IMMirpa~iMHa xaprxa:

Immigracion Card: DDDDDDDDD IMMirpa~iMHa xaprxa:

Immigracion Card: DDDDDDDDD
npI16YTTR BI16YTTR
ARRIVAL DEPARTURE

1.
npi3BHlIle
SUmame DDDDDDDDDDDDDD DDDDDDDDDDDDD
2. IM'R
Name DDDDDDDDDDDDDD 2.
IM'A
Name DDDDDDDDDDDDD
3.
rpOMa,QRHCTBO
Citizenship DDDDDDDDDDDDD 3. rpOMa,QRHCTBO
Citizenship DDDDDDDDDDDD
4.
AaTa Hapoll*eHHA
Da1e ot birth DDDDDDDDDDDD 4.
AaTa HapoAlKeHHR
Date ot birth DDDDDDDDDDD
5.
CTaTb
Sex DDDD 5.
CepIR, N2 nacnopra
Passport N2 DDDDDDDDDD
6. CepiR, m nacnopra
DDDDDDDDDDDD 6. ni,QnMc npen'JmHMKa
I I

a=~~~
Passportm Signature of bearer

7.
THn, N2 Bi3H, TepMiH An'
Visa type, visa number, DDDDDDDDDDDD 7.
DDDDDDDD
N2TpaHCnopTHoro
Flight (Registration
3aco6y (pe.cy)
Vehicle) N2
val idity period

AiTIł (iM'A, piK HapO.QJKeHHR DDDDDDDDDDDD

aChildren (name, date otbirth)
MeTa nplł6ynR 9.
DDDDDDD
Ha3Ba, aapeea CTOpOHIł, 1Il0 nplłHMas
Name a~d address ot recelVlIIg company
(person)
9. Purpose ot joumey
Ha3Ba, a,qpeca CTOpoHIł, 1Il0 nplłHM3&
10. Name andaddress
(person)
ot receiving company DDDDDDDDDDDDDDDDDDD
DDDDDDDDDDD
m rpaacnopracro 3aco6y (peHcy)
11. Flight (Registration Vehicle) m

12. ni.QnHc npe~fRBHHKa

Signature ot bearer

nO,Qaf:TbCSł pa30M 3 nacnoprOM noc3lłOsii1 oco6i opraals OXOpOHH ,Aep)l(3SHOrO nOAaSTbCR pa30M 3 nacnopTOM nOCa,QoBiH oc06i cpraats OXOpoHM AeplKaBIfO.ro-
KOPlloHy ni.o 'łaC nepentH3HHA ,Rep)l(3SHOrO KOPAOHy Ta 36epiraCTbCR npOTArOM yCbOro KOPIIOKY nill ~ac nepeTMHaHHR lIeplKaBHoro KopllOHy Ta 36eplra&TbCR npoTRrOM yCbOro
~acy nepe6YBaHHR B YKpaiHi. ~acy nepe6YBaHHR B YKPaiHi.
npe.tlOCTa~ReTCA BMeCTe c nacnopTOM AOIDKHOCTHOMy nHllY opraHOM oxpaHbl npeJ:łocr3E!:TUłerCA BMeCTe c nacncprcu A01'OKHOCTHOMy JlMlłY opraHOM oxpaHbl
rOCYAapcTBeHHOH rpaHHljbl npa nepece~eHIłIł rOCYAapCTBeHHOH rpaHlłljbl Ił cexpauserca rOCYllapCTBeHHoH rpaHMljbl npa nepec~eHMM rOCYllapCTBeHHoM rpaHHljbllł coxpaasercs
Ha npOTRlKeHMM aeere BpeMeHIł npe6blBaHHM B YKpaMHe. Ha npOTRlKeHMH ecere BpeMeHM npe6blBaHHM B YKPaHHe.
This card must be presented together w.ith the passport to Ukrainian border autbort- This card must be presented together with the passport to Ukralnian border autnon-
tles when crossing the State border ot and is kept tor the whole perto d ot stay in Ukraine. ties when crossing the state border ot and is kep! torthe whole period ot stay in ~ine.·.
 nPABWlA 3A110BHEHH~ IMMlrP~II1HOr KAPTKH

