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VISA APPLICATION FORM

Stamp of office

Issuing visa

1. Surname

FOR CONSULATE
USE ONLY

2. Maiden name / Previous surnames

Data złożenia wniosku:

3. Given names

Przyjmujący wniosek:

4. Date of birth (YY – MM - DD)

5. Identification number (if applicable)

Dodatkowe dokumenty:

6. Place and country of birth

Ważny dokument podróży

Środki finansowe

7. Present citizenship(s)

8. Citizenship at birth

Zaproszenie

Środek transportu

9. Sex

10. Marital status

Ubezpieczenie

male

female

single

married

separated

Inne:

divorced

widowed

other

11. Father’s given name

12. Mother’s given name

Wiza:

Odmowa

Udzielona

13. Type of travel document

Passport

Diplomatic passport

Service passport

Travel document for aliens

Typ wizy / cel pobytu:

Travel document (as in Geneva Convention of 1951)

Seaman’s book   

A

Other travel document (what type):   

B

C/

14. Travel document number

15. Issued by

D/

W/

16. Date of issue

17. Valid until

18. If you reside in another country than country of your origin – do you have permission to return to this country?

No

Yes (document number and date of validity)

19. Present job

20. Employer’s address and telephone number. For students – name and address of school / university

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