AVATS

3/10/2014
AVATS
Your application is held online for a period of 30 days. During this period, it can be retrieved back any time using the transaction number provided below : Your unique transaction number is - 15846442 Visa Details What type of visa are you applying for? Journey Type: What is the reason for travel? Purpose of Travel Passport Type: Passport/Travel Document Number: Personal Details Surname: Forename: Other Name: Date Of Birth: Gender: Nationality Current Location: Current Address: Address Line 1 Address Line 2: Address Line 3: Address Line 4: Contact Phone: Contact Email: General Information Length of residence: Do you have permission to return to that country after your stay in Ireland? Have you applied for an Irish Visa before? Have you ever been issued an Irish Visa? Please provide location of application or reference number: Have you ever been refused an Irish Visa? Please provide location of application or reference number: Have you ever been in Ireland before? Do you have family members living in Ireland? Have you ever been refused permission to enter Ireland before? Have you ever been notified of a deportation order to leave Ireland? Have you ever been refused a visa to another country? Have you ever been refused entry to, deported from, or otherw ise required to leave another country? If yes to any of the above please give details Have you any criminal convictions in any country? Passport Details Passport/Travel Document Number: Type of Travel Document: Issuing Authority/Type: Date of Issue: Date of Expiry: 142036226 National Passport Oran 11/01/2014 10/01/2019
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Short Stay (C) Single Conference
National Passport 142036226
Proposed dates you w ish to enter and leave Ireland: From: 06/04/2014 To: 10/04/2014 Leila Issad
08/08/1956 Female Algeria Algeria
Cite 156 logements Bloc 14 Yaghmoracen
0772175999 [email protected] No Of Years: 57 No Of Months: 0 Yes No No
No
No No No No No No
No
https://www.visas.inis.gov.ie/AVATS/CompleteFormSummary.aspx
3/10/2014
AVATS
Is this your first Passport?
No
1. Passport/Travel Document Number: 4854959 Issuing Authority: Date of Issue: Date of Expiry: 2. Passport/Travel Document Number: Issuing Authority: Date of Issue: Date of Expiry: Employment/College Details Are you currently employed in your country of residence? Current Employer: Duration Of Employment: Position Held: What is your w ork address? Address Line 1: Address Line 2: Address Line 3: Address Line 4: Employer's Phone: Employer's Email: Are you currently a student in your country of residence? Are you travelling w ith others Will you be travelling w ith any other person? No Contact / Host in Ireland Contact details for Contact / Host in Ireland. If you have no personal contact/host please give accommodation name and address. Address Line 1: Address Line 2: Address Line 3: Address Line 4: Contact Phone: Is the contact/host in Ireland personally know n to you (e.g: family / Friends) "Surname/Family Name(as in passport): Forename: Country of Citizenship: Occupation: Relationship To Applicant Department of Justice Reference number(for non-EEA nationals): Your Family Personal Status: Spouses/Partners details: Surname / Family Name(as in passport): Forenames(as in passport): Other Name(s)(Maiden or name at birth): Date of Birth: Passport Number: Gender: In w hat country does your spouse/partner currently live?
https://www.visas.inis.gov.ie/AVATS/CompleteFormSummary.aspx 2/4
Oran 28/04/2009 27/04/2014
Yes Professor No Of Years: 36 No Of Months: 0 Education
College M'rah Abdelkader
No
Education International 5,Bd du Roi Albert II 1210 Brussels,Belgium
+3222240611 No
Single
3/10/2014
AVATS
Is your spouse/partner travelling w ith you? If yes, on applicant's passport? Children Details How many dependant children do you have? Please provide the details of any dependant children. Child 1 Surname: Forename: Date Of Birth: Gender: Nationality: Is this child travelling w ith you? If yes, on applicant's passport? Child 2 Surname: Forename: Date Of Birth: Gender: Nationality: Is this child travelling w ith you? If yes, on applicant's passport? Child 3 Surname: Forename: Date Of Birth: Gender: Nationality: Is this child travelling w ith you? If yes, on applicant's passport? Child 4 Surname: Forename:" Date Of Birth: Gender: Nationality: Is this child travelling w ith you? If yes, on applicant's passport? Child 5 Surname: Forename: Date Of Birth: Gender: Nationality: Is this child travelling w ith you? If yes, on applicant's passport? Child 6 Surname: Forename: Date Of Birth:
https://www.visas.inis.gov.ie/AVATS/CompleteFormSummary.aspx 3/4
3/10/2014
AVATS
Gender: Nationality: Is this child travelling w ith you? If yes, on applicant's passport? Agency Details Did you receive any assistance in completing this form from an agent/agency? No
https://www.visas.inis.gov.ie/AVATS/CompleteFormSummary.aspx
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AVATS

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3/10/2014

Short Stay (C) Single Conference

National Passport 142036226

08/08/1956 Female Algeria Algeria

Cite 156 logements Bloc 14 Yaghmoracen

0772175999 [email protected] No Of Years: 57 No Of Months: 0 Yes No No

Is this your first Passport?

Oran 28/04/2009 27/04/2014

Yes Professor No Of Years: 36 No Of Months: 0 Education

College M'rah Abdelkader

Education International 5,Bd du Roi Albert II 1210 Brussels,Belgium

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