Fill and Sign the Palco Timesheet Form

FEDERAL REPUBLIC OF NIGERIA Form Imm. 22 PHOTOGRAPH APPLICATION FORM FOR VISA/ENTRY PERMIT This form must be completed in full, your application may be rejected for wrong and misleading information. 1. Surname (MR/MRS/MISS)………………………Other Names.……………………………………………… 2. Sex ……………………………………Marital Status……..…………………………………………………… 3a. Present Nationality…………………….3b. Previous Nationality ……………………………………………… 4a. Date of Birth (day/month/year)……………………… 4b. Place of Birth ……………………………………. 5. Residential Address …………………………………………………………………………………………….. ……………………………………………………….Telephone No. …………………………………………. 6. Office Address …………………………………………………………………………………………………. ……………………………………………………….Telephone No. …………………………………………. 7. Profession ………………………………………………………………………………………………………. 8. State what branches of the Armed Forces of your country you have served or are serving in …………………………………………………. From ……………………. to ……………………………. 9. Colour of Hair ……………………………..Colour of eyes …………………. Height ………………………. 10. Visible Identification marks …………………………………………………………………………………… 11. Passport No……………………………….Date of issue…………………….Date of expiry…………………. Place of issue……………………………..issuing Government……………………………………………….. 12. Purpose of journey (please give full details)……………………………………………………………………. ………………………………………………………………………………………………………………….. 13. Number of entries required A. Single B. Multiple 14. Intended duration of stay ……………………………………………………………………………………….. 15a. Proposed date of travel (day/month/year) ………………(15b). Mode of travel to Nigeria……………………. 16. Indicate how much money is available for your trip …………………………………………………………... 17. If your reason for journey to Nigeria is for employment, state: a) Name of Employers …………………………………………………………………………………… b) Post to be occupied……………………………………………………………………………………. c) Give a full description of job …………………………………………………………………………. …………………………………………………………………………………………………………. 18. Persons joining spouses, parents or relatives, should give full particulars of the employment of parents or spouse in Nigeria including the address where they reside .……………………………………………….. ………………………………………………………………………………………………………………… 19. How long has/have your spouse/parents been in Nigeria……………………………………………………. 20. Your intended address in Nigeria (NOT P.O. BOX) ………………………………………………………… ………………………………………………………………………………………………………………… 21. Have you ever applied for a Nigerian visa before? Yes/No/ ………………………………………………… 22. Where did you apply for the visa? …………………………………………………………………………… 23. Indicate whether visa was granted or rejected ……………………………………………………………….. 24. Give reason if visa was rejected ……………………………………………………………………………… 25. Have you ever visited Nigeria? Yes/No ……………………………………………………………………… 26. If yes, was it for: i. ii. Business iii. Temporary Employment iv. Residency v. 27. Tourism Transit State the period of these visits and the Addresses at which you stayed ……………………………………… From To Address i. …………………… …………………………………………… ii. …………………… …………………… …………………………………………… iii. 28. …………………… …………………… …………………… …………………………………………… How long have you lived in the country where you are applying for visa/entry permit?……………………. ………………………………………………………………………………………………………………… 29. Have you ever: a) Been infected by any contagious disease (e.g. Tuberculosis) or suffered serious mental illness? Yes …………………………………….No…………………………………………………………. b) Been arrested or convicted for any offence or crime even though subject of pardon, arrested or other such legal action? Yes …………………………………..No…………………………………. c) d) Been deported? Yes ……………..No………………. if so, from which country?…………………. e) Sought to obtain a visa by misrepresentation or fraud? Yes…………………No………………….. f) 30. Been involved in narcotic activities? Yes …………………………………No……………………... Tested positive for HIV/AIDS? If yes, please state status …………………………………………. Give a list of the countries you have lived in for more than a year during the last five years: Country …………………………… …………………………… …………………………… …………………………… …………………………… 31. City …………………………… …………………………… …………………………… …………………………… …………………………… Date ……………………………… ……………………………… ……………………………… ……………………………… ……………………………… Which Countries have you visited during the last twelve (12) months: Country …………………………… …………………………… …………………………… …………………………… …………………………… City …………………………… …………………………… …………………………… …………………………… …………………………… Date ……………………………… ……………………………… ……………………………… ……………………………… ……………………………… I understand that I will be required to comply with the Immigration/Alien and other laws governing entry of the Immigrants unto the country for which I now apply for Visa/Entry Permit. Date…………………………………. Signature……………………………………………….. For official use only: DATE REMARKS (FOR OFFICIAL USE ONLY)