[별지 제30호의3서식] <신설 1994.7.20>
難民臨時上陸許可(延長)申請書 APPLICATION FOR (EXTENSION) TEMPORARY REFUGE LANDING PERMIT
姓 FAMILY NAME				漢字姓名
名 GIVEN NAMES					男 MALE 女 FEMALE
生年月日 DATE OF BIRTH
年 YEAR	月 MONTH	일 DAY	國籍 NATIONALITY
旅券番號 PASSPORT NO.			職業 및 職場名
			OCCUPATION
上陸(延長)理由 REASON FOR LANDING (EXTENSION)
上陸(延長)申請期間 PERIOD OF LAND- ING(EXTENSION)			入港便名 FLIGHT NO./ DISEMBARKATION
I hereby apply for temporary refuge landing permit, pursuant to the provision of the article 16-2 of the immigration law.
申請日 DATE OF APPLICATION			申請人 署名 SIGNATURE OF APPLI- CANT
공용란 OFFICIAL USE ONLY
許可期間 PERIOD OF PERMIT			居住 DESIGNATED PLACE OF STAY
行動範圍 AREA OF MOVEMENT			其他 OTHERS
23236-12711민 94.6.1 승인			182mm×257mm (인쇄용지(2급) 60g/㎡)