Consular Section
1504-5, 15th Floor, Office Tower, Shangri-la Centre
No.9 Xiang Gang Zhong Road, Shinan District, Qingdao
Tel. & Fax: 0532 8667 0056 E-mail: h APPLICATION FOR VISA
以英文填写
先生 女士 小姐 First Name (名) Middle Name Family name (姓) (in BLOCK letters) (大写字母) Former Name (if any) __________________________________ 曾用名 （如有） Nationality 国籍Chine /中国人Other ( ) Plea Specify
Nationality at Birth ___________________________________ 出生地所在国
Birth Place ______________ Marital Status Married 出生地 生日期 No.___________________ Issued at _____________________ 号码 签发地
(plea also specify prent position and name of employer)
职业 （请列出目前职位和雇主姓名）
________________________________________________________
Current Address _____________________________________
现地址 _____________________________________________ Tel. _____________________ E-mail ____________________ 电话 邮箱地址
Permanent Address (if different from above) _______________________ 永久地址（如与现在地址
不同，请注明）____________________ ________________________________________________________________________________________________________________ Tel. 电话 ________________________________________________ Name(s), date(s) and place(s) of birth of minor children accompanying 如有用同本护照的随行儿童，请填写姓名、出生日期及出生地
________________________________________________________________________________________________________________ Date of Arrival in Thailand _____________________________ 抵达泰国日期 Traveling by 交通工具 ____________________________________ Flight No. or Vesl’s name 航班号/船次 ____________________ Duration of Propod Stay 停留时间 ________________________ Date of Previous Visit to Thailand _________________________ 上次赴泰日期
旅游过境
商务外交/公务
(plea specify) 其他（请列出） _______________________ Countries for which travel document is valid 护照适用国 ___________________________________________________ Propod Address in Thailand 拟停留地址 _________________
______________________________________________________________________________________________________
Name and Address of Local Guarantor in China 本国担保人姓名及地址
___________________________________________________
电话/传真 ____________________________________ 本国担保人姓名及地址 Tel./Fax.电话/传真 ____________________________________ 本人在次声明：如被拒签，不要求退还签证费用。
Signature ___________________________ Date ___________
签名
日期
