El Ferro
六個月內兩寸半身彩色
近照兩張
符合本欄框尺寸之適當
照片
Please attach two head
& shoulder color photos
□核
准
□拒
FOR OFFICIAL USE ONLY
件
簽證類別:□停留
□居留
簽證效期
簽證號碼
□外交
入境次數:□單次
□禮遇□多次
停留期限
簽證日期
費
審核意見及備註:
appropriate to the size
額
複審官員簽章
of this blank (taken
初審官員簽章
last 6 months).
中華民國簽證申請表
VISA APPLICATION FORM FOR ENTRY INTO TAIWAN,REPUBLIC OF CHINA本表格須由申請人親自簽署,未成年兒童之申請表須由其父母或合法監護人簽署
The applicant must sign this form. Applicants who have not reached the age of majority must have the form signed by a parent or legal guardian.
請以正楷填寫各欄 Pleasecomplete all sections in BLOCK LETTERS
WHICH CATEGORY OF VISA ARE YOU APPLYING FOR?
擬申請何種簽證
1.種
類: ■停留簽證
□居留簽證
□外交簽證
□禮遇簽證
Category
Visitor visa
Resident visa
Diplomatic visa
Courtesyvisa
2.入境次數: ■單 次
□多 次
Entry
Single
Multiple
申請人資料
APPLICANTS'S DETAILS:
3.全 名(與護照所載相同):
Full Name (exactly as in passport)
姓 Surname
Kuoli Lu
Richard
名 Given name4.舊有或其他姓名(如有):
Former or other name (if any)
5.中文姓名(如有):
Chinese name (if any)
6.國 籍:
Nationality
7.舊有或其他國籍(如有):
Former or other nationality (if any)
8.性
Sex
別:
BRAZIL, FEDERATIVE REPUBLIC OF(巴西)
■男
Male10.出生日期:
Date of birth
12.職 業:
Occupation
9.婚姻狀況: □未婚 □已婚 ■鰥寡 □分居 □離婚 □其他
□女
□其他
Female
Marital Status Single Married Widowed Separated
年Year/月Month/日Day
11.出生地點: 市(City)
Place ofbirth Yue-Yang
1936/05/18
Divorced Other
國(Country)
China
13.服務機關或就讀學校:
Name of employer or school
retired / 退休
14.在台住址及電話號碼:
Address and telephone number in Taiwan
REPUBLIC OFCHINA (中華民
國)
Hung Chow South Road N' 165 Taipei
Engenheiro Civil
2-2781-5853
15.本國住址及電話號碼:
Colonia Agricola Aguas Claras Chacara 15
Permanent address and telephone number in homecountry
6130391818
申請人護照
APPLICANTS'S PASSPORT
16.種 類:
□外交
□公務
■普通
□其他
Type
Diplomatic Official
Regular Other; Please specify
17.護照號碼:
Passport No.
19.發照日期:...
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