Fill and Sign the Nunez College Transcript Request Form

Please Indicate Type of Visa Requested Please attach 2 photographs taken within the last 6 months (2x2 inches) Diplomatic Visa Official Visa Courtesy Visa Non-Immigrant Visa Tourist Visa Transit Visa Visa Hours: Monday - Friday(9.00 am.-12.30 pm.) APPLICATION FOR VISA Royal Thai Consulate-General 351 E 52nd Street, New York, NY 10022 Tel.(212)754-1770 Fax.(212)754-1907 www.thaiconsulnewyork.com Mr. Mrs. Number of Entries Requested _____ Miss First Name Middle Name Former Name (if any) Family Name (in BLOCK letters) Countries for which travel document is valid Nationality Proposed Address in Thailand Nationality at Birth Marital Status Birth Place Name and Address of Reference in U.S.A. Date of Birth Type of Travel Document No. Issued at Date of Issue Expiry Date Tel./Fax. Name and Address of Reference in Thailand Occupation (specify present position and name of employer) Tel./Fax. I hereby declare that I will not request any refund from my paid visa fee even if my application has been declined. Current Address Signature Tel. E-mail Permanent Address (if different from above) Date Attention for Tourist and Transit Visas Applicants I hereby declare that the purpose of my visit to Thailand is for pleasure or transit only and that in no case shall I engage myself in any profession or occupation while in the country. Signature Date FOR OFFICIAL USE Tel. Names, dates and places of birth of minor children (if accompanying) mfavisaform10092007 Application/Reference No. Visa No. Type of Visa: Date of Arrival in Thailand Traveling by Flight No. or Vessel’s name Duration of Proposed Stay Diplomatic Visa Non-Immigrant Visa Official Visa Tourist Visa Courtesy Visa Transit Visa Multiple Entries Category of Visa: Number of Entries: Single Double Date of Issue Date of Previous Visit to Thailand Purpose of Visit: Tourism Transit Business Diplomatic/Official Other (please specify) Expiry Date Documents Submitted Authorized Signature and Seal Fee