PHOTO

4.5 × 3.5 cm

HONORARY CONSULATE OF TANZANIA-OSAKA VISA APPLICATION FORM

FOR OFFICIAL USE ONLY

Visa No.____________________________ GRR No. ___________________________ Officer _____________________________ Date _______________________________

Type of visa requested: Travel visa Transit visa 1. Surname or Family Name __________________________________________________________ 2. First Name (s) ___________________________________________________________________ 3. Maiden Name ___________________________________________________________________ 4. Date of Birth ________________________________________ Sex ________________________ 5. Place of Birth _____________________ Country of Birth ________________________________ 6. Nationality _____________________________________________________________________ 7. Current Address _________________________________________________________________ Tel ______________________________ E-mail _______________________________________ 8. Marital status: Married Single Divorced Widowed 9. Names, date and place of birth of minor children accompanying you * In case a minor is traveling alone, please submit a parental authority. ______________________________________________________________________________ 10. Profession / Occupation __________________________________________________________ Employer’s address ______________________________________________________________ 11. Passport No. ______________________ Date Issued ___________________________________ Valid Until _______________________ Issued At _____________________________________ 12. Date of Entry _____________________ Departure Date _________________________________ Duration of Stay ________________ Budget available for your stay U.S.$___________________ 13. Contact address in Tanzania _______________________________________________________ _________________________________________ Tel __________________________________

14. Purpose of Visit Leisure, Holiday Other Business Various Visiting friends, relatives Study Diplomatic Mission Transit Official Meeting, Conference Health Treatment Same day visitor

15. Requested number of entries: Single Double Multiple 16. In case of transit: Do you have an entry permit for the final country of destination? Yes No Valid until:

17. I hereby declare that the information stated above is true and correct: Signature of Applicant ___________________________ Date ____________________________