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Expiration Date: 12-31-2006
Estimated Burden 30 minutes
U.S. Department of State
APPLICATION FOR A, G, OR NATO VISA
1. Passport Type
Diplomatic
PLEASE TYPE OR PRINT YOUR ANSWERS IN THE SPACE PROVIDED BELOW EACH ITEM
DO NOT WRITE IN THIS SPACE
4. Passport Place of Issuance:
3. Passport Issuing
2. Passport Number
Country
City
Country
Visa Classification
Official
Regular
6. Passport Expiration Date (dd-mmm-yyyy) 7. Current Visa Status
5. Passport Issuance Date (dd-mmm-yyyy)
Multiple or
Entries
8. Surnames (As in Passport)
Validity
Issued/Refused On
9. First and Middle Names (As in Passport)
By
11. Place of Birth:
City
10. Date of Birth (dd-mmm-yyyy)
13. Sex
12. Nationality
Country
14. Marital Status (Check one)
Male
Widowed
Single
Married
Female
Divorced
Legally Separated
15. Home Address (Include apartment number, street, city, state, zip code)
16. Home Telephone Number
(
17. Telephone Number (Mission/Organization)
(
)
18. Personal Identification Number (PID)
)
19. Relationship to Principal Applicant
Spouse
Child
Parent
Household Employee
Other
20. Name and PID of Principal Alien
21. Estimated Date of Completion of Tour/Employment (dd-mmm-yyyy)
22 Travel Date (dd-mmm-yyyy)
23. Sponsoring Embassy/Consulate/ Organization
24. Address of Embassy/Organization
DO NOT WRITE IN THIS SPACE
EMBASSY/ORGANIZATION SEAL
50 mm x 50 mm
PHOTO
Signature of Applicant
staple or glue photo here
Date (dd-mmm-yyyy)
TYPED NAME OF PERSON PREPARING FORM
*Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time required for searching existing data
sources, gathering the necessary data, providing the information required, and reviewing the final collection. Send comments on the accuracy of this estimate
of the burden and recommendations for reducing it to: U.S. Department of State (A/RPS/DIR) Washington, DC 20520.
DS-1648
12-2003
File Type | application/pdf |
File Title | Application for A, G, or NATO VISA |
Subject | VISA |
Author | A/RPS/DIR |
File Modified | 2006-10-12 |
File Created | 2004-09-27 |