_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _II MINISTERIO DEL INTERIOR II DIRECCIÓN GENERAL DE MIGRACIONES Y NATURALIZACIÓN II ANDEAN MIGRATION CARD II II II (PLEASE PRINT) II 1. SURNAME II II 2. NAMES II 3. COUNTRY OF BIRTH II 4. NATIONALITY II 5. COUNTRY OF RESIDENCE II 6. POINT OF EMBARKATION, NO STOPOVER II II 7. TYPE OF DOCUMENT OF TRAVEL PASSPORT SALFE-CONDUCT OTHERS II II 8. NUMBER OF DOCUMENT II 9. DATE OF BIRTH 10. SEX 11. MARITAL STATUS III DAY MONTH YEAR MALE FEMALE SINGLE MARRIED OTHERS I

I 12. OCUPATION OR PROFESSION II 13. TYPE OF LODGING II DIRECCIÓN II PRIVATE HOTEL GUESTHOUSE II II 14. MEANS OF TRANSPORT AIR LAND MARITIME RIVER II I

I 15. NAME OF CARRIER I

I 16. MAIN PURPOSE OF TRAVEL I

I HOLIDAYS VISITING BUSINESS HEALTH WORK OTHERS II II (FOR OFFICIAL USE ONLY) II I

I PERUANO OFIC/DIPLOMA TRIPULANTE II TIPO DE VISA I

I TEMPORAL RESIDENTE SELLO DE ENTRADA O SALIDA II - - - - - - - - - - - - - - - - - - - - - - II MINISTERIO DEL INTERIOR II DIRECCIÓN GENERAL DE MIGRACIONES Y NATURALIZACIÓN II ANDEN MIGRATION CARD II II (PLEASE PRINT) I

I 1. SURNAME II II 2. NAMES II II 3. DATE OF BIRTH DAY MONTH YEAR II II 4. NATIONALITY II II 5. TYPE OF DOCUMENT OF TRAVEL PASSPORT DENTIFICATION CARD SALFE-CONDUCT OTHERS II 6. NUMBER OF DOCUMENT II 7. AMOUNT EXPENDED DURING YOURS STAY US $ II (FOR OFFICIAL USE ONLY) II CONSERVAR PARA SU RETORNO II II II II II II SELLO DE ENTRADA SELLO DE SALIDA I- - - - - - - - - - - - - - - - - - - - - - - -

IDENTIFICATION CARD