Mu (Form) N14

N NGH CP, B SUNG, SA I TH THC, GIA HN TM TR

(1)
Application for visa renewal, replacemant or modification, length of stay extension
(Dng cho ngi nc ngoi ang tm tr ti Vit Nam)
To be completed by foreign non - permanent residents in Viet Nam

1- Ngi lm n (Details of the applicant):

H tn (ch in hoa): ...................................................................... Gii tnh: nam
n
Full name (in block letters)
Female

Sex

Male

Sinh ngy ......... thng .......... nm ................. Quc tch: ................................................

Date of birth (day, month, year)

Nationality

H chiu s: ....................... c gi tr n ngy ....../....../.......... Ngh nghip: ................

Passport Number

Expiry date (day, month, year)

Occupation

Ngy nhp cnh Vit Nam: ......................... Mc ch nhp cnh: ..................................

Date of latest entry

Purpose of entry

a ch tm tr Vit Nam: ...............................................................................................

Current residential address in Viet Nam

S in thoi (nu c) Telephone Number (if any): ........................................................................

2- C quan/t chc hoc thn nhn Vit Nam mi, bo lnh:
(Details of the receiving, sponsoring agency/employer or guarantor in Viet Nam)

C quan, t chc: tn (Name of the receiving, sponsoring agency/employer)............................................

a ch (Address); ...................................................................................................................
Thn nhn: h tn ..................................................... ngy sinh ........................................
Full name of the guarantor (a relative of the applicant)

Date of birth (day, month, year)

Giy chng minh nhn dn/h chiu/th thng tr s:.....................................................

Identity card/Passport/Permanent residence card number

cp ngy ............................................. c quan cp ..........................................................

Date of issue

Issuing authority

a ch thng tr/tm tr ti Vit Nam:............................................................................

Permanent/temporary residential address in Viet Nam

3- Ni dung ngh (Details of application):

- Cp th thc:
mt ln nhiu ln gi tr t ngy: ....../ ...../ ...... n
ngy...../ ...../ ............
Entries requested
year)

Single

Multiple

Validiry from (day, month, year)

to

(day, month,

- B sung, sa i th thc (Visa modified as):.............................................................................

- Gia hn tm tr n ngy: ....../ ....../ ............
Length of stay extended to the date (day, month, year)

- L do (Reasons for the request): ...................................................................................................

4- Nhng iu cn trnh by thm (Additionnal explanations): .....................................................
............................................................................................................................................
.............., ngy ..... thng ...... nm ..........
Place and date (day, month, year) of the application

() Mi ngi khai 01 bn, km h chiu gi trc tip n c quan qun l xut nhp cnh

(To apply, please submit a completed application form enclosed with his/her passport in peron at the Immigration
Office).

Xc nhn (2) (Certified by)

Ngi bo lnh (The sponsor)

Ngi lm n

applicant)

(k, ghi r h tn, chc v, ng du)

Signature, full name, title and seal

(k, ghi r h tn)

(k , ghi r h tn)

Signature and full name

Signature and full name

Ghi ch Note on the mart (), (2):

() Xc nhn ca th trng c quan, t chc mi, bo lnh hoc ca Trng Cng an phng ,
x ni ngi bo lnh thng tr
2

(Certification is given by the chief of the receiving, sponsoring agency/organization of the applicant or of the Chief Police
of the Ward/Commune where the sponsor resides).