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1625 K Street NW Suite 750 Washington DC 20006 Tel: 888 838 4867 ♦ Email: [email protected]
Visa requirements shown below are for U.S. citizens ONLY. Nationals of all other countries please contact
Pinnacle Travel Document Systems directly for specific requirements for your itinerary.
Cambodia 1 1 Laos 1 1 Myanmar 3 3
Please enclose your actual passport along with five (5) photographs, one (1) completed visa application form each for Cambodia and Laos and two (2) completed visa application forms and one (1) completed Work History form for Myanmar. Please also enclose two (2) clear photocopies of the vital information page of your passport, a copy of your flight itinerary showing entry and exit for Myanmar and your internal travel itinerary obtained from Alexander+Roberts. Photographs should be passport-type with a clear background approximately 2” x 2” in dimension. (Note that machine or home digital photographs are not acceptable and must be different than those in your current passport.) Your passport must be valid for a minimum of six (6) months beyond the completion of your travel and must have at least six (6) blank unused pages available not including those reserved for amendments and endorsements at the back of your passport. Contact PTDS directly for assistance with renewal of or to add pages to your U.S. passport, as this can easily be done at the same time you apply for your visa.
Fees shown above include all necessary consular and service fees as well as the cost to return your passport(s) from our offices via FedEx within the continental U.S. (Please add $29.00 to cover extra shipping costs for addresses in Alaska, Hawaii, or Canada.) We strongly suggest that you send your documents to us via FedEx or some other form of traceable overnight courier service.
Visa(s) # # Cost Req’d Forms Photos 1 – Persons - 2
Application Expedite Fee Deadline Per Person
60 days prior $130.00 to your departure
Adventures in Thailand, Laos & Angkor Wat
Extension
Applications must be received in our offices no fewer than 60 days prior to your departure from your shipping address. Documents received after the deadline will be subject to the per person late fee shown above. (Please do not submit your documents more than 90 days before your departure due to the validity of your visas.) Special requests for passports to be expedited due to other travel plans prior to your tour departure may also require expediting fees. Please contact PTDS directly regarding any special processing needs or before submitting documents you expect may be received substantially after the deadline as there may be special requirements and/or additional fees to process your request. It may not be possible to cancel processing of your applications once they have been submitted.
Please note that consular fees, shipping fees and application requirements quoted are subject to change without notice. Check or credit card payment accepted. Credit card payment subject to 3.5% surcharge.
$289.00 $549.00
If you prefer to obtain your visas for Cambodia and Laos on arrival deduct $260.00 from the fees shown above. Visas for Myanmar MUST be obtained prior to departure. Visas are not required for short tourist stays in Thailand. Due to short
validity of the Lao visa please note that your passport may not be returned until approximately 30 days prior to your departure. Given persistent delays with processing your visa for Myanmar may not be obtainable if documents are received
after the deadline. Please use the enclosed sample information verbatim and substitute your personal information.
PLEASE BE CERTAIN TO RETURN THE FOLLOWING TO: Pinnacle Travel Document Systems
1625 K Street NW Suite 750 Washington DC 20006
♦ Your actual passport (Please keep a photocopy for your records.) ♦ This completed form ♦ Two (2) clear photocopies of the vital information page of passport ♦ One (1) completed visa application form per person for Cambodia ♦ One (1) completed visa application form per person for Laos ♦ Two (2) completed visa application forms per person for Myanmar ♦ One (1) completed Work History form per person for Myanmar ♦ One (1) copy of your flight itinerary showing entry and exit for Myanmar ♦ One (1) copy of your internal travel itinerary obtained from Alexander + Roberts ♦ Five (5) passport-type photographs per person
♦ Credit or debit card authorization below
PLEASE TYPE OR PRINT CLEARLY
Full Name:________________________________ Full Name:________________________________
Passport #:____________________ Exp:___/___ Passport #:____________________ Exp:___/___ Mo Y r Mo Y r
Home ________________________________ Home Tel: ________________________________
Mailing ________________________________ Work Tel: ________________________________
Address: ________________________________ Email: ____________________________________
________________________________ Date of Departure from Home: ____/____/_____ (FedEx cannot deliver to PO boxes) Mo nt h Da y Ye a r
Address ________________________________ Tour Name: Thailand, Laos & Angkor Wat
For Return________________________________ Date of Tour Departure: ____/____/_____ Mo nt h Da y Ye a r Of ________________________________ Date of Entry to Laos: _____________________
Passport: ________________________________ Special Instructions:___________________
Tel: ________________________________ _________________________________________
