Chile Visa Application
Transcription
Chile Visa Application
Deliver / Mail / Drop-off to a location that is closest to your jurisdiction: 2200 Pennsylvania Ave NW 45 West 34th St. Suite 703 323 Geary Street, # 815 4th Floor E. San Francisco, CA 94102 New York, NY 10001 Washington, DC 20037 Toll Free 1-877-917-7705 Toll Free 1-877-203-2551 Toll Free 1-877-400-0235 Fax 1-866-835-4372 MANDATORY ORDER FORM 'VMMZDPNQMFUFUIJTGPSNBOETVCNJUXJUIZPVSBQQMJDBUJPO1SPDFTTJOHXJMMCFIFMEJGJUFNTBSFNJTTJOHPSJODPNQMFUF 4FDUJPO$0/5"$5*/'03."5*0/ /".& 5&-&1)0/& &."*- &NBJMBEESFTTXJMMCFVTFEUPQSPWJEFWJUBMQBTTQPSUUSBDLJOH JOGPSNBUJPOBTXFMMBTQFSJPEJDUSBWFMVQEBUFTQBZNFOUJOWPJDF 4FDUJPO5:1&0'7*4"50#&130$&44&%DPNQMFUFNVMUJQMFMJOFTJGBQQMZJOHGPSNPSFUIBOPOFWJTB 7*4" $045 )*/5-*45"#07&5)&$06/53:'03"11-*$"5*0/$"5&(03:UPVSJTUCVTJOFTTXPSLFUD 5:1&TJOHMFEPVCMFPSNVMUJQMF 0'7*4" 7*4" $045 )*/5-*45"#07&5)&$06/53:'03"11-*$"5*0/$"5&(03:UPVSJTUCVTJOFTTXPSLFUD 5:1&TJOHMFEPVCMFPSNVMUJQMF 0'7*4" 7*4" $045 )*/5-*45"#07&5)&$06/53:'03"11-*$"5*0/$"5&(03:UPVSJTUCVTJOFTTXPSLFUD 5:1&TJOHMFEPVCMFPSNVMUJQMF 0'7*4" 7*4" $045 )*/5-*45"#07&5)&$06/53:'03"11-*$"5*0/$"5&(03:UPVSJTUCVTJOFTTXPSLFUD 5:1&TJOHMFEPVCMFPSNVMUJQMF 0'7*4" 505"-7*4"$045 #09" 46.61"#07	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he world unfortunately is not a safe place. When you travel abroad and surrounded by foreign environment many situations, in some cases hostile may arise, like terrorist attacks, banditry or even war. Plus there are natural disasters and catastrophes. Visacenter.us can help you to make your contact information in the country where you are traveling available to US Embassy/Consular officials responsible for helping Americans abroad. What is the registration? Upon your request the Department of State in Washington DC will be provided with your major contact information in the country of your travel. In the event there is a need to contact Americans to offer urgent advice or evacuation during a natural disaster or civil unrest, US Embassy/Consulate contacts all registered US citizens in that country. U.S. consular officers assist Americans who encounter serious legal, medical, or financial difficulties. OFFICIAL REGISTRATION IS RECOMMENDED for ALL Americans traveling abroad for business or pleasure, or residing abroad, irrespectively of the length of travel. It is best to register BEFORE the start of the trip. What should I do to register? To register, you are required to fill-out short US Embassy Registartion Request Form with your basic contact and travel information. What is the cost? The cost of peace of mind is just USD10.00 per person. □ Yes, I want to register and agree that Visacenter.us submits on my behalf my data exactly as provided by myself on the form for US Embassy Registartion service by The Bureau of Consular Affairs of the US Department of State and agree that for this act the charge of CAD 10.00 be added to the total payment for my visa services order. Signature: __________________________________ Date: ____________________ Next step: → Please, fill-out the following US Embassy Registration Request Form US EMBASSY REGISTRATION REQUEST FORM BASIC INFORMATION FIRST NAME LAST NAME DATE OF BIRTH MONTH DAY GENDER M/ F YEAR CITIZENSHIP PASSPORT PASSPORT NUMBER PASSPORT DATE OF ISSUE MONTH DAY YEAR MONTH DAY YEAR PASSPORT DATE OF EXPIRATION HOME