IMPORTANT PASSPORT AND VISA INFORMATION FOR VISITING

Brazil

We are pleased to provide you with information and forms to obtain the necessary travel documentation forentry into Brazil.

A passport, valid for at least six months beyond the length of stay in Brazil, is required, as well as a visa, which provides for entry and exit. Brazilian tourist visas are stamped in passports; and, in general, the consulates require one clean visa page (not amendment page) for each visa stamp.

IMPORTANT NOTE: When visas are required they are necessary entry documents, but they do not guarantee entry into a country. The Immigration Officer at the point of arrival will review visas and/or other documents and make a determination as to whether entry will be permitted, the purpose of entry and the length of stay.

If you need assistance in securing a new or renewal passport, or additional visa pages to your passport, please contact CIBT at 1-800-406-1523, Monday - Friday, 9:00am - 5:00pm, CST (customerservice@cibt.com). Information on current State Department requirements, forms, and fees will be provided to you at the time of your call. NOTE: Expeditedpassport processing normally takes 5-10 business days, and visa processing can only commence after passport processing is concluded. Please be sure you contact CIBT for specific information in urgent situations prior to forwarding your documentation.

Requirements, forms, and fees for U.S. citizens, which are subject to change without notice, are given on the attached “VISA ORDER FORM.” Travelers who are not U.S. citizens can call CIBT at 1-800-406-1523 for nationality specific information and requirements.

Please use the checklist in the “Requirements are Per Person” section of the Visa Order Form to correctly identify the documentation that should be forwarded to the CIBT office. All passports are returned via UPS to the address you provide in the “Return Shipping Address” section.

Please complete all questions via online or enclosed visa application form, and sign the form using blue or black ink. Please refer to the guidelines on the following page in answering all blanks on the form. Then, attach required number of photographs (as indicated on the Visa Order Form), where applicable.

Photograph guidelines: approximately 2” x 2”, in color, official passport-type presenting a full frontal facialview on a clear background, and should be recent enough to represent a good likeness of the passport holder.

Please do not send your documentation to the CIBT office more than 90 days prior to your tour departure. The

approximate processing time required to obtain your requested visa (DO NOT include shipping days to and from the CIBT office):

Brazil: 40 or more business days

Need Date: Please specify on the CIBT Visa Order Form (last page) if you have any other travel plans that will require you to have your passport by a specific date. If you need your visa in less than 30 business days, please call CIBT immediately at 800-406-1523 so that we can determine if a visa can be obtained in time for your trip. Applications that can be expedited will incur rush fees.

Please calculate the total number of days required to process your travel documentation requests (either visa alone or passport/visa together), and consider the date you forward documentation to the CIBT office and the date you require the passport to be returned to you prior to your tour departure. Then indicