Application for visa renewal, replacement 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)
Sex
Male
Female
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
in thoi lin h /Contact telephone number ..........................................................................................
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 ............................................................................................................................... in thoi lin h /Contact telephone number ......................................................................................... - Thn nhn: h tn ................................................................... Ngy sinh: ....................................... Full name of the guarantor (a relative of the applicant)
Identify card/ Passport/ Permanent Residence Card number
Cp ngy: ....................................c quan cp: ...............................................................................
Date of issue
Issuing authority
Quan h vi ngi lm n /Relationship to the applicant .........................................................................
a ch thng tr/ tm tr ti Vit Nam: ........................................................................................... Permanent/ temporary residential address in Viet Nam
in thoi lin h /Contact telephone number .........................................................................................
3- Ni dung ngh: - Cp th thc: mt ln nhiu ln c gi tr n ngy: ............/........../..................... Entries requested
Single
Multiple
Validity to (day, month, year)
- 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 /Additional explanations: ..................................................................... ...................................................................................................................................................... ...................., ngy......thng.......nm............. Xc nhn (2) /Certified by (k, ghi r h tn, chc v, ng du) Signature, fullname, title and seal
Place and date (day, month, year) of the application
Ngi bo lnh /The sponsor Ngi ngh /The applicant (k, ghi r h tn) (k, ghi r h tn) Signature and fullname Signature and fullname
hi ch Note on the mark (1), (2):
(1) Mi ngi khai 1 bn, km h chiu gi trc tip n c quan qun l xut nhp cnh. (To apply, please submit a completed application form anclosed with his/her in peron at the Immigration Office). (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. (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).