TOURIST VISA REQUIREMENTS: Ancient Treasures on board Viking Orion – Egypt M/E, India, Sri Lanka, Cambodia, Vietnam M/E, China Segment

Total Cost: One Person - $ 927 Total Cost: Two People - $1830

Cost includes service fees, consular fees* and return shipping. For Overnight Delivery add $10.00. For delivery outside the contiguous U.S. please add additional $35.00.

Please Send to GENERATIONS VISA SERVICE: (see address below) • Your SIGNED passport: having seven (7) completely blank “visa” page & six months remaining validity.

If you need help securing or renewing your passport, please contact GenVisa at 800-845-8968 for requirements and fees.

• Eight (8) recent professional color pictures per person paper clipped to the application forms ( 2”x2”).• Egypt: One completed and signed visa application form per person per country (attached). Please include present

employment information in Other Information section of the application form (page 2 of the application):

company’s name, physical address and phone number. If retired, please state RETIRED.

India: One completed and signed attached application form per person (pages 4-6). For your convenience

GenVisa will complete and submit the online application on your behalf. Please fill out the form legibly. Additional

Particulars Form (page 7) must be completed by each applicant in addition to the application form.

Sri Lanka: One completed and signed visa application form per person (prefilled and enclosed).

China: One typed/computer generated and signed visa application form per person, printed on one sided

page. For fillable application scroll down to pages 10-13 of this visa kit. For manually completed application

(enclosed) please include additional $49 fee per person - application refilling fee.

Vietnam: One completed online, printed and signed application form per person. Use the following link

to access the online application: http://visa.mofa.gov.vn Note: place of visa submission and collection

should be EMBASSY OF VIETNAM IN THE UNITED STATES OF AMERICA. For manually completed

application (enclosed) please include additional $49 fee per person - application refilling fee.

Cambodia: One completed and signed visa application form per person (prefilled and enclosed).

• Itemized cruise itinerary in triplicate showing dates of travel and ports of call in each traveler’s name.

• Clear copy of Driver’s License or government ID for each traveler as proof of residence.

• Payment: a check or money order payable to GenVisa in US Dollars and drawn on a US bank.

Complete and return this entire form with the requested materials – use a traceable form of mail. Important: Do not send your passport/materials more than 6 months prior to your trip date.

Visa processing generally takes up to 4 months. If you need your passport returned within 12 weeks: add $270 per person for expedited service, within 8 weeks: add $390 per person for expedited service. These requirements are

for U.S citizens only. Canadian passport holders and legal U.S. residents please contact GenVisa for additional requirements and fees. *Consular fees and forms are subject to change without notice. For terms and conditions,

current requirements, updated forms and fees please check at www.genvisa.com/viking

YOUR RETURN SHIPPING ADDRESS

Last Name: _______________________________________________ First Name: ______________________________________

Last Name: _______________________________________________ First Name: ______________________________________

Return to: Home or Business (recommended for security reasons) Name & c/o:____________________________________

EXACT address: _______________________________________________ Apt/Ste#: _______ Phone: _______________________

City: __________________________________ State: _____________ Zip Code: ____________________

Date you need your passport: ____________ Your E-mail address (Important): _________________________________

Date THIS CRUISE Departs the US: __________________ Optional insurance: $9.00 per passport: in the unlikely event that your passport is lost or damaged in transit. This will cover

your full out of pocket visa(s) and passport replacement costs up to $2,000. Please check one of the boxes below.

Yes, I have added an additional $9.00 per person for the optional insurance. [FedEx signature required upon delivery.]

No, I decline the optional insurance and understand that in the unlikely event my passport is lost or damaged;

Generations Visa Service liability is limited to $100 [No signature required upon delivery.]

Send materials to: Viking – Ocean Cruise (Egypt/India/Sri Lanka/China/Vietnam/Cambodia)

GENERATIONS VISA SERVICE

2233 WISCONSIN AVE N.W. #311WASHINGTON D.C. 20007-4126 1-800-845-8968

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04/27/2018

ON BOARD VIKING CRUISE SHIP

TOURISM/CRUISE SINGLE

US DEPT OF STATE P

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04/27/2018

�1)1 i_., ... ;:11 ::,1_,.il. L.-,I ��1)1 � 1_,.; )' � l.,,il I � �')I.JI�_, (:'-J

I.; Accompanying family members \ Relationship Date and Place of birth

Members de la famille en compagnie Lien de parente Date et lieu de naissance

1.

