Application fon Ghana Entrv Permit/Visa

tr'orOfricialUse
Visa N'
Type of Visa.....
Date of Issue.....
Charges.
Signature of Issuing Ofïicer
ApplicationfonGhanaEntrv Permit/Visa
PANS MISSION
t.
This form mustbe completedin QuadrupLicate
and in Capital Iæatersand submittedtogetherwith four (4) rec€ntpassport-sizepictues
within at leasttiree (3) daysbeforc tbe ùtended daleof depaft[d,4 renplir enL*es Maiu;cuta,y lotndrequarre(4)phot;s d \dennftel
déposer trois (3) lours avant l-adate prévue pour le volnge
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Full nanes and Addressesofreferences in Ghana shoulclbe stated(including TelephoneNumbcr. ifavailable/Non! et adrcsse,de.leux
rèféren.esau Chana (nunë,o de té\éphone,ti disponible)
Any information statedon the FoIm and subsequentlylbrurd to bc incorrect mav rcnder Unu)- I'cnnil,/Vrsa voidlEn casdeJaussedàctoratrcn,
le vito d'entré?fde
séJous avërcranul et nèanl
Travell€rsto Ghanamust be in possessionofan intemationai flcalth C.Ttilicate for Yellow Fevcr/?orr vrlzg eut et pner de semunird un
certtfcat iitamafional de vaccinottoncontre la lèvre Jaune,
Applicans applying by post should provide Self-addressedstarnpedenvclopcvzb! | rlènanJèutp.tr Lùt1rrrc.dottobheatorement
lourni de,
envelopperMbrées, ltbelëes à son non et adrcsse.
(a) Surname/l,lom
(b) Irtnt Narne (slt,rënom1s1
Previous Narne (if applicable/À'onr precetlanl
( b ) D a t e o f B i r t h / D a t e d e , \ ' a t s s u n c e. .
( d ) P l a c c o f B v t h J t . t e ud e , \ ' a t s s u n t t ,
(e)Nationalityl|,ianonaltte ....
(l) Iionncr Natrclnalitl (if iury')/,t',.rttrt.ttittt,inr(,,(.1(r,
(g) Passport No/À'' de I'asseport
(h) Date of Issuc/Irare de ctéltt,runc,,
. ..
(i) Place of lssue/lreu de déltvrance.. .
I
L,
Professiort /Occupaion/
[) Date of Lxpin/ztare d exptruttt,n
f ' r o | e s s r o n ' Q u a l t r ë. . .
(a) Bnsiness Address &'l'el
N"/ Adresse.t À/" cletelephonetlu ltr,uclerr,tt,,trl.
(b) Residerrtial Addre;s & l'el NolAdresserestclentteile .
Proposed date of Departure lbr Gh.uta/l)ute prerwe yxtu, Ie tlepart ût (ihund
(a)'fravellur g by I lvlo1,en de rran spor r
.)AtrlAvon
(b) Is apphcantrn possesslonof return bcket?
Le demandeur drspose-t-rl d'un brllet aller/retour ?
)Seit/Buteuu
LutJJRoute
l'ickct N.
li" du Brllet
(c) Financialmeansat Applicant'sdisposal......
Ressources du demandeur ou ses mo),ens d'extslence pendant son sé1our auGhana
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Purposeof Journey/votf du vo)'age
Namesand Addre;ses of
'l'w'o
[lBusinesJ;tgcrres
[lTounsnr/Tourtsme
LlEmployn'rcnl/Entptot
[)Offrcial/Opctet
Itclèrcnces ln Ghani/,voms& Adressestle ccuxréfërencës
ou Ghana
tr
8.
If for Employment,
Name& Acidress
t" O*t,U,,, or^r rr)rr,,ot,
ni,,oi,^
& adressede l'employeur au Ghana
"rU*p,"r",
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10.
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Applicant's Signattrdsignaîure
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t 2.
Accompanied by (children)/Accompagné (e) de (edants figurant sur le passeporr)
.....Date of ApplicationlDate..