 01 January 2018 | |

|16. |Requesting a visa good for: | |

| |Number of entries: | |

| |(Single entry OR Multiple entries) | |

| |Length of stay: | |

| |- Up to one month | |

| |- Up to 03 months | |

| |- Up to 06 months (US passport only) | |

| |- Up to one year (US passport only) | |

| | | |

|I solemnly declare that the statements made in this application are true and correct. |

| | | |

| | |Date: |

| | |Full name of Applicant: |

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