2.

3.

4.

5.

l.

2.

3.

4.

5.

,,.WI ·! � .)I 4JUWI , l.;./:11 • L.-,1 .) 'J": - . •

Names of children endorsed on same passport Noms des enfants ajoutes au meme passeport

� �WI ..:,l,,..WI (:' .. ); � �WI ..:,l_.,.;....JI J:, � Date of previous visits Purpose of previous visits

Date de visites nrecadentes Motif de visites orecedentes

1.

2.

3.

4.

5.

i

,,.WI _jl_� � .)1 �WI. �)'I ::,� �.J (:'-JI.;

Date and place of birth of children endorsed on same passport Noms des enfacts ajoutes au rneme passeport

�WI .::.,l,,..WI J)l;. _,..,,,.,. � l..l.,;":l'I .:,l__,::.c Address in Egypt during previous stays

Addresse en Egvote durant !es seiours orecedents

0_;.1 ul.. _,Lu. Other Information Autres Informtion

� Jr" (:'Jl.i �_,.JIMade at Made on Signature Fait a Fait le Signature

·.

�1.:.S:.11 r.J.l;,. �.) •· •. 11 rl�":l' �. �11.1,. For consular use only Please do not write below

·. Espace reservea !'usage consulaire - priere e ne rien y ecrire

Office Hours : 9.30-l.OO Mon-Fri Requirements: l. one 2"x.2" recent photo2. Passport ( still valid for at.least 6 months)3. FEE- $15 per passport for U.S. Citizen ( Money order or Cash only). No Personal or company check please. For other nationalities, please

contact the Consulate.4. For Non-Americans photocopy of greencard and round-trip ticket.5. For Business Visa- a letter from the company stating the purpose of the trip and the financial guarantee of the company.6. Self-Addressed Stamped envelope for certified mail for the return of the passport/s . Via EXPRESS MAIL, please send ST AMPS and label.

Via FEDERAL EXPRESS, or any overnight service; please send money order, WE 'DO NOT ACCEPT ACCOUNT NUMBERS. We do nottake responsibility for any loss that may occur in mailing passport/s.

· ·

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India Visa ApplicationQuestionnaire

Please answer all the questions and legibly complete all the fields of the following questionnaire.

Return to GenVisa with the rest of the required information listed on Tourist Visa Requirements

on Page 1.

QUESTIONS ANSWERS

APPLICANTS INFORMATION

1. Surname, as in passport

2. Given Names (first, middle)

3. Other names used (maiden, etc.)

4. Place of Birth (TOWN, State, Country)

5. Driver’s License Number

6. Religion

7. Visible Identification Marks (moles, scars,

tattoos on your face or arms)

8. Education (List your highest education)

9. Marital Status ☐Single ☐ Married ☐Divorced

☐ Widowed

10. Spouse’s Full Name as in passport

11. Spouse’s Nationality

12. Spouse’s Previous Nationality

13. Spouse’s Place of Birth (TOWN, State,

Country)

PASSPORT DETAILS

14. Passport number

15. Place of Issue

16. Date of issue (dd/mm/yyyy)

17. Date of expiry (dd/mm/yyyy)

18. Current Nationality

APPLICANT’S ADDRESS DETAILS

19. House Number and Street (NO PO BOX)

20. City and State

21. Zip Code

22. Phone Number

23. Email Address (please print)

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04/27/2018

FAMILY DETAILS

24. Father’s Full Name

25. Father’s Nationality

26. Father’s Place of Birth (TOWN, State,

Country)

27. Mother’s Full Name

28. Mother’s maiden name, if known

29. Mother’s Nationality

30. Mother’s Place of Birth (TOWN, State,

Country)

31. Were your Grandfather/Grandmother

Pakistan Nationals or Belong to Pakistan

Held Area?

PROFESSION/OCCUPATION DETAILS OF APPLICANT

32. Present Occupation (if retired, say retired)

33. Employer/Business Name

34. Designation/Position

35. Employer’s Full Street Address ____________________________________

____________________________________

36. Employer’s Phone Number

37. Past Occupation

38. Military Service (if yes, please list

organization, designation, rank and

station)

_____________________________________

_____________________________________

VISIT DETAILS

39. Type of Visa TOURIST

40. Places to be visited (cities in India) MUMBAI, GOA

41. Number Of Entries MULTIPLE

42. Duration of Visa 120 MONTHS

43. Date of arrival (dd/mm/yyyy) 8 SEPTEMBER 2018

44. Port of Arrival MUMBAI

45. Port of Exit GOA

PREVIOUS VISA DETAILS

46. Have you ever visited India? If Yes,

Please list details why and when?