Please indicate below if there are known periods prior to your tour during which you will need your passport for another international tr ip or when you will not be available to sign for the return of your passport. I wil l need my passport(s) for other international travel from _____/____/_____ to _____/____/_____ Mo nt h Da y Yea r Mo nt h Da y Yea r
I wil l not be at my home and/or return shipping address from _____/____/_____ to _____/____/_____ Mo nt h Da y Yea r Mo nt h Da y Yea r
CREDIT CARD AUTHORIZATION: AMEX / V ISA / MC (please circle one)
Cardholder Name:_____________________ Signature:______________________ Bi l l ing Zip Code: _____________
Card #: ______________________________CID#______________ Expires: ____/___ Amount: US$ _________ Mo Y r A+R CAMB/LAOS 2014(LAOS55/CAMBX65/MYANMAR25)70 394/759 FX29 (APP FEE)10 6PGS VAL 6MOS DL 60DAYS 130.00 3.5% TE LAOS 60 DAYS (SEE ENTRY ABOVE) TE CAMBODIA 90 DAYS
2014 – Pinnacle Travel Document Systems
IMPORTANT NOTICE REGARDING PASSPORT PAGES & VALIDITY:
You must have at least six (6) blank unused pages available in your passport for visas and entry/exit stamps, not including those at the back of your passport reserved for amendments and endorsements to the passport. In addition, your passport must be valid for six (6) months beyond the completion of your travel. If you are a U.S. citizen, and need to renew or add pages to your passport Pinnacle Travel Document Systems can easily assist you with this at the same time your visas are being processed. The total additional fees for these services (including U.S. government expediting fees) are $222.00 for passport pages and $250.00 for passport renewals.
You will need to complete an application form and a letter of authorization for PTDS and must send your actual passport to us. Specific requirements and the necessary forms are available for download from our Internet site:
Passport Pages Passport Renewals
First Time Passports Second Passports
WWW.Traveldocs.com/PTDSPassports
You may also contact us via email at [email protected] or by phone at 888-838-4867 and we will send you an instruction kit.
DIRECTORATE OF IMMIGRATION AND NATIONAL REGISTRATION IMMIGRATION DEPARTMENT
APPLICATION FOR TOURIST ENTRY VISA
(To be handed over to the immigration officer at the airport.) 1. Name ......................................................... PHOTO 2. Father’s Name in Full .................................................... 3. Nationality ......................... 4. Sex .................................. 5. Date of Birth ............................... 6. Place of Birth ........................ 7. Occupation .............................................................................................................. 8. Personal description
(a) Colour of Hair ......................... (b) Height .................................................. (c) Colour of eyes ........................ (d) Complexion ..........................................
9. Passport (a) Number ................................ (b) Date of Issue .......................................... (c) Place of Issue ...................... (d) Issuing Authority ..................................... (e) Date of Expiry ..............................................................................................
10. Permanent Address ................................................................................................ 11. Address in Myanmar ............................................................................................... 12. Purpose of entry into Myanmar ............................................................................... 13. Name and address of guarantor during stay in Myanmar .......................................
................................................................................................................................. 14. Financial resources in Myanmar ............................................................................. (a) Cash (Kyats and Foreign Currency) .................................................................. (b) Bank deposit ...................................................................................................... (c) Name of Bank .................................................................................................... (d) Amount .............................................................................................................. 15. Attention for Applicants
(a) Apart from the professions mentioned in this visa application are not to engage in any sort of work with or without changes.
(b) Applicant shall abide by the laws of the Union of Myanmar and shall not interfere in the internal affairs of the Union of Myanmar.
(c) Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of the Union of Myanmar.
I hereby declare that I fully understand the above mentioned conditions that the particulars given above are true and correct and that I will not engage in any activities irrelevant to the purpose of entry stated herein.
16. Daytime phone no. .................................................. ..................................
Date .............................. Signature of applicant .......................................................................................................................................
(FOR OFFICIAL USE ONLY) Visa No. .......................................... Date ................................. Visa Authority ............................................................................
