Visa Application for Burkina Faso Demande de Visa Burkina Faso

TRAVCOUR (UK) LTD ORDER FORM
Collingham House, 6-12 Gladstone Road, Wimbledon, SW19 1QT
Main Tel: 020 85431846 Fax 020 85409190
e-mail: [email protected] Website: www.travcour.com
Opening Hours: Mon – Fri 9 am to 5.30 pm
SERVICES FOR BURKINA FASO VISAS
(PLEASE COMPLETE ALL SECTIONS IN BLOCK CAPITALS)
STEP ONE: In order to apply for your visa, please ensure that you enclose the following documents in your delivery to us. Failure to do so will
result in a delay in your application. (Please note that embassies reserve the right to request additional documents)
Visa application
Photos
Passport
Order form & payment
2
2
1
Business visas will also require an invitation from the company being visited in Burkina Faso and UK introduction letter.
STEP TWO: Please insert dates of travel & tick the service you are applying for.
Embassy process time - standard service
Embassy process time express service
Up to 10 working days
N/A
Burkina Faso Visas
Tourist 3 month Single entry
Tourist 3 month Multiple entry
Tourist 6 month Single entry
Tourist 6 month Multiple entry
Business 3 month Single entry
Business 3 month Multiple entry
Dates of entry/exit
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To
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1
Visa validity
3-6 months from date of issue
Embassy
Visa fee
60.00
80.00
85.00
100.00
80.00
100.00
Travcour
service charge
45.00
45.00
45.00
45.00
45.00
45.00
Total to send excluding
return postage
105.00
125.00
130.00
145.00
125.00
145.00
STEP THREE: Please tell us the address you would like your passport to be returned to. This does not need to be your residential address.
Title: Mr. /Mrs./Miss: First Names .............................................................................Surname.................................................................................................
Address ......................................................................................................................................................................................................................................
................…................................................................................................................Postcode ...............................................................................................
Telephone Number .....................................….............................................................Email ....................................................................................................
Please indicate the latest date your passport can be returned to you:
……../………/.............
STEP FOUR: Return fees are only payable per return address (maximum of 4 passports). Carriers own terms & conditions apply. We do not accept
responsibility for the delivery of documents. Please put a tick by the type of return you would like us to use for your documents.
Return type
Charge
Terms
Royal Mail Special Delivery
9.00
Only applicable for UK residents. For terms & conditions please visit www.royalmail.com
DHL International Ltd
40.00
For terms & conditions please visit www.dhl.co.uk
Travcour courier
POA
Subject to local area & availability. Please contact 020 85431846
Personal collection
N/A
Please await our call to advise your documents are ready
Own prepaid envelope
N/A
For security, please only send prepaid secure mail & note your tracking number
STEP FIVE: You must enclose payment in order for us to process your order. Please include embassy fees, Travcour charges & return postage.
Cheque (Please make cheques payable to Travcour (UK) Ltd.)
Credit/Debit Card (please complete the following section)
Postal Order
Name of the cardholder ...........................................…............
Card number
Issue date: ……....../……....…
Cash
SCN
Expiry date: …...…../……...…
Issue No: (if applicable) ……..........…....…
N.B. Please note there is a 2.5% Admin Fee when you pay by Credit/Debit Card. We do not accept American Express or Diners.
Signature ...........….………................... .............................................................................................
Date ……../………/............
DISCLAIMER: Whilst every effort is made to issue your requirements the embassy/consulate reserve the right to refuse your application & therefore no guarantees can be provided.
By placing an order with Travcour (UK) Ltd you confirm that you agree to our Terms and Conditions as detailed at www.travcour.com including that Travcour (UK) Ltd will not &
cannot be held liable nor responsible for the actions, losses or delays of any nature incurred by embassies, passport office, government offices, third party courier carrier,
subcontracted couriers or Royal Mail.