____________________________________

____________________________________

47. Has permission to visit or to extend stay

in India previously have been refused?

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04/27/2018

48. Have you visited “South Asian

Association for Regional Cooperation”

(SAARC- Afghanistan, Bangladesh,

Bhutan, India, Maldives, Nepal, Pakistan,

Sri Lanka) countries in past 3 year? If yes,

please indicate when and list details.

49. Countries visited in past 10 years (list just

Names of the countries you have visited

In last 10 years)

50. Reference Name in India (including

Address and Phone Number)

Port Agent Main Office

101 Thane Belapur Rd

New Mumbai, MH 400708, India

022 41 563301

51. Reference Name in United States (Name,

Complete physical address and phone

Number)

Viking Ocean Cruises

5700 Canoga Ave

Woodland Hills, CA 91367

800-706-1483

Signature: _____________________

Date: ________________

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04/27/2018

ADDITIONAL PARTICULARS FORM FOR VISA SERVICES

1. Name of Applicant :

2. Passport Number and Nationality :

3. Please specify whether holding dual nationality. :If yes, please provide name of countries andpassport numbers

4. Any previous Nationality held? If yes, specify :

5. Name of Spouse and current Nationality :

6. Any other Nationality previously held by spouse? If yes, :please provide name of countries and passport numbers

7. Has the applicant ever changed his/her name? If yes, :specify details and submit appropriate documentation forthe same

8. Did the applicant or his/her parents or his/her grandparents :ever hold the citizenship of Bangladesh, Afghanistan, Bhutan,China, Nepal or Sri Lanka at any point of time? If yes, pleaseprovide details

9. Whether the applicant or his/her parents or his/her : grandparents ever hold the citizenship of Pakistan, orNICOP (National Identity Card for Overseas Pakistanis) orPOC (Pakistan Origin Card)? If yes, specify details

10. Did the applicant work before or is currently Working with :Armed Forces/Police/Para-Military Forces/Governmentservice? If yes, name of Organization, Designation, Placeof Posting and Rank should be given

11. Did the applicant ever hold official/diplomatic passport? :If yes, specify details

12. Current Employment status along with full details of employer :

13. Has the applicant ever been convicted of any criminal offense :or is currently facing criminal charges in any court of law?If YES, specify details.

14. Has the applicant or any of his parents ever applied for asylum?:If yes, specify details

DECLARATION

I hereby declare that the above particulars are true. I also agree that in case any false information is given inthe above form, appropriate action as per Government of India rules and regulations may be taken against me, including butnot limited to revoking of issued Visa and any other action as deemed fit by the Government of India or itsagencies.

Date :

Place : ___________________________(Signature of the Applicant)

Please note:In case of minor child, both parents/legal guardian should sign the declaration

Please note - All questions must be answered with details. Where applicable, please answer as Yes or No. Do not answer as N/A. Incorrect / Incomplete applications and applications answered in N/A will not be processed.

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SRI LANKA ETA Request Form

Traveler Details:

Surname/Family Name:

First Name:

Middle Name:

Gender:

Street Address:

City:

State and Zip Code:

Phone Number:

Email Address:

Date of Birth:

Country of Birth:

Passport Information:

Passport Number:

Passport Issue Date:

Passport Expiration Date:

Travel Information:

Date of Departure from United States: September 9

Date of Arrival in Sri Lanka: September 13

Lengh of Stay: 2 days

Place of Stay: On board Viking Orion

Purpose of Visit: Tourism

Please note: for travel into Sri Lanka, the traveler must carry an original, signed passport valid for 6

months beyond his or her return to United States, with at least one blank visa page. Amendment and Endorsement pages in the back of the passport are not suitable for visa placement. The ETA is submitted online with the ETA approval communicated via email. You MUST carry the ETA approval with you at all times. Round Trip Itinerary and most recent Bank Statement must be present at all times while in Sri Lanka.