Date ............................ Signature of Office-in-charge Place ........................... Consulate General of the Union of Myanmar New York
2
PLEASE DATE AND SIGN YOUR APPLICATIONS
FORM A
JOHNATHAN BONHAM DOEJOHANN SEBASTIAN DOE
USA MALE13 MARCH 1961 USA
ENGINEER
BROWN 5 FT. 11 INCHESBROWN CAUCASION
9876543210 12 JANUARY 2010USA DEPT OF STATE11 JANUARY 2020
1234 MAIN STREET ANYWHERE USA 98765
CHATRIUM HOTEL ROYAL LAKE YANGON MYANMAR
TOURISMDESTINATION ASIA
ROOM 1 2ND FL. PEARL CONDO BUILDING A KABA AYE PAGODA ROAD YANGON MYANMAR
PRE PAID TOURNOT APPLICABLE
NOT APPLICABLENOT APPLICABLE
NOT APPLICABLE
987-654-3210
ROYAL EMBASSY OF CAMBODIA IN : Washington D.C.
KINGDOM OF CAMBODIA Nation Religion King
~ ~
VISA APPLICATION FORM Photograph
4 x 6
Please submit 1 copy with 1 photo and your passportSurname: Present occupation:
First name:
Sex: Male FemaleDate of birth: Day..…..Month………Year…......Place of birth: ……………………………………
Place of residence:
Fax: /Phone:
Birth nationality:Present nationality: Work Place:
Passport of traveling document is valid for (country)
Date of entry to Cambodia: Day.….Month……Year…….Date of departure (length of stay)
Purpose of visit Diplomatic Tourist Official Business Others (Please Specify)
Point of entry:Means of Transportation:
Point of exit: Means of Transportation:
Address during the visit: Organization, Persons to be visited :First trip to Cambodia Yes
No
Passport No:Place of issue:Date of issue:Date of Expiration: Traveling on group tour Yes
NoSexSurname First name
Patronymic M FDate of birth Permanent
AddressChildren under 12 years
traveling with you
Relatives in the Kingdom of Cambodia
I hereby declare that the information on this form is true and correct
Place, (Date)………..…………….
(Signature of the applicant)
For official use
éf¶pþl; …………........... Tidæakarelx ………………elxsMKal;………………
RbePT …………………
éf¶ …… Ex …… qñaM ……
htßelxam®nþITTYlbnÞúkkic©karkugs‘ul
PLEASE DO NOT FORGET TO DATE AND SIGN YOUR VISA APPLICATION
PLEASE STAPLE ONE (1) PHOTO HERE
DOE Engineer
Jonathan Bonham✔
1234 Main Street Anywhere CA 98765
987-654-3210 No Fax03 MARCH 1961
USAUSA ABC International, Inc.
ALL COUNTRIESPER YOUR 2014
PER YOUR ITINERARY
✔
SIEM REAP
AirSIEM REAP
AIR
RAFFLES HOTEL, SIEM REAP
RAFFLES HOTEL, SIEM REAP DESTINATION ASIA
0123456789US Department of State
09 MAY 1999 10 MAY 2015
✔
✔
NONE
NONE
Los Angeles CA USA
GENERAL TOURS
PLEASE STAPLE 1 PHOTO HERE
PLEASE DO NOT FORGET TO DATE AND SIGN YOUR VISA APPLICATION
Jonathan DOE
13 MAR 1961 Los Angeles CA USA
USA Engineer
0123456789 National Passport Center
10 MAY 2005 09 MAY 2015
1234 Main Street Anywhere CA 98765 987-654-3210
NOT APPLICABLE
FOR US PASSPORTHOLDERS
TOURISM
PER YOUR ITIN AIR
HUAY XAI PER YOUR ITIN
DESTINATION ASIA 856 71 260 881
HOUSE NO. 04 UNIT 1 BAN KHILI LUANG PRABANG LAOS
SIEM REAP, CAMBODIA
GENERAL TOURS
Visa is valid for 3-months from the date of issue Copy No.1
EMBASSY OF THE REPUBLIC OF THE UNION OF MYANMAR, WASHINGTON D.C. APPLICATION FOR ENTRY VISA (TOURIST)
1. Name in Full ( Fill in Block Letters)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
( First Name ) (Middle Name ) ( Last Name)
2. Father's Full Name _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _
( First Name ) (Middle Name ) ( Last Name)
3. Date of Birth (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
4. Place of Birth (City / State / Country): _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _
5. Nationality: U.S. / (Others): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. Sex (F) / (M)
6. Present Occupation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(If retired write " retired", if student write "student")
