DEMAND DE VISA - VISA APPLICATION

(A etablir en 2 exemplaires)
(Fill in 2 copies)

Dated'entree....................................................................
Date of entry

Date desejour..................................................................
Length of Stay

[]Tourist          []Transit          []Diplomatic          []Official          []Service          []Business

Nom.....................................................................................................Sexe............................................................
Name                                                                                                    Sex

Autre noms.............................................................................................................................................................
Other names

Date et lieu denaissance......................................................................................................................................
Date and place of birth

Nationalite denaissance......................................................................Actuelle..................................................
Nationality at birth                                                                              Present

Domicilea.........................................................................................................................................
Permanent Address

Residanta...............................................................................................................................................................
Residing at

Passport No. .........................................etabliea........................................par....................................................
Passport No.                                          issue date                                     by

Profession...............................................................................................................................................................
Occupation

Employeur...............................................................................................................................................................
Employer

Nom dupere..................................................................et de lamere...................................................................
Father's name                                                               Mother's name

Denationalite.................................................................denationalite................................................................
Nationality                                                                     Nationality

Adresse desparents.............................................................................................................................................
Parent's Address

Nom de l'epoux ou del'epouse.............................................................................................................................
Name of spouse

Ne(e)a....................................le......................................nationalite......................................................................
Born in                                   on                                      nationality

Adresse actuelle del'epouse...............................................................................................................................
Present address of spouse

Visites ou sejours anterieurs au Rwanda et dates desejour..........................................................................
Former visits or stays in Rwanda, and length of stay

Sejours anterieurs en Afrique, lieux etdates....................................................................................................
Previous stays in Africa, place, & dates

Motif de la demande de visaactuelle................................................................................................................
Reason for application of visa

Personnes a visiter au Rwanda et leuradresses.............................................................................................
Persons proposed to be visited in Rwanda and their addresses

Personnes accompagnant:(enfants).................................................................................................................
Persones accompanying: (children)

Noms   ..........................................   Date de naisssance..........................  Sexe..........................
Names  ..........................................  Date of Birth     ...........................      Sex...........................
             ..........................................                                 ..........................              ............................
            .........................................                                  ..........................              ...........................

Faita.............................................................le..............................................................................
Place of application                                     on                                                                       

Je certifie que mes declarations ci-dessus sont exactes et je m'engagea longer dans un hotel ou tout autre dispositif d'accueil agree par l'Office Rwandais duTourisme.
I hereby certify that all information given is complete and correct and I hereby agreeto stay in any hotel or in any lodging place approved by the Tourism Office of Rwanda.

SIGNATURE....................................................

Ne pas ecrire en dessous de cette ligne.
Do not write below this line

Visa No.   ..........................................   delivre le  ...........................  Expirant le..........................
                .........................................   issued on ..........................   Expires on ..........................

QUITTANCE No. ............................      SIGNATURE......................................................