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04/27/2018

IMPORTANT PASSPORT AND VISA INFORMATION FOR VISITING CHINAPLEASE READ THIS IMPORTANT INFORMATION PRIOR TO CALLING GENVISA SERVICE

Viking Ocean Cruises is pleased to provide its travelers with information and forms tosecure the necessary travel documentation for entry into China.A passport, valid for at least six months beyond the date of your return from the cruise,as well as a valid visa, which provides for entry and exit. China visas are pasted directlyinto passports and with all the cruise stops at least TEN (10) blank visa pages are required. (Note: the last three pages of your passport are for the US Department ofState use only and will not be considered for visa placement). If you needassistance in securing or renewing your current passport, please contact GenVisa at800-845-8968 (Monday – Friday 9:00 AM – 5:30 PM ET) for requirements and fees.Photographs should be recent, professional, passport type photos, in color, on acompletely white background, presenting a full frontal facial view to represent a goodlikeness of the passport holder. For specific China Embassy photo guidelines pleaserefer to the enclosed page 14.

The following information is meant to serve as guidelines in filling out theenclosed visa application form (some fields have been prefilled on your behalf):

PLEASE NOTE: you are NOT REQUIRED to use only CAPITAL letters. You can use both!

No. 1.1: Write your last name (surname), middle and first names, exactly as theyappear in your passport.No. 1.2: Your Chinese name in Chinese characters only if born in China. If notapplicable, please write “N/A.

No. 1.3: Maiden name or other names you may have had or been known by in the past.No. 1.8: If born in China please also indicate city and province.No. 1.9: Please provide your Driver License number or Citizenship number for anaturalized citizen.No. 1.13: Enter what is listed under Authority on the picture page of your passport,usually “US Department of State” or U.S. Dept of State.No. 1.15: If you checked “Businessperson”, please specify occupation in “Other”.No. 1.17: If retired please indicate so in the name field, and answer N/A for mailingaddress and phone number.No. 1.23: In addition to the accompanying relative list at least one other family member.No. 2.2: Do not change prefilled selection for visa category! US citizens automaticallyget multiple entry visas regardless of their travel needs.No. 2.4: Approximate date of arrival is fine.No. 2.5: Total number of days you will be spending in Mainland China. Your total staycannot exceed 60 days.No. 2.6: Prefilled for your convenience: “On board Viking Cruise Ship Orion”No. 2.7: Myself or “prepaid cruise with Viking Ocean Cruises”

No. 2.8: N/A or prepaid tour with “name of the tour operator”.

No. 3.1-3.7: Please check appropriate boxes. If you have previously been refused aChinese visa, have a criminal record please contact GenVisa for assistance.IMPORTANT NOTE FROM THE CHINESE EMBASSY: Persons suffering from mental

disorder, leprosy, AIDS, venereal diseases, contagious tuberculosis or other diseases shall not be allowed to enter China. The Validity of the Visa, Duration of Stay, and Number of Entries, are issued at the discretion of the consular officers, whose decisions are based strictly on the laws and regulations of the Chinese Government. The consular officers are entitled to change and/or revoke issued visas. They reserve the right to refuse any application and withhold disclosure of the reason for the refusal. All visa requirements are subject to change without notice at the discretion and interpretation of the Chinese Embassy and Consulate General.

PLEASE CALL THE GENVISA TEAM AT 1-800-845-8968 WITH ANYQUESTIONS REGARDING THE VISA APPLICATION PROCESS.

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第 1 页 共 4 页 / Page 1 of 4

Form V.2013

中 华 人 民 共 和 国 签 证 申 请 表Visa Application Form of the People’s Republic of China

(For the Mainland of China only)

申请人必须如实、完整、清楚地填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在□内打√选择。如有关项目不适用，

请写“无”。The applicant should fill in this form truthfully ，completely and clearly. Please type the answer in capital English letters in the

space provided or tick (√) the relevant box to select. If some of the items do not apply, please type N/A or None.

一、个人信息 Part 1: Personal Information

1.1 英文姓名Full English nameas in passport

姓 Last name

粘贴一张近期正面免冠、浅色背景

的彩色护照照片。

照片/PhotoAffix one recent color passportphoto (full face, front view,

bareheaded and against a plain lightcolored background).

