Fill and Sign the Rameyandassociatesinccomapplication Form

EMBASSY OF THE DEMOCRATIC REPUBLIC OF THE CONGO 1726 M Street. NW Suite 601 Washington, DC 20036 Phone: (202) 234-7690/91 Fax: (202) 234-2609 VISA APPLICATION FOR SHORT STAY DO NOT WRITE IN THIS SPACE. FOR EMBASSY USE ONLY. Documents verification: 6+ month valid passport Residence card Vaccination Certificate Airline ticket Company letter Invitation Issued Refused Date: / M/S / M/M Notes: 2M/S 2M/M 3M/S 3M/M 6M/S 6M/M Done by: Verified by: PLEASE PRINT OR TYPE IN THE SPACES PROVIDED BELOW 1. Passport number 2. Issuing authority 3. Issuance date (day/month/year) 4. Expiration date (day/month/year) / / / / 20 5. Names (as in passport): First Middle Last Others 6. Place of birth City and state 7. Date of Birth (day/month/year) 8. Nationality (origin) Country 9. Gender: 10. Marital status: / Male Female 11. Spouse’s information (even if separated or divorced): First name Last name Single / Married Divorced Widowed Separated Date (dd, mm, yyyy) and place of birth Nationality / / 12. Present address (street, city, province or state, postal code, country) 13. Duration at this address Years 14. Telephone numbers Home Fax Business Business fax Mobile/Cellular 15. Name of employer or school 16. Present address of employer or school (street, city, province or state, postal code, country) 17. Telephone 18. Fax 20. Names of the person in the DRC* who you will be staying with. First Last 19. Present occupation / profession Other 21. Hotel name (if applicable): 22. Address in the DRC* (street, city, province or state) 23. Telephone numbers Home Fax Relationship Business Mobile 2 Months 24. Purpose of current trip to the DRC* 25. Length of stay in the DRC* (in days) 26. When do you intend to arrive in the DRC*? / / 20 27. Have you ever been in the DRC*? (start with your latest trip and continue on the bottom of this page or use additional pages if needed) Yes No If yes, when? For how long? Port of entry 28. Father’s information First name Last name Middle name or other Nationality 29. Mother’s information First name Last name Middle name or other Nationality I certify that I have read and understood all the questions in this application and the answers I have provided are true and correct to the best of my knowledge. I understand that any false statement may result in the denial of a visa or denial of entry into the Democratic Republic of the Congo Please type or print your names, date of birth and passport numbers again: First Name Last Name Passport number: Today’s date (day/month/year) / / 20 Applicant’s signature: Photos (attach 2 identity format pictures here) (*) DRC: Democratic Republic of the Congo Please write in the space below any additional information that could not fit in the space provided on the form. Make sure you write the number of the information you are referring to. Use additional pages as needed. 3