VISA APPLICATION
IMPORTANT! Please print or write in block letters using ball-point pen
I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will
lead to my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the law
of the Russian Federation. I undertake to leave the territory of the Russian Federation before the expiry of the visa, if
granted. I have been informed that possession of a visa is only one of the prerequisites for entry into the territory of the Russian
Federation. In case I am not allowed to enter Russia, I won't be entitled to compensation.
1. Nationality (If you had USSR or Russian nationality at some time please indicate
7. Main purpose of the journey
when and why you lost it)
8. Category and type of visa
2. Surname (as indicated in passport)
9. Number of entries
Single entry
3. First name, other names, patronymic names (as indicated in passport)
Double entry
10. Date of entry into Russia
Multiple entry
11. Date of exit from Russia
(dd/mm/yy)
4. Date of birth (dd/mm/yy)
12. How many times have you been
5. Sex
Male
6. Passport #
(dd/mm/yy)
Female
to Russia?
Date of the latest trip to Russia (dd/mm/yy)
Date of issue
Expires on
from
till
(dd/mm/yy)
13. Name of host organisation you intend to visit? (for tourists - name and reference number of host travel company, for business visas - name of host
(dd/mm/yy)
organisation and point of destination, for private visas - full name and address of the inviting person)
14. Route of journey (points of destination)
15. Do you have medical coverage valid in Russia?
yes
Provide details
no
16. Children under 16 years and other relatives listed in your passport and travelling with you :
Surname, first name, date of birth (dd/mm/yy), your residence address
no
yes
17. Other names used in the past (maiden, religious, nicknames etc.)
18. Your residence address, telephone, fax, email
Place for
photograph
19. Your place of birth (if you were born in Russia or USSR, specify when and which country you have emigrated to)
20. Place of work or study, position (name of employer, address, tel, fax, email)
I hereby agree that my personal data will be
processed and communicated electronically
for approval of my visa application.
Date (dd/mm/yy), personal signature
21. Do you currently have relatives in Russia? (please indicate their full names, relation
degree, dates of birth, address)