中间名 Middle name

名 First name

1.2 中文姓名Name in Chinese

1.3 别名或曾用名

Other name(s)

1.4 性别 Sex □ 男 M □ 女 F1.5 出生日期

DOB(yyyy-mm-dd)

1.6 现有国籍

Current nationality(ies)1.7 曾有国籍 Former nationality(ies)

1.8 出生地点(市、省/州、国)

Place of birth(city, province/state,country)

1.9 身份证/公民证号码

Local ID/ Citizenship number

1.10 护照/旅行证件种类

Passport/Travel document type

□ 外交 Diplomatic □ 公务、官员 Service or Official

□ 普通 Ordinary □ 其他证件(请说明) Other (Please specify):

1.11 护照号码

Passport number

1.12 签发日期

Date of issue(yyyy-mm-dd)

1.13 签发地点

Place of issue

1.14 失效日期

Date of expiry(yyyy-mm-dd)

1.15 当前职业

（可选多项）

Currentoccupation(s)

□ 商人 Businessperson

□ 公司职员 Company employee

□ 演艺人员 Entertainer

□ 工人/农民 Industrial/Agricultural worker

□ 学生 Student

□ 乘务人员 Crew member

□ 自雇 Self-employed

□ 无业 Unemployed

□ 退休 Retired

□ 前/现任议员 Former/incumbent member of parliament

职位 Position________________________

□ 前/现任政府官员 Former/incumbent government official

职位 Position________________________

□ 军人 Military personnel

职位 Position________________________

□ 非政府组织人员 NGO staff

□ 宗教人士 Religious personnel

□ 新闻从业人员 Staff of media

□ 其他(请说明) Other (Please specify):

1.16 受教育程度

Education

□ 研究生 Postgraduate □ 大学 College

□ 其他(请说明) Other (Please specify):

1.17 工作单位/学校

Employer/School

名称

Name

联系电话

Phone number

地址 Address邮政编码

Zip Code

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二、旅行信息 Part 2: Travel Information

1.18 家庭住址

Home address

1.19 邮政编码

Zip Code

1.20 电话/手机

Home/mobile phone number

1.21 电子邮箱

E-mail address

1.22 婚姻状况 Marital status □ 已婚 Married □ 单身 Single □ 其他 Other(Please specify):

1.23 主要家庭成员

(配偶、子女、父母

等,可另纸)

Major family

members（spouse,

children,parents,etc.,may type on

separate paper）

姓名 Name 国籍 Nationality 职业 Occupation 关系 Relationship

1.24

紧急联络人信息

EmergencyContact

姓名

Name

手机

Mobile phone number

与申请人的关系

Relationship with the applicant

1.25 申请人申请签证时所在的国家或地区 Country or territory where the

applicant is located when applying for this visa

2.1 申请

入境事由 Major

purposeof your visit

□ 官方访问 Official Visit □ 常驻外交、领事、国际组织人员

As resident diplomat，consul or staff of international

organization□ 旅游 Tourism

□ 交流、考察、访问 Non-business visit □ 永久居留 As permanent resident

□ 商业贸易 Business & Trade □ 工作 Work

□ 人才引进 As introduced talent □ 寄养 As child in foster care

□ 执行乘务 As crew member

□ 过境 Transit

□ 短期探望中国公民或者具有中国永久居留资格的

外国人 Short-term visit to Chinese citizen or

foreigner with Chinese permanent residence status

□ 与中国公民或者具有中国永久居留资格的外国人家庭

团聚居留超过 180 日 Family reunion for over 180 days

with Chinese citizen or foreigner with Chinesepermanent residence status

□ 短期探望因工作、学习等事由在中国停留居留的外

国人 Short-term visit to foreigner residing in China

due to work, study or other reasons

□ 长期探望因工作、学习等事由在中国居留的外国人 As

accompanying family member of foreigner residing inChina due to work, study or other reasons

□ 短期学习 Short-term study for less than 180 days □ 长期学习 Long-term study for over 180 days

□ 短期采访报道 As journalist for temporary news

coverage

□外国常驻中国新闻机构记者 As resident journalist

□ 其他(请说明)Other (Please specify)：

2.2 计划

入境次数

Intended numberof entries

□ 一次(自签发之日起 3 个月有效) One entry valid for 3 months from the date of issue

□ 二次(自签发之日起 3-6 个月有效) Two entries valid for 3 to 6 months from the date of issue

□ 半年多次（自签发之日起 6 个月有效) Multiple entries valid for 6 months from the date of issue

□ 一年多次（自签发之日起 1 年有效) Multiple entries valid for 1 year from the date of issue

□ 其他（请说明）Other (Please specify):

2.3 是否申请加急服务 Are you applying for express service?

注：加急服务须经领事官员批准，将加收费用。Note: Express service needs approval of

consular officials, and extra fees may apply.