7. Marital Status: Married Separated Divorced Widowed Single (Never Married)
8. Spouse's Full Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Personal Description
9. (a) Color of Hair _ _ _ _ _ _ _ _ _ _ _ (b) Height: m _ cm _ _ / ft. _ in. _ _
(c) Color of Eyes _ _ _ _ __ _ _ _ _ _ (d) Complexion _ _ _ _ _ _ _ _ _ _ _ _ _ _
Passport 10. (a) Number _ _ _ _ _ _ _ _ _ _ _ _ (b) Date of Issue (dd/mm/yyyy) _ _ / _ _ / _ _ _ _
(c) Dt. of expiration (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
(d) Place of issue: (e) Issuing Authority:
United States, _ _ _ _ _ _ _ _ _ _ _ United States, Department of State / Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ National Passport Centre / Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
11. Present Address in U.S. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Include apartment number, street, city, state or province & postal zone)
12. Contact Phn. No. (Res.) ( _ _ _ ) _ _ _ _ _ _ _ (Work) ( _ _ _ ) _ _ _ _ _ _ _ e-mail:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
13. Address in Myanmar:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
14. Have you ever been to Myanmar: Yes No (If Yes) Date of Last Visit: (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
15. Have you ever been refused to enter Myanmar: Yes No. (If Yes) When: (dd/mm/yyyy): _ _ / _ _ / _ _ _
Why: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
16. Purpose of Visit: Tourism / _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Expected date of Arrival: _ _ / _ _ / _ _ _ _ Flight No._ _ _ _ _ _ & Departure: _ _ / _ _ / _ _ _ _ , Flight No. _ _ _ _ _ ) dd mm yyyyy dd mm yyyyy
Attention for Applicant: (a) Apart from the professions mentioned this visa application form applicants are not to engage in any sort of work, with or without charges.
(b) Applicant shall abide by the Laws of the Republic of the Union of Myanmar and shall not interfere in the Internal Affairs of the Republic of the Union of Myanmar. (c) Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of the Republic of the Union of Myanmar. I hereby declare that I fully understand the above mentioned conditions, that the particulars given above are true and correct and that I will not engage in any activities irrelevant to the purpose of entry stated herein.
-------------------------------------------- Signature of Applicant
Date (dd/mm/yyyy) : _ _ / _ _ / _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (FOR OFFICE USE ONLY)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Visa No. ___________________ Date : ________________________ Visa Authority:MOFA Lt. No. 46 11 11 (76) Dated : 11 March 1994 (If other): MOFA Lt. No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, Dated:_ _ _ _ _ _ _
Signature of Officer in-Charge
Embassy of the Republic of the Union of Myanmar WashingtonD.C., U.S.A Contact : Tel. (202) 332 4352, (202) 238 9332 Fax.(202) 332 4351. http://mewashingtondc.com , e-mail: [email protected]) Up Dated : May, 2014
PHOTO Recently taken
color photo
with full face, front view, no hat
and against a plain light background
Official use only E.V.T(F.I.T) E.V.T (Package Tour)
DO NOT FORGET TO SIGN AND DATE YOUR APPLICATIONS
JOHNATHAN BONHAM DOE
JOHANN SEBASTIAN BACH
13 03 1961
LOS ANGELES USACALIFORNIA
✔ ✔
ENGINEER
✔
JOANNA DOE
BROWN ✔ 5 11BROWN CAUCASION
9876543210 09 02 201008 02 2020
✔
1234 MAIN ST. ANYWHERE, CALIFORNIA USA
987654-3210 456-1234987 [email protected] HOTEL ROYAL LAKE YANGON, MYANMAR
✔
✔
✔ PRE PAID TOUR WITH ALEXANDER+ROBERTSIP Y PYI P Y I PYI
Embassy of the Republic of the Union of Myanmar Washington D.C.
