APPLICATION FOR ENTRY VISA

APPLICATION FOR ENTRY VISA
EMBASSY OF THE REPUBLIC OF GHANA, ABIDJAN
Before filling this form, carefully read all instructions on the next page
Lire attentivement les instructions avant de remplir le formulaire
FIRMLY AFFIX ONE (3.5x4.5)
ID PHOTOGRAPH NOT OLDER
THAN SIX MONTHS HERE
COLLER ICI UNE PHOTO
D’IDENTITÉ (3.5X4.5) DE
MOINS DE SIX MOIS
OFFICIAL USE/RESERVE AU SERVICE
Visa No................................................................
Type of Visa.........................................................
Date of issue........................................................
Charge (FCFA)......................................................
Signature of Issuing Officer.................................
Please note: Four (4) copies of this form should be completed IN CAPITAL LETTERS and submitted together with 4 recent passport photographs.
A votre attention: Ce formulaire doit être complété en 4 exemplaires EN LETTRES MAJUSCULES et soumis avec 4 photos d’identité récentes.
1.
(a) Surname (Exactly as in passport)
First name(s) (Exactly as in passport)
Nom (Comme dans le passeport)……………………………………………………… Prénoms (Comme dans le passeport) …………………………………………………………
………………………………………………………………………………………….
…………………………………………………………………………………………………….
Previous Names (if applicable)
Noms précédents (s’il y en a)…………………………………………………………………………………………………………………………………………………………………………………..
(b) Date of Birth
(c) Country & Place of Birth
Date de naissance………………………………………………………………………
Pays et ville de naissance……………………………………………………………............
(d) Nationality
(e) Former Nationality (if any)
Nationalité………………………………………………………………………………….
Nationalité précédente (s’il y en a)………………………………………………………..
(f) Passport No.
(g) Date of Issue
Numéro du passeport…………………………………………………………………
Date de délivrance………………………………………………………………………………..
(h) Place of Issue
(i) Date of Expiry
Lieu de délivrance………………………………………………………………………
Date d’expiration…………………………………………………………………………………..
2.
Profession/Occupation
Profession ou emploi………………………………………………………………………………………………………………………………………………………………………………………………
3. (a) Business Address & Tel. No.
Adresse et No. de Tel (Bureau)………………………………………………………………………………………………………………………………………………………………………………..
(b) Residential Address & Tel. No.
Adresse et No. de Tel (Domicile)……………………………………………………………………………………………………………………………………………………………………………..
4.
Destination and Proposed Date of Departure for Ghana
Destination et date prévue pour le départ au Ghana………………………………………………………………………………………………………………………………………………
5. (a) Travelling by :
By Air
By Land
By Sea
Mode de voyage : Par avion
En voiture
En bateau
(b) Type & Ticket No.
(c) Vehicle/Boat Registration No.
Type et No. Du billet…………………………………………………….
Immatriculation de véhicule/Bateau……………………………………………………..
6.
Purpose of Journey :
Business
Official
Employment
Tourism
Education
Transit
Motif du voyage:
Affaires
Officiel
Emploi
Tourisme
Etudes
Other (Please specify)/Autre (Précisez)…………………………………………………………………………………………………………………..
7.
Financial means at Applicant’s disposal (please state amount)
Moyens financiers du demandeur…………………………………………………………………………………………………………………………………………………………………………..
8.
Names, Address and Tel. No. of two References in Ghana
Noms et adresses de 2 répondants au Ghana
(i) ……………………………………………………………………………………………………………………………………………………………………………………………………………………………….
(ii) ……………………………………………………………………………………………………………………………………………………………………………………………………………………………….
9.
If for Employment, Name & Address of Employer in Ghana
En cas d’emploi, nom et adresse de l’employeur au Ghana…………………………………………………………………………………………………………………………………….
10.
Duration of Stay in Ghana
Durée du séjour au Ghana………………………………………………………………………………………………………………………………………………………………………………………
11.
Date of Last Visit to Ghana
Date de la dernière visite au Ghana………………………………………………………………………………………………………………………………………………………………………..
12.
Date of Application
Applicant’s Signature
Date de la demande……………………………………………………………………………
Signature du demandeur……………………………………………………………..