□ 是 Yes □ 否 No

2.4 本次行程预计首次抵达中国的日期

Expected date of your first entry into China on this trip (yyyy-mm-dd)

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三、其他事项 Part 3: Other Information

3.1 是否曾在中国超过签证或居留许可允许的期限停留？Have you ever overstayed your visa orresidence permit in China?

□是 Yes □否 No

3.2 是否曾经被拒绝签发中国签证,或被拒绝进入中国？Have you ever been refused a visa for China, orbeen refused entry into China?

□是 Yes □否 No

3.3 是否在中国或其他国家有犯罪记录？Do you have any criminal record in China or any othercountry?

□是 Yes □否 No

3.4 是否具有以下任一种情形 Are you experiencing any of the following conditions?

① 严重精神障碍 Serious mental disorder

② 传染性肺结核病 Infectious pulmonary tuberculosis

③ 可能危害公共卫生的其他传染病 Other infectious disease of public health hazards

□是 Yes □否 No

3.5 近 30 日内是否前往过流行性疾病传染的国家或地区？Did you visit countries or territories affectedby infectious diseases in the last 30 days?

□是 Yes □否 No

3.6 如果对 3.1 到 3.5 的任何一个问题选择“是”，请在下面详细说明。If you select Yes to any questions from 3.1 to 3.5, please give details below.

2.5 预计行程中单次在华停留的最长天数

Longest intended stay in China among all entriesDays

2.6 在中国境内行

程（按时间顺序,

可附另纸填写）

Itinerary inChina (in time

sequence，may

type on separatepaper)

日期 Date 详细地址 Detailed address

2.7 谁将承担在中国期间的费用？Who will pay for

your travel and expenses during your stay in China?

2.8 中国境内邀请

单位或个人信息

Information ofinviter in China

姓名或名称

Name

地址

Address

联系电话

Phone number

与申请人关系

Relationship with the applicant

2.9 是否曾经获得过中国签证？如有，请说明最近一次获得中国签证的时

间和地点。Have you ever been granted a Chinese visa? If applicable,please specify the date and place of the last time you were granted the visa.

2.10 过去 12 个月中访问的其他国家或地区 Other countries or territoriesyou visited in the last 12 months

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3.7 如果有本表未涉及而需专门陈述的其他与签证申请相关的事项，请在此或另纸说明。If you have more information about your visa application other than the above to declare,please give details below or type on a separatepaper.

3.8 如申请人护照中的偕行人与申请人一同旅行，请将偕行人照片粘贴在下面并填写偕行人信息。If someone else travels and shares thesame passport with the applicant , please affix their photos and give their information below.

偕行人信息

Information

偕行人 1Person 1

粘贴照片于此Affix Photo

here

偕行人 2Person 2

粘贴照片于此Affix Photo

here

偕行人 3Person 3

粘贴照片于此Affix Photo

here

姓名Full name

性别Sex

生日DOB(yyyy-mm-dd)

四、声明及签名 Part 4: Declaration & Signature

4.1 我声明，我已阅读并理解此表所有内容要求，并愿就所填报信息和申请材料的真实性承担一切法律后果。I hereby declare that I have read and understood all the questions in this application and shall bear all the legal consequences for theauthenticity of the information and materials I provided.4.2 我理解，能否获得签证、获得何种签证、入境次数以及有效期、停留期等将由领事官员决定，任何不实、误导或填写不完整均可能

导致签证申请被拒绝或被拒绝进入中国。I understand that whether to issue a visa, type of visa, number of entries, validity and duration of each stay will be determined by consularofficial, and that any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into China.4.3 我理解，根据中国法律，申请人即使持有中国签证仍有可能被拒绝入境。I understand that, according to Chinese law, applicant may be refused entry into China even if a visa is granted.

申请人签名 日期Applicant’s signature: Date (yyyy-mm-dd):

注：未满 18 周岁的未成年人须由父母或监护人代签。Note: The parent or guardian shall sign on behalf of a minor under 18 years of age.

五、他人代填申请表时填写以下内容 Part 5：If the application form is completed by another person on the applicant's

behalf, please fill out the information of the one who completes the form

5.1 姓名 Name5.2 与申请人关系 Relationshipwith the applicant

5.3 地址 Address 5.4 电话 Phone number

5.5 声明 Declaration

我声明本人是根据申请人要求而协助填表，证明申请人理解并确认表中所填写内容准确无误。I declare that I have assisted in the completion of this form at the request of the applicant and that the applicant understands and agrees thatthe information provided is true and correct.