Work History for Visa Applicant
1. Name in Full (Fill in block letters):___________________________________________
Surname (As in Passport):_________________________________________________
First Name & Middle Name:________________________________________________
2. Date of birth (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
3. Place of birth: U.S., ______________________ (Other): _____________________
4. Permanent Home Address:_________________________________________________
______________________________________________________________________
5. Tel. (Res.) ( ) _____________ (Work Place) ( ) ____________
e-mail: ___________________________________________________
6. Work Description (Current)
Job Title :__________________________________________________________
From(dd/mm/yyyy):____/___/______-To (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
(b) Office __________________________________________________________
Department ________________________________________________________
Describe your Duties: _____________________________________________
_______________________________________________________________
7. Work Description (Previous)
(a) Job Title:____________________________________________
From (dd/mm/yyyy) _ _ / _ _ /_ _ _ _ To (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
(b) Office __________________________________________________________
Department ________________________________________________________
Describe your Duties: _____________________________________________
_______________________________________________________________
_______________________________________________________________
I hereby declare that the particulars given above are true and correct and that I will not engage in any
activities irrelevant to the purpose of my entry.
____________________
Signature of Applicant
Date: (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
Up Dated : May, 2014
DO NOT FORGET TO SIGN AND DATE YOUR APPLICATIONS
JOHNATHAN BONHAM DOE
DOEJOHNATHAN BONHAM
13 03 1961
✔ LOS ANGELES, CA1234 MAIN ST. ANYWHERE, CALIFORNIA USA
987 654-3210 987 [email protected]
ENGINEER 09 07 2005 06 25 2014
ENGINEERINGENGINEERING
ENGINEERING
PRODUCTION MANAGER12 10 1990 09 07 2005
PRODUCTIONPRODUCTION
PRODUCTION
Visa is valid for 3-months from the date of issue Copy No.1
EMBASSY OF THE REPUBLIC OF THE UNION OF MYANMAR, WASHINGTON D.C. APPLICATION FOR ENTRY VISA (TOURIST)
1. Name in Full ( Fill in Block Letters)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
( First Name ) (Middle Name ) ( Last Name)
2. Father's Full Name _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _
( First Name ) (Middle Name ) ( Last Name)
3. Date of Birth (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
4. Place of Birth (City / State / Country): _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _
5. Nationality: U.S. / (Others): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. Sex (F) / (M)
6. Present Occupation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(If retired write " retired", if student write "student")
7. Marital Status: Married Separated Divorced Widowed Single (Never Married)
8. Spouse's Full Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Personal Description
9. (a) Color of Hair _ _ _ _ _ _ _ _ _ _ _ (b) Height: m _ cm _ _ / ft. _ in. _ _
(c) Color of Eyes _ _ _ _ __ _ _ _ _ _ (d) Complexion _ _ _ _ _ _ _ _ _ _ _ _ _ _
Passport 10. (a) Number _ _ _ _ _ _ _ _ _ _ _ _ (b) Date of Issue (dd/mm/yyyy) _ _ / _ _ / _ _ _ _
(c) Dt. of expiration (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
(d) Place of issue: (e) Issuing Authority:
United States, _ _ _ _ _ _ _ _ _ _ _ United States, Department of State / Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ National Passport Centre / Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
11. Present Address in U.S. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Include apartment number, street, city, state or province & postal zone)
12. Contact Phn. No. (Res.) ( _ _ _ ) _ _ _ _ _ _ _ (Work) ( _ _ _ ) _ _ _ _ _ _ _ e-mail:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
13. Address in Myanmar:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
14. Have you ever been to Myanmar: Yes No (If Yes) Date of Last Visit: (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
15. Have you ever been refused to enter Myanmar: Yes No. (If Yes) When: (dd/mm/yyyy): _ _ / _ _ / _ _ _
Why: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
16. Purpose of Visit: Tourism / _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Expected date of Arrival: _ _ / _ _ / _ _ _ _ Flight No._ _ _ _ _ _ & Departure: _ _ / _ _ / _ _ _ _ , Flight No. _ _ _ _ _ ) dd mm yyyyy dd mm yyyyy
Attention for Applicant: (a) Apart from the professions mentioned this visa application form applicants are not to engage in any sort of work, with or without charges.
