2.

PASTE
FORM :- VISA Nº. B62/2013 STATE OF ERITREA PHOTOGRAPH
DEP. OF IMMIGRATION & NATIONALITY
APPLICATION FORM FOR VISA (35X45mm)

1. REFERENCE Nº.
DO NOT STAPLE

3. APPLICATION FOR ENTRY EXIT

RE-ENTRY EXTENSION/RENEWAL

(PLEASE USE CAPITAL LETTERS)

4. FULL NAME AS IN PASSPORT

4.1 FORMER OTHER NAME (if different from above) 5. MOTHER’S NAME

6. SEX MALE 7. PLACE OF BIRTH (country) (city or town) 7.1. DATE OF BIRTH
Date Month Year
FEMALE / /
8. OCCUPATION 9. PRESENT NATIONALITY 9.1 NATIONALITY BY BIRTH 10. ERITREAN ID No.

11. MARITAL STATUS MARRIED DIVORCED SINGLE WIDOWED

12. PASSPORT TYPE Number Place of Issue Date of Issue Date of Expiry
/ / / /
13. PERMANENT Country City/Town Street& House No. Telephone
ADDRESS
(outside Eritrea)
14. ADDRESS IN Zone Sub Zone City/town Street & House No. Telephone
ERITREA

15. ENTRY VISA

15.1 PURPOSE BUSINESS EMPLOYMENT TOURISM OFFICIAL
OF ENTRY
STUDENT FAMILY VISIT OTHER TRANSIT

If transit, entry visa to the country of destination valid until ________/ _________/ __________
15.2 ENTRY SINGLE MULTIPLE 15.3 PERIOD OF STAY___________
DESIRED
15.3 HOST (REFERENCE) Zone City/Town Street & House No. Telephone
IN ERITREA
(for non resident aliens)

16. EXIT / RE-ENTRY VISA

16.1 COUNTRY OF DESTINATION

16.2 RESIDENT PERMIT No. Place of Issue Date of Issue Date of Expiry
(if resident in Eritrea) / / / /
16.3 PURPOSE RESIDE ABROAD BUSINESS EMPLOYMENT OFFICIAL
TOURISM TRAINING MEDICAL OTHER
16.4 GOOD FOR SINGLE MULTIPLE 16.5 VISA VALID FOR
 17. PERSONS TRAVELLING ON THE SAME PASSPORT
No. NAME SEX PLACE OF BIRTH DATE OF BIRTH
DATE MONTH YEAR
1
2
3
4

17.1 Paste photograph of the person/s traveling on the same passport in the space provided below

1. 2. 3. 4.
PASTE
PHOTOGRAPH PASTE PASTE PASTE
PHOTOGRAPH PHOTOGRAPH PHOTOGRAPH
(35X45mm)
(35X45mm) (35X45mm) (35X45mm)
DO NOT STAPLE
DO NOT STAPLE DO NOT STAPLE DO NOT STAPLE

18. VISA EXTENSION/RENEWAL

VISA Type of Visa Place of Issue Date of Issue Purpose of Extension
EXTENSION/
RENEWAL / /

19. I ______________________________________________________________________ declare that the information

given above is correct and complete. Signature ___________________ Date ______ / _________ / _________

20. FOR OFFICIAL USE ONLY

DECISION TAKEN _____________________________________________________________________________________

VISA GOOD FOR SINGLE MULTIPLE RE-ENTRY VISA VALID FOR ___________________________

THE VISA IS EXTENDED/RENEWED UP TO _______ /________ /_________ (for visa extension/renewal only)

REMARKS ______________________________________________________________________________________________

________________________________________________________________________________________________

AMOUNT TO BE PAID ___________________ CURRENCY __________________

NAME OF AUTHORITY _____________________________________________________

SIGNATURE ______________________ DATE _________/ ____________/ __________ ↑

RECEIPT No. _______________________ VISA No. _______________________________ SEAL

21. RESERVED FOR CASHIER

22. CHECKING
Reception Photo capturing Data Capturing Cash receipt Verification Printing Quality Control Issuance