代填人签名/Signature： 日期/Date (yyyy-mm-dd):

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* Required for further contact

Visa Approval/Reference Number (if any):

EMBASSY OF VIETNAM

1233 20th

Street, NW, Suite 400

Washington, D.C. 20036

Tel: (202) 861-0737 & (202) 861-2293

Fax: (202) 861-0917

http://www.vietnamembassy.us

VISA

APPLICATION

(FOR NON-VIETNAMESE

PASSPORT HOLDERS)

______

01 Photo

(2 inches x 2 inches)

Glued photo here 01 additional photo

stapled to this form for a

loose -leaf visa request

1. Name (in block letters):

.................................................................................………………………………………….

Family name First name Middle name

2. Date of birth:.................../............./….… …

Date / Month / Year

3. Male: Female

4. Place of birth:..............................................

5. Nationality at birth:......................................

Nationality at present:..................................

6. Passport number:........................................

Date of issue:................ ........... ........... .........

Date of expiry:........... ........... ........... ...........

7. Profession:......................................................

Place of employment:.....................................

.................................... ......................... ....

……….…………………………………………

Telephone (Office):…....…....................... .....

8. Present mailing address: (P.O Box Not

Accepted for USPS express mail)

………….………………………………………

…………………………………………………

…………………………………………………

…………………………………………………

* Email :………………………….

* Telephone :.......................................

9. Purpose of visit to Vietnam:

…………………………………………………

…………………………………………………

…………………………………………………

10. Name, address of your contact (sponsor, host,

hotel…) in Vietnam (if any)

.........................…………

................................................................……

.........................................................................

.........................................................................

.........................................................................

..………………………………………….…

11. Proposed date of entry:

.......... …./…............/......... ..... Date / Month / Year

Proposed date of exit:

....… … /…………/……........ Date / Month / Year

12. Requesting a visa good for:

• Times of entries:

- Single (one time) visit

- Multiple visits

• Length of stay:

- One month

- 03 months

- Less than 6 Months (with an approval only)

- Up to one year (with an approval only)

I solemnly declare that the statements made in this application are true and correct.

Date:…………………………………………………

Signature of Applicant ...............................................

Check list: Before submitting, make sure you have included:

Original Passport (for a visa sticker request); or Passport copy (front photo page, for a loose-leaf visa request)

Completed and signed Application with One Photo glued or stapled;

PLEASE USE THIS FORM ONLY IF YOU CHOSE APPLICATION TRANSCRIBING SERVICE FOR $49

PREPAID CRUISE WITH VIKING CRUISESON BOARD VIKING ORION

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ROYAL EMBASSY OF CAMBODIA

IN : Washington D.C.

KINGDOM OF CAMBODIA Nation Religion King

~ ~

VISA APPLICATION FORM Photograph

2 x 2

Please submit 1 copy with 1 photo and your passport Surname: Present occupation:

First name:

Sex: Male □ Female □Date of birth: Day..…..Month………Year…......

Place of birth: ……………………………………

Place of residence:

Fax: /Phone:

Birth nationality:

Present nationality: Work Place:

Passport of traveling document is valid for (country)

Date of entry to Cambodia: Day.….Month……Year…….

Date of departure (length of stay)

Purpose of visit □ Diplomatic

□ Tourist □ Official

□Business □Others (Please Specify)

Point of entry:

Means of Transportation:

Point of exit:

Means of Transportation:

Address during the visit: Organization, Persons

to be visited :

First trip to Cambodia □ Yes

□ No

Passport No:

Place of issue:

Date of issue:

Date of Expiration: Traveling on group tour □ Yes

□ No

Sex Surname First name

Patronymic M F Date of birth

Permanent

Address

Children under 12 years

traveling with you

Relatives in the

Kingdom of Cambodia

I hereby declare that the information

on this form is true and correct

Place, (Date)………..…………….

(Signature of the applicant)

For official use

éf¶pþl; …………........... Tidæakarelx ………………

elxsMKal;……………… RbePT ………………… éf¶ …… Ex …… qñaM …… htßelxam®nþITTYlbnÞúkkic©karkugs‘ul

UNITED STATES

SIHANOUKVILLECRUISE SHIP

ON BOARD VIKING ORION

SIHANOUKVILLECRUISE SHIP

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