(b) Applicant shall abide by the Laws of the Republic of the Union of Myanmar and shall not interfere in the Internal Affairs of the Republic of the Union of Myanmar. (c) Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of the Republic of the Union of Myanmar. I hereby declare that I fully understand the above mentioned conditions, that the particulars given above are true and correct and that I will not engage in any activities irrelevant to the purpose of entry stated herein.
-------------------------------------------- Signature of Applicant
Date (dd/mm/yyyy) : _ _ / _ _ / _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (FOR OFFICE USE ONLY)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Visa No. ___________________ Date : ________________________ Visa Authority:MOFA Lt. No. 46 11 11 (76) Dated : 11 March 1994 (If other): MOFA Lt. No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, Dated:_ _ _ _ _ _ _
Signature of Officer in-Charge
Embassy of the Republic of the Union of Myanmar WashingtonD.C., U.S.A Contact : Tel. (202) 332 4352, (202) 238 9332 Fax.(202) 332 4351. http://mewashingtondc.com , e-mail: [email protected]) Up Dated : May, 2014
PHOTO Recently taken
color photo
with full face, front view, no hat
and against a plain light background
Official use only E.V.T(F.I.T) E.V.T (Package Tour)
CHATRIUM HOTEL ROYAL LAKE YANGON MYANMAR
✔ PRE-PAID TOUR WITH ALEXANDER+ROBERTS
Visa is valid for 3-months from the date of issue Copy No.2
EMBASSY OF THE REPUBLIC OF THE UNION OF MYANMAR, WASHINGTON D.C. APPLICATION FOR ENTRY VISA (TOURIST)
1. Name in Full ( Fill in Block Letters)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
( First Name ) (Middle Name ) ( Last Name)
2. Father's Full Name _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _ _
( First Name ) (Middle Name ) ( Last Name)
3. Date of Birth (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
4. Place of Birth (City / State / Country): _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ / _ _ _ _ _ _ _ _ _ _
5. Nationality: U.S. / (Others): _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 4. Sex (F) / (M)
6. Present Occupation: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(If retired write " retired", if student write "student")
7. Marital Status: Married Separated Divorced Widowed Single (Never Married)
8. Spouse's Full Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Personal Description
9. (a) Color of Hair _ _ _ _ _ _ _ _ _ _ _ (b) Height: m _ cm _ _ / ft. _ in. _ _
(c) Color of Eyes _ _ _ _ __ _ _ _ _ _ (d) Complexion _ _ _ _ _ _ _ _ _ _ _ _ _ _
Passport 10. (a) Number _ _ _ _ _ _ _ _ _ _ _ _ (b) Date of Issue (dd/mm/yyyy) _ _ / _ _ / _ _ _ _
(c) Dt. of expiration (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
(d) Place of issue: (e) Issuing Authority:
United States, _ _ _ _ _ _ _ _ _ _ _ United States, Department of State / Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ National Passport Centre / Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
11. Present Address in U.S. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Include apartment number, street, city, state or province & postal zone)
12. Contact Phn. No. (Res.) ( _ _ _ ) _ _ _ _ _ _ _ (Work) ( _ _ _ ) _ _ _ _ _ _ _ e-mail:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
13. Address in Myanmar:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
14. Have you ever been to Myanmar: Yes No (If Yes) Date of Last Visit: (dd/mm/yyyy): _ _ / _ _ / _ _ _ _
15. Have you ever been refused to enter Myanmar: Yes No. (If Yes) When: (dd/mm/yyyy): _ _ / _ _ / _ _ _
Why: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
16. Purpose of Visit: Tourism / _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
(Expected date of Arrival: _ _ / _ _ / _ _ _ _ Flight No._ _ _ _ _ _ & Departure: _ _ / _ _ / _ _ _ _ , Flight No. _ _ _ _ _ ) dd mm yyyyy dd mm yyyyy
Attention for Applicant: (a) Apart from the professions mentioned this visa application form applicants are not to engage in any sort of work, with or without charges.
(b) Applicant shall abide by the Laws of the Republic of the Union of Myanmar and shall not interfere in the Internal Affairs of the Republic of the Union of Myanmar. (c) Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of the Republic of the Union of Myanmar. I hereby declare that I fully understand the above mentioned conditions, that the particulars given above are true and correct and that I will not engage in any activities irrelevant to the purpose of entry stated herein.
