Fill and Sign the Registration Formpdf Ogden City School District

DOMINICAN REPUBLIC Photo CONSULAR DEPARTMENT VISA APPLICATION FORM 1. Surnames 1.1 Surnames (as appears in passport) 1.2 Other surnames used (maiden, married, etc.) 2. Names 2.1 First and middle names (as appears in passport) 2.2 Other names used (religious, professional, alias, nicknames, etc.) 3. Birth and nationality information 3.1 Country of birth 3.2 Province/State 3.3 Locality/City/District 3.4 Date of birth (dd/mm/yyyy) 3.5 Primary nationality 3.6 Secondary nationality (if applicable) 4. Sex, occupation and education 4.1 Sex 4.2 Highest academic degree attained 4.3 Occupation 5. Current location (residence) 5.1 Country 5.2 Province/State 5.3 Locality/City/District 5.4 Street name (address) 5.5 No. 5.10 Home telephone number 5.11 Mobile telephone number (cellphone) 5.14 Personal e-mail 5.6 Floor 5.7 Staircase 5.12 Work telephone number 5.8 Door 5.9 Post/Zip code 5.13 Fax Lumber 5.15 Professional / Work e-mail 6. Passport information 6.1 Passport number 6.2 Country of issue 6.3 City or State where passport was issued 6.4 Issuing country 6.5 Date of issue (dd/mm/yyyy) 6.6 Expiration date (dd/mm/yyyy) 7. Personal identity documents 7.1 Country of document 7.2 Type of document 7.3 Document number 7.4 Expiration date (dd/mm/yyyy) 8. Marital status and spouse’s information 8.1 Marital status 8.2 Name of spouse (even if divorced) 8.3 Spouse´s date of birth (dd/mm/yyyy) 8.4 Spouse’s nationality 9. Length of stay in the Dominican Republic and purpose of visit 9.1 On what date do you plan to travel? (dd/mm/yyyy) 9.2 For how many days? 9.3 What is the purpose of the visit? __ Pleasure __ Studies __ Business __ Work __ Dependence __ Official __ Diplomatic __ Residence __ Courtesy __ Other(___________________________________________) 10. Name and location where you will stay in the Dominican Republic 10.1 Name (of hotel or person you will stay with) 10.4 In which province? 10.2 Telephone number 10.3 Mobile telephone number (cellphone) 10.5 City/Locality 10.6 Sector or neighborhood 10.8 Name of the street or avenue (address) 10.8 Number 10.9 Post/Zip code 11. Employer and/or educational institution information 11.1 Activity 11.2 Name of institution 11.3 Telephone number 11.4 Address 12. Other than yourself, will anyone pay for your travel expenses? (If self, do not complete) 12.1 Name 12.2 Relationship Page 1 de 2 13. Have you ever visited the Dominican Republic? ___ Yes ___ No (If “Yes”, please answer questions to the 13.1 Date of travel (dd/mm/yy) 13.2 How many days? right, starting from the most recent visit) 14. Have you even been issued a visa to the Dominican Republic? ___ Yes ___ No (If “Yes”, please specify the following information for each visa) 14.1 Date (dd/mm/yyyy) 14.2 Country of issue 14.3 City 14.4 Type of visa 14.5 Visa number Note: Please only include information that may be proved at the time of this application. 15. Visas granted by other countries 15.1 Issuing country 15.2 Country where it was issued 15.3 Date of expiry (dd/mm/yyyy) 15.4 Type of visa 15.5 Visa number Note: Please only include information that may be proved at the time of this application. 16. Have you ever had your visa cancelled or revoked by the Dominican Republic? ___ Yes 17. Have you ever been denied a Dominican visa? __ Yes __ No ___ No (If “Yes” please specify the following) 17.1 Date (dd/mm/yyyy) 17.2 Country 17.3 State/City 17.4 Type of visa 18. Do you intend to work or study in the Dominican Republic? ___ Yes ___ No (If “Yes”, please specify the activity, name and details of employer or place of study in the Dominican Republic) 18.1a Type of activity 18.4a Province 18.2a Name (person, company or educational institution) 18.5a Locality/City 18.1b Type of activity 18.4b Province 18.3a Telephone number 18.6a Street 18.7a Number 18.2b Name (person, company or educational institution) 18.5b Locality/City 18.3b Telephone number 18.6b Street 18.7b Number 19. Has anyone ever applied for a visa on your behalf? ___ Yes ___ No (If “Yes”, please specify who and their relationship to you) 19.1 Name (business or person) 19.2 Relationship / kinship 20. Name of person who will accompany you 20.1 Name Signature of applicant 20.2 Relationship / kinship Finger 1 (left index) Finger 2 (right index) Internal Information (do not fill in) File Resolution Number Number Date Date Place Status Please specify which documents support this application: Page 2 de 2