Registered Company No: 4651386
VAT No: 238 0357 68
RK
BU
Visa Application for Burkina Faso
Demande de Visa Burkina Faso
INA FAS
O
Application is made to the Honorary Consul of Burkina Faso in
the United Kingdom, Colin Seelig.
UN
ITE
PROGRES
E
TIC
JUS
Please affix your photo here
Please read the accompanying notes before completing this
form. For duplicate forms, please visit
www.burkinafasovisa.co.uk
OFFICIAL USE ONLY
No.
Date
Personal DETAILS
Surname Nom (en capitales)
First Names
Prénoms (en minuscules)
Maiden Name Née (nom de jeune fille)
Date of Birth Né le
Place of Birth
à
Original nationality
Nationalité d’origine
Present nationality
Nationalité actuelle
Marital Status
Situation de famille
Profession Profession
Children
Enfants
Age
Age
Military rank
Situation militaire
contact DETAILS
Usual Address
Domicile habituel
Post Code
Code Postale
Current Address Résidence actuelle
Post Code
Code Postale
Email Courriel
Telephone (daytime)
Téléphone (jour)
identification
Passport No.
No. passeport
Date of Issue Délivré le
or Identity Card No.
ou No. carte d’identité
Issued by
Délivré par
Valid until
Valable jusqu’au
Demande de Visa: Issue 03.12
page 2/3
RK
BU
Visa Application for Burkina Faso
Demande de Visa Burkina Faso
INA FAS
O
OFFICIAL USE ONLY
No.
Date
UN
ITE
PROGRES
E
TIC
JUS
visa request
Type of visa required: Single
Nature du visa:
Simple
Multiple
Multiple
Stay of: 3 months
Séjour de:
3 mois
6 months
6 mois
Proposed date of arrival in Burkina Faso (day/month/year)
Quelle date prévoyez-vous d’arriver au Burkina Faso (jour/mois/année)
Reasons for journey Motifs détaillés du voyage
here will you enter Burkina Faso?
W
Indication précise du lieu d’entrée au Burkina Faso?
Where will go on leaving Burkina Faso?
Où comptez-vous vous rendre en quittant le Burkina Faso?
Your address in Burkina Faso during your stay
Indication de votre adresse exacte (rue et no.) au Burkina Faso pendant que vous y séjourmerez
Have you ever visited Burkina Faso? Yes
Avez-vous déjà venu au Burkina Faso? Oui
No
Non
Have you ever lived in Burkina Faso? Yes
Avez-vous déjà habité le Burkina Faso? Ou
No
Non
If so, when and where?
Quand et où?
Names and addresses of any businesses you wish to contact if this is a business trip
Indiquez avec précision les noms et adresses (rue et No.) des commerçants et industriels que vous désirez rencontrer s’il s’agit d’un
voyage d’affaires
Names and addresses of any friends or relatives in Burkina Faso
Attaches familiales au Burkina Faso (addresses exactes, rue et no.)
Name and address of reference in your country of residence
Référence dans le Pays de résidence (addresses exactes, rue et no.)
Do you intend to set up a business in Burkina Faso?
Comptez-vous installer au Burkina Faso un commerce ou une industrie?
declaration
I undertake not to accept any employment paid or unpaid during my stay in Burkina Faso, not to attempt to stay permanently and to leave the
territory of Burkina Faso at the expiry of the visa which is issued to me. I declare that the above facts are true, and that if I have made any false
declaration I may be refused entry and further visas in the future.
Vous engagez-vous à n’accepter aucun emploi rémunéré ou au pair durant votre séjour au Burkina Faso à ne pas chercher à vous y installer définitivement et à
quitter le territoire du Burkina Faso a l’expiration du visa qui vous sera éventuellement accordé? Ma signature engage ma responsabilité et m’expose, en sus de
poursuites prévues par la loi en cas fausse déclaration, à me voir refuser tout visa à l’avenir.
Signature Date
Demande de Visa: Issue 03.12
page 3/3