-------------------------------------------- Signature of Applicant
Date (dd/mm/yyyy) : _ _ / _ _ / _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (FOR OFFICE USE ONLY)_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Visa No. ___________________ Date : ________________________ Visa Authority:MOFA Lt. No. 46 11 11 (76) Dated : 11 March 1994 (If other): MOFA Lt. No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, Dated:_ _ _ _ _ _ _
Signature of Officer in-Charge
Embassy of the Republic of the Union of Myanmar WashingtonD.C., U.S.A Contact : Tel. (202) 332 4352, (202) 238 9332 Fax.(202) 332 4351. http://mewashingtondc.com , e-mail: [email protected]) Up Dated : May, 2014
PHOTO Recently taken
color photo
with full face, front view, no hat
and against a plain light background
Official use only E.V.T(F.I.T) E.V.T (Package Tour)
CHATRIUM HOTEL ROYAL LAKE YANGON MYANMAR
✔ PREPAID TOUR WITH ALEXANDER+ROBERTS
Embassy of the Republic of the Union of Myanmar Washington D.C.
Work History for Visa Applicant
1. Name in Full (Fill in block letters):___________________________________________
Surname (As in Passport):_________________________________________________
First Name & Middle Name:________________________________________________
2. Date of birth (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
3. Place of birth: U.S., ______________________ (Other): _____________________
4. Permanent Home Address:_________________________________________________
______________________________________________________________________
5. Tel. (Res.) ( ) _____________ (Work Place) ( ) ____________
e-mail: ___________________________________________________
6. Work Description (Current)
Job Title :__________________________________________________________
From(dd/mm/yyyy):____/___/______-To (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
(b) Office __________________________________________________________
Department ________________________________________________________
Describe your Duties: _____________________________________________
_______________________________________________________________
7. Work Description (Previous)
(a) Job Title:____________________________________________
From (dd/mm/yyyy) _ _ / _ _ /_ _ _ _ To (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
(b) Office __________________________________________________________
Department ________________________________________________________
Describe your Duties: _____________________________________________
_______________________________________________________________
_______________________________________________________________
I hereby declare that the particulars given above are true and correct and that I will not engage in any
activities irrelevant to the purpose of my entry.
____________________
Signature of Applicant
Date: (dd/mm/yyyy) _ _ / _ _ /_ _ _ _
Up Dated : May, 2014
ROYAL EMBASSY OF CAMBODIA IN : Washington D.C.
KINGDOM OF CAMBODIA Nation Religion King
~ ~
VISA APPLICATION FORM Photograph
4 x 6
Please submit 1 copy with 1 photo and your passportSurname: Present occupation:
First name:
Sex: Male FemaleDate of birth: Day..…..Month………Year…......Place of birth: ……………………………………
Place of residence:
Fax: /Phone:
Birth nationality:Present nationality: Work Place:
Passport of traveling document is valid for (country)
Date of entry to Cambodia: Day.….Month……Year…….Date of departure (length of stay)
Purpose of visit Diplomatic Tourist Official Business Others (Please Specify)
Point of entry:Means of Transportation:
Point of exit: Means of Transportation:
Address during the visit: Organization, Persons to be visited :First trip to Cambodia Yes
No
Passport No:Place of issue:Date of issue:Date of Expiration: Traveling on group tour Yes
NoSexSurname First name
Patronymic M FDate of birth Permanent
AddressChildren under 12 years
traveling with you
Relatives in the Kingdom of Cambodia
I hereby declare that the information on this form is true and correct
Place, (Date)………..…………….
(Signature of the applicant)
For official use
éf¶pþl; …………........... Tidæakarelx ………………elxsMKal;………………
RbePT …………………
éf¶ …… Ex …… qñaM ……
htßelxam®nþITTYlbnÞúkkic©karkugs‘ul
ALL COUNTRIES2014
✔
Siem Reap
AIR
SIEM REAP
AIR
RAFFLES GRAND HOTEL D'ANGKOR
RAFFLES GRAND HOTEL D'ANGKOR DESTINATION ASIA
✔
GENERAL TOURS
TOURISM
HUAY XAI
DESTINATION ASIA 856 71 260 881
HOUSE NO 04 UNIT 1 BAN KHILI LUANG PRABANG LAOS
SIEM REAP, CAMBODIA
GENERAL TOURS