Fill and Sign the Shelby County Affidavitpdffillercom Form

IMPORTANT! OFFICE USE ONLY R_____________________ D_____________________ S_____________________ V_____________________ Work Phone No. ( __)___________ Res. Phone No. (__ )____________ P PA AK KIIS ST TA AN NV VIIS SA AA AP PP PL LIIC CA AT TIIO ON NF FO OR RM M www.embassyofpakistan.org 1) Name in Full Mr/Mrs/Ms First M.I Last 1a) E-mail address:___________________________________________________________ 2) Address (Present in US) 2) Address (Permanent) 3) Date of Birth (mm/dd/yy) 4) Place of Birth (Town, State, Country) 5) Present Nationality 6) Previous Nationality 7) Applicant’s Profession: 8) Passport issue date: 9) Valid until: 10) Passport #: 11) Place of Issue of Passport: 12) Passport issued by: 13) Name of Father/Husband: 14) Nationality of Father/Husband: (a)Previous (b) Present 1 15) Purpose/Object (Tick mark any one of the under mentioned, and explain in detail) (a) Business: • Diplomatic/Official Assignment • Cultural/Education/News Media/Professional/Research Assignment • Promotion of Business/Investment/Establishment of Industry/Trade & Commerce (b) Tourist: • Expedition/Mountaineering • Family Reunion • Pilgrimage • Sightseeing/Visit to Historical Sites (c) Transit: Details: ____________________________________ 16) Duration of Stay: Please mention the dates from entry and exit from Pakistan: (a) Single Journey: (b) Multiple Journeys: 17) Have you visited Pakistan before: (If so, please give date, place and length of stay) 18) Have you ever been refused a visa (tick please)? 19) Have you ever been refused a visa for other country (tick please)? Yes No If so, give details (why?) Yes No If so, give details (why?) 20) Address/Telephone # on arrival and during stay in Pakistan: 1. 2. 21) (a) Date of Arrival in Pakistan:________________ (c) Name of Airline:______________ (b) Port of Departure: ______________________ (d) If Transit, give Details:_________ 22) Today’s Date: Signature of the Applicant: 2