Borang Mohon Visa

Print Form
Form V.2011A
Visa Application Form of the Peoples Republic of China
Applicant should fill out this form truthfully and completely

on a computer and print out. Please type your answer in capital English letters in the space provided or cross the appropriate box to
select. Please state N/A or None if a section does not apply to you. If there is additional information to declare, please type on a
separate sheet.
(Form V.2011B)
Please also complete the Supplementary Visa Application Form (Form V.2011B) if you are not a U.S. citizen, or if you are applying
for work visa or student visa, or if you will be accompanied by anyone who shares the same passport with you.
Section 1Personal information
1.2
Sex
Surname
1.1
Full name as shown
on your passport
Given name
M
F
Photo requirements
Replace with your first & middle name as in passport
1.3
Name in Chinese character ( if applicable)
None
1.4
Other name or previous name
if applicable
None
1.5
Name in native language
1 One colored photo

6 Within 6 months
Passport photo
Front-facing
Hatless
Light-colored
background
As in 1.1
1.6
Current nationality
1.7
Former nationality
1.8
Concurrent nationality
1.9
Date of birth (yyyy-mm-dd)
None
1.10 (/)
Place of birth (city,
province/state, country)
1.11
U.S. ID card number
1.12
Marital status
Married
Widowed
1.13
Current
occupation(s)
Never Married
Divorced
OtherPlease specify:
Businessman
Company employee
Teacher
Student
Housewife
Unemployed
Government official
Staff of media
Religious worker
Active duty military personnel
Member of national parliament
Crew member
Retired
() Other (Please specify):
1.14
Passport type
Diplomatic passport / Service/Official passport

Ordinary passport
()Other (Please specify):
1.15
Passport number
1.16
Date of issue (yyyy-mm-dd)
1.17 (/)
Place of issue (city, province/state,
country)
1.18
Expiry date (yyyy-mm-dd)
1.19 ()
Please select pick-up day (Extra fee is charged for express pick-up)
( 4-5 ) Normal (the 4th or 5th working day)

( 2-3 )Express (the 2nd or 3rd working day)
2011 6 CNNYCONSULATE JUNE 2011 EDITION
1 4 / Page 1 of 4
Form V.2011A
Section 2: Details of travel to China
2.1
Major
purpose(s) of
your visit(s) to
China
Tourism
As resident journalist
Family visit
As journalist for temporary news coverage
Visiting friends
As resident diplomat or consul
Business trip
Commercial performance
Meeting
As crew member
Transit
Study
Employment
Official visit
() Other (Please specify):
2.2
Intended
number of
entries
( 3 )
One entry valid for 3 months from date of application
( 6 )
Two entries valid for 6 months from date of application
6 Multiple entries valid for 6 months from date of application

12 Multiple entries valid for 12 months from date of application
Other (Please specify):
2.3
Intended date of your first entry (yyyy-mm-dd)
2.4
Your longest intended duration of stay
Days
2.5 i)
Please list cities and provinces to visit in China in a time sequence
2.5 ii)
Please list residence(s) and phone number(s) during your stay in China in a time sequence
Detailed address
1.
City
Province
Phone number
Replace with detail address here. Must list detail street

address, not only hotel name!
2.
3.
4.
2.6
Who will pay for your trip to China?
Myself Inviter
Parent(s) or guardian(s)
Other (Please specify):
2.7 ?Do you have

medical insurance covering your visit in China? If Yes, please fill out the name of the
medical insurance company and your account number.
Yes
No
2.8 /
Name, address and phone number of your
inviter or contact unit in China
2.9 /
Name, address and phone number of your
relative, friend or contact person in China
2 4 / Page 2 of 4
Form V.2011A
Section 3: Information about your family, work or study
3.1
Address
Current home address
City
/
Province/State
Zip code
3.3
Mobile phone
number
3.2
Home phone number
3.4
Email address
3.5
Name, phone number and

address of your current
employer or school
Name
Address
Phone number
City
/
Province/State
Name
Nationality
Zip code
Occupation
Relationship
3.6
Major family members
3.7
Contact person in case of
emergency
3.8
Contact persons
phone number
Section 4: Other information

4.1
Have you ever visited China
before? If Yes, please specify date, places and purpose of the
latest visit.
4.2 12
Have you ever visited other
countries or territories in the past 12 months? If yes, please
specify date, name of countries or territories and purpose of the
visits.
No
Yes
No
Yes
4.3
Have you ever overstayed your visa or residence permit in China?
Yes
No
4.4 ,
Have you ever been refused a visa for China, or been refused entry into China?
Yes
No
4.5
Do you have any criminal record in China or any other country?
Yes
No
4.6 ? Are you suffering from any of the following diseases?

Serious mental disorder
Infectious pulmonary tuberculosis
Other infectious disease of public health hazards
Yes
No
4.7 30
Did you visit countries or territories infected by infectious diseases in the past 30 days?
Yes
No
3 4 / Page 3 of 4
Form V.2011A
4.8 4.3 4.7

If you answered Yes to any of questions 4.3 to 4.7, please give details below.
N/A
Section 5: Relevant declaration

5.1 (Form V.2011B)Please also complete
the Supplementary Visa Application Form (Form V.2011B) if you are not a U.S. citizen, or if you are applying for work visa or student visa, or if you
will be accompanied by anyone who shares the same passport with you.
5.2 Please use the space below or a separate sheet for
additional information / declaration / statement other than already provided in this application.
None
Section 6: Signature
6.1 I have read and understood all the
questions in this application. I declare that the information provided above is true and accurate. I shall take all responsibilities for any false
information.
6.2
I understand that the decision on whether to issue a visa, validity/ type of visa, number of entries, and duration
of each stay will be decided by consular officers, and that any false, misleading or incomplete information may result in the refusal of a visa or denial of
entry into China.
Date (yyyy-mm-dd):
.
Applicants signature:
18 Note: Parent or guardian may sign on behalf of an applicant aged under 18.
Section 7If the application form is completed by another person on the applicants behalf, please fill out
the following:
7.1
7.2
Name of the person completing
Relationship to the
this form on the applicants behalf
applicant
7.3
Address
7.4
Phone number
7.5
7.6
Type of ID document
Number of ID
7.7 Declaration
I declare that I have assisted in the completion of this form at the request of the applicant, and the applicant understands and confirms that the
information provided is true and correct.
/Date (yyyy-mm-dd):
/Signature
Official use only
4 4 / Page 4 of 4

Borang Mohon Visa

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Print Form

Visa Application Form of the Peoples Republic of China

Applicant should fill out this form truthfully and completely

Replace with your first & middle name as in passport

1 One colored photo

Diplomatic passport / Service/Official passport

()Other (Please specify):

( 4-5 ) Normal (the 4th or 5th working day)

2011 6 CNNYCONSULATE JUNE 2011 EDITION

Section 2: Details of travel to China

As journalist for temporary news coverage

As resident diplomat or consul

() Other (Please specify):

One entry valid for 3 months from date of application

Two entries valid for 6 months from date of application

6 Multiple entries valid for 6 months from date of application

Replace with detail address here. Must list detail street

2.7 ?Do you have

Section 3: Information about your family, work or study

Name, phone number and

Section 4: Other information

4.6 ? Are you suffering from any of the following diseases?

2011 6 CNNYCONSULATE JUNE 2011 EDITION

4.8 4.3 4.7

Section 5: Relevant declaration

Official use only

2011 6 CNNYCONSULATE JUNE 2011 EDITION

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