YBArA! KapTKa 3anOBHIOCTbCA OC06MCTO BnaCHMKOM nacnopra. KapTKa

3anOBHIOCTbCA TakO'" HaKO"'1łYoc06y BnMcaHy B nacnopr i AKanpAMye ~epe3 KOPAoH
pa30M 3 enaCHMKOM nacnopra, 3anOBHIOihe KapTky TeMHo-cKHiMM a60 'łOpHKMM
'IOpHMnaMM. He ~03BQI1SIeTbCJł 3anOBHRTM KapTlcy'IOpHKn3MM 'IepsoHoro a60 3eJ1eHoro
Konbop~ .
&YAb nacxa, 3anoBHiTb nons 1~ ~aCTHHM«npM6yrrA» Ta 1~ ~acTMHM«BM6yrrA»
iMMirpalliiiHol"KapTKMOMXOA',"M 3 iHcjJOpMallil",
AKaaaeceua y Baw naCnOpTHHiiAOKYMeHT.
nOnA 7-11_aCTHHM«npH6yrrA»3anOOHin. oiAnooiAHoAO A3HHXOi3HYKparHHTa
oi3oooraHKeTM,AKYBM3anOOHHnHA"A OTpMMaHHAO"'3HOl"0i3M YKpal"HM,a60 OMxoAA~M
3 cjJaKTM~HMX AaHMXnpo nObAKY.
Bei nona 3anOBHłOłOTbCR p036ipnMBO APYKoBaHKMM niTepaMM npK Heo6x~Hoc.Ti
3anOB""T" noIUI K3prKM AeKinbKoM3 cnoe3MM, 33J1MWaMTe MilI{ HMMMnponycKYY O~"H
CMMBOn.
B nyHKTi 12 ~aCTMHM«npM6yrrA» Ta nyHKTi6 ~aCTMHM «BM6YTTA»nOCTaBTecoiii
OC06HCTMiiniAnMc.
nOAaETbCSI pa30M 3 naCnOpTOM nocanoata ocoot opraata OXOpoHM
AeplKaBHOrO KOPAOHy niA xac nepeTMHaHHSI aepxaeaoro KOPAOHy Ta nPABHIlA 3A110IlHEHH~ HMMHrPA~HOHHOI1 KAPTO'łKH
36epiraETbCSI nporarou yCboro 'Iacy nepe6yBaHHSI B YKpa'iHi.
BHHMAHHE! KapTO~Ka3anonHAeTCAnH~HOBn3AenblleM nacnopra,
npeAOCTaBIlSleTCSI BMeCTe c nacnoprou AonlKHocTHoMy nM~y opraaov TaJOKe l<aprO'lKa aanonase'rcs Ha Ka>KAOrO '1enOseK3, KOTOpblM e"MC3H B nacnopr
OXpaHbł roCYAapCTBeHHOH rpaHM~bl npa nepeCe'leHMM rOCYAapCTBeHHOH Iłcne~T sepes rpaHM4Y BMeCTe c BIlClAenbQeM nacnopra, 3anonHRihe kapT0'łKYT0l1bKO

rpaHM~bl M coxpaaaercs Ha npOTSllKeHMM scero BpeMeHM npe6blBaHMM B leMHO-CK""M" "11M 'łepH"IM" 'łepHMnaMI4. 3anpeLqaeTCR aanonaeuae K3pTO'łKM
'łepHMnaMM KpaCHaro MnM 3e.neHoro ueera,
YKpaMHe.
nO",anYMCTa, 3anOnHMTe nona 1~ ~aCTM«npM6b'TMe» M1-6 ~aCTM«OT6b'TMe»
This card must be presented together wit h the passport to Ukrainian MMMMrpallHoHHoiiKapTo~KMMCXOAAM3MHcjlopMaIlMM,BHeceHHoii o Baw nacnopTHb'li
border authorities when cross ing the State border, ot and is kept tor the AOKYMeHT.
nOM 7-11 'łaCTK «npM6brTMe» 33nonHHTe COOTBeTCTBeH HO AClHHblM BH3bl YKpaMHltl
whole period ot stay in Ukraine.
M BM30BOM 3HKeTbl, KOTOpYHJ Bbl3anOJ1HMM AIlR nonyąeHMR B1se3AHOM BM3'" YKpaMHI.I,
MM MCXo,qR 143 cłJaKTM'łeCKMX .qaHHbIX o noe~e.
Bce nOJIR 3anonłUłlOTCJI pa360p'łMBO ne'łaTHblMM 6YKBaMM. npK He06xo.qMMocTK
3anOJ1HeHMJł noneii KapTO'lKM HecKonbKMMM CnOBaMM, OCTaBnRKTe Me~ HMMM nponycK
B OAMH CMMBon.
B nyHKTe 12 ~aCTH~npM6b'TMe» MnyHKTe 6 _aCTM«OT6b'TMe» nOCTaObTeCBOIO
nH~1łY1OnOAnHCb.

IMMIGRATION CARO COMPlETION REQUIREMENTS

ATTENTION! Thecard is filled in bythe ownerotthe passportpersonally. Thecard

to filled in per each person as well, who is putdownlnto the pass port and who goes across
the bordertogetherwith,the owner otthe passport. Fili in the card with dark blue or black
inkonly.
Please fili the lines 1~ ot the part «Arrivab, and 1~ ot the part «Oeparture» ot the
Immigration card according to the intormation in your passport.
Lines 7-11 ot the part«Arrival» fili according to Ukrainian visa and visa's applicatlon
or according to the facts about the trip.
Ałtthe lines are filled legible by in capilal błocks. Leave the blanks between the words
Ifyou need severalwords to fili the lines ofthe card.
Put your signatu re in the point 12 the part «Arrivab, and In the point 6 ofthe part
«Oeparture».