[별지 제17호서식] 대 한 민 국 REPUBLIC OF KOREA 사 증 발 급 신 청 서 APPLICATION FOR VISA
APPLICATION NO._____________________________________________PASSPORT CLASSIFICATION DIPLOMATIC ( ) DATE _________________________________________________________OFFICIAL ( ) ORDINARY ( ) 1. NAME ___________________________ (SEX) LAST, FIRST MIDDLE 2. NATIONALITY __________________________ 3. PLACE OF BIRTH ______________________________ DATE OF BIRTH ______________________ 4. PRESENT ADDRESS ___________________________ PHONE NO. ____________________________ 5. PERMANENT ADDRESS _________________________________________________________________ 6. SPOUSE'S NAME & NATIONALITY ______________________________________________________ 7. OCCUPATION & TITLE(EXPLAIN FULLY) _______________________________________________ 8. PURPOSE OF ENTRY(EXPLAIN FULLY) _________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ 9. PASSPORT NO. ____________ ISSUED BY ____________ ON ________ VALID TILL __________ 10. PREVIOUS VISIT, IF ANY __________________ DESIRED LENGTH OF STAY _____________ 11. PORT OF EMBARKATION ___________________ MEANS OF TRANSPORTATION __________ 12. PORT OF ENTRY(KOREA) _________________ EXPECTED DATE OF ENTRY _____________ 13. ADDRESS IN KOREA _____________________________________________ PHONE NO. ________ 14. THREE REFERENCES IN KOREA
N A M E		A D D R E S S
15. LINEAL MEMBERS OF FAMILY. IF ACCOMPANIED
N A M E		SEX	DATE OF BIRTH		RELATION	NATIONALITY
34㎜/45㎜ PHOTO	I declare that the statements made in this application are true and correct to the best of my knowledge and bel-ief, that I will observe the provisions of the Immigrati-on Law of the republic of korea and that I will not enga-ge in any activities irrelevant to the purpose of entry stated herein
SIGNATURE OF APPLICANT _______________________________________________________________ SPACES BELOW FOR OFFICIAL USE ONLY ________________________________________________ APPROVED DATE OF ISSUANCE _______________________________ CLASSIFICATION OF VISA AUTHORITY ___________________________________________________ ? SINGLE OR VISA NUMBER _____________________ VISA'FEE _________________ ? MULTIPLE VALIDITY ______________________________________________________ STATUS( ) REMARKS ______________________________________________________
23236-00611 일 '93.3.22 승인				210㎜×297㎜ 인쇄용지(2급) 60g/㎡