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Fill and Sign the Prior Authorization Forms

Fill and Sign the Prior Authorization Forms

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THE REPUBLIC OF UGANDA VISA APPLICATION SERIAL NO. …………………………………………………… (For official use only; please do not write in this space) 1. Family Name: ……………………………………………………………………………………………………................................ 2. Other names: ………………………………………………………………………………………………………………………….. 3. Former Name(s): ……………………………………………………………………………………………………………………... 4. Address/Telephone a. Permanent Address: ……………………………………………………………………………………………… ……………………………………………………………………………………………… b. Present Address: …………………………………………………………………………………………….. ……………………………………………………………………………………………… c. Telephone No (s): Home: (………) ……………….………… Work: (………) ………………..………… d. E-mail: ……………………………………………………………………………………………… 5. Nationality …………………………………………………………………………………………………………………………….. 6. Date and Place of Birth ……………………………………………………………………………………………………………… Day/Month/Year 7. Marital Status: (check/tick one): Place Married Single Divorced 8. Other family members accompanying applicant: (complete appropriate line/s) Name Date of Birth Place of Birth Spouse…………………………………………………………………………………………………………………………………….. Child………………………………………………………………………………………………………………………………………. Child………………………………………………………………………………………………………………………………………. Child………………………………………………………………………………………………………………………………………. 9. Passport No:…………………………………… Issued at:……………………………………………...On………………………. Type (check/tic one) Diplomatic Official Ordinary 10. Type of Visa required (check/tick one) Transit Form J 6/01 Single Entry Multiple Entry (Six Months) Side one Multiple Entry (12 Months) 11. Proposed Date of Arrival: …………………………………………………………………………… Day/Month/Year Duration of Stay: …………………………………………………………………………………………. 9. Reason for Journey: ………………………………………………………………………………………………………………….. 10. Date(s) of any Previous Visit(s): …………………………………………………………………………………………………. a. If in transit, ultimate destination: ………………………………………………………………………………………. b. Has a VISA been obtained for Country of Destination? ……………………………………………………………. 11. Any contact person in the Country of which VISA is applied: a. Name(s): …………………………………………………………………………………………………………………... First Last b. Phone: ………………………………………………………………………………. 12. The full address in Uganda where you intend to stay: ………………………………………………………………………… ……………………………………………………………………………………………………………………………………………… Applicant(s) Signature: ………………………………………………………………….. Date: ……………..…………….20…… Form J 6/01 Side two

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