RESIDENCE ADDRESS 1 ADDRESS 2 CITY STATE ZIP CODE CONTACT EMAIL ADDRESS DESTINATION INFORMATION COUNTRY PURPOSE OF VISIT DESTINATION DATE OF ARRIVAL MONTH DAY YEAR MONTH DAY YEAR DESTINATION DATE OF DEPARTURE TYPE of RESIDENCE HOTEL HOME SCHOOL OTHER ADDRESS at DESTINATION CITY PHONE NUMBER AT DESTINATION Note: If you have more than one destination please, provide details on a separate sheet of paper. DATE: MONTH DAY YEAR SIGNATURE: Embajada de Chile en Canada Embassy of Chile in Canada Ambassade du Chili au Canada DIPLOMATIC/OFFICIAL VISA A.-PERSONAL INFORMATION A.- INFORMATION PERSONNELLE 1.- LAST NAME: (As shown in your passport) 1.- Nom: (comme dans le passeport) 3.- GENDER: 3.- GENRE F:_____ VISA DIPLOMATIQUE/OFFICIELLE 2. FIRST AND MIDDLE NAME: (As shown in your passport) 2. Prénom(s) : (comme dans le passeport) 4.- PLACE OF BIRTH: (City, Province, Country) 4.- LIEU DE NAISSANCE: (Ville, Province, Pays) M: _____ 5.- DATE OF BIRTH: (DD/MM/YYYY) 5.- DATE DE NAISSANCE: (JJ/MM/AAAA) 6.- CITIZENSHIP: (Current and others) 6.- NATIONALITE: (Actuel et autres) 7.- PASSPORT Nº / TRAVEL DOCUMENT: 7.- NOMBRE DU PASSEPORT/ DOCUMENT DU VOYAGE : 8.- EXPIRATION DATE: (DD/MM/YYYY) 8.- DATE D’EXPIRATION DU PASSEPORT : (JJ/MM/AAAA) 9.- MARITAL STATUS: 9. SITUATION DE FAMILLE: 10.- LENGTH OF STAY: 10.- DURÉE DU SÉJOUR: Single_______ Married_____ Widowed___ Separated___ Divorced___ Célibataire____ Marié_______ Veuf______ Séparé_____ Divorcé ___ 11.- DEPARTURE DATE: (DD/MM/YY) 11.- DATE DU DÉPART: (JJ/MM/AAAA) Months/Mois:______ Weeks/Semaines:______ Days/Jours:______ 12.- ADRESS IN CANADA: (Number, Street, Unit , City, Province, Postal Code) 12.- ADRESSE AU CANADA: (Nombre, Rue, Appartement, Ville, Province, Code Postale) 13.- PURPOSE OF YOUR VISIT: 13.- RAISON DE VOTRE VISITE: 14.- EMPLOYER: 14.- EMPLOYEUR: 15.- JOB TITLE: 15.- TITRE DU TRAVAIL: B.-FAMILY MEMBERS: (if accompanying you to Chile) B.- MEMBRES DE FAMILLE : (Si ils vous accompagnent au Chili) 1.- LAST NAME: (As shown in your passport) 1.- NOM : (comme dans le passeport) 2. FIRST AND MIDDLE NAME: (As shown in your passport) 2. PRENOM(S) : (comme dans le passeport) 3.- GENDER: 3.- GENRE: 4.- RELATIONSHIP: 4.- RELATION FAMILIERE: F:_____ M: _____ 5.- DATE OF BIRTH: (DD/MM/YYYY) 5.- DATE DE NAISSANCE : (JJ/MM/AAAA) 6.- CITIZENSHIP: (Current and others) 6.- NATIONALITE: (actuel et autres) 2.1.- LAST NAME: (As shown in your passport) 2.1.- NOM: (comme dans le passeport) 2.2.- FIRST AND MIDDLE NAME: (As shown in your passport) 2.2.- PRENOM(S): (comme dans le passeport) 2.3.- GENDER: 2.3.- GENRE: 2.4.- RELATIONSHIP: 2.4.- RELATION FAMILIERE: F:_____ M: _____ 2.5.- DATE OF BIRTH: (DD/MM/YYYY) 2.5.- DATE DE NAISSANCE : (JJ/MM/AAAA) 2.6.- CITIZENSHIP: (Current and others) 2.6.- NATIONALITE: (actuel et autres) 3.1.- LAST NAME: (As shown in your passport) 3.1.- NOM : (comme dans le passeport) 3.2.- FIRST AND MIDDLE NAME: (As shown in your passport) 3.2.- PRENOM(S) : (comme dans le passeport) 3.3.- GENDER: 3.3.- GENRE: 3.4.- RELATIONSHIP: 3.4.- RELATION FAMILIERE: F:_____ M: _____ 3.5.- DATE OF BIRTH: (DD/MM/YYYY) 3.5.- DATE DE NAISSANCE : (JJ/MM/AAAA) 3.6.- CITIZENSHIP: (Current and others) 3.6.- NATIONALITE: (actuel et autres) Embajada de Chile en Canada. Embassy of Chile in Canada. Ambassade du Chili au Canada 1 of 2 Embajada de Chile en Canada Embassy of Chile in Canada Ambassade du Chili au Canada C.-ADDITIONAL INFORMATION: C.- INFORMATION ADDITIONNELLE: Have you or any of your family members: Est-ce que vous ou quelqu’un de votre famille : 31. - In the last years, suffered pulmonary tuberculosis or H1N1 or have been in contact with a person with pulmonary tuberculosis or H1N1? YES/OUI NO/NON YES/OUI NO/NON YES/OUI NO/NON 34. - Have requested any Chilean immigration visa? (Permanent resident, Student, Work, Visitor, Temporary Resident, etc.) 34. – A demandé n'importe quel Visa Chilienne d'immigration ? (Résident, Etudiant, Travail, Visiteur, Résident Temporaire, Etc.) YES/OUI NO/NON 35. - Have been denied a visa to travel to Chile? YES/OUI NO/NON YES/OUI NO/NON 31.- A eu tuberculoses pulmonaire ou H1N1 ou a eu contact avec une personne qui a eu une de ces maladies, pendants les dernières années ? 32. - Committed, been arrested, or have been accused from any offence in any country? 32.- Engagé, être arrêté ou avoir accusés de n'importe quelle offense dans n'importe quel pays? 33. - Have been denied access to Chile, or been requested to leave Chile? 33. – a eu nié l'accès au Chili, ou a été demandés de quitter le Chili ? 35. - A été niés une visa pour voyager au Chili ? 36.- During peace or war times, have been involved in the execution of a war crime or a crime against humanity, for example; assassination, torture, aggression, summit to slavery, deprive civilians or war prisoners from food or in the deporting of civilians? 36.- Durant des périodes de paix ou de guerre, a été impliqués dans l'exécution d'un crime de guerre ou d'un crime contre l'humanité, par exemple ; l'assassinat, torture, l'agression, esclavage, priver aux civils ou aux prisonniers de guerre de la nourriture ou dans l'expulsion de civils ? If YES, please give details: (you may add an extra page if needed) Si OUI, fournissez svp les détails: (vous pouvez ajouter une page supplémentaire si nécessaire) 37.- YOUR CONTACT INFORMATION: 37- VOTRE INFORMATION DU CONTACT: Phone: (Code & Number) Téléphone: (Code & numéro) Cellular: (Code & Number) Cellulaire: (Code & numéro) E-mail/Courriel:_______________________________________ ( ( ) ) AFFIDAVIT: I declare that I am aware that during my stay in Chile I may not carry out gainful activities nor intervene in its internal policy or in acts against its Political Constitution or the Laws, Decrees and other provisions applicable in its territory and promise, during my stay in Chile NOT to apply for a change of my status. I further declare that all the particulars contained in this Application are true. DÉCLARATION SOUS SERMENT : Je déclare que je me rends compte que pendant mon séjour au Chili je ne peux pas effectuer des activités rémunératrices ni intervenir dans la politique interne ou dans des actes contre la constitution politique, les lois, les décrets dans le territoire et promet que, pendant mon séjour au Chili, je ne demanderais pas un changement de mon statut. Je déclare aussi que toutes les informations contenues dans ce formulaire sont vraies. DD / MM / YY JJ / MM / AA ----------------------------------------------------DATE ------------------------------------------------------------------------------APPLICANT’S SIGNATURE SIGNATURE DU SOLLICITEUR Embajada de Chile en Canada. Embassy of Chile in Canada. Ambassade du Chili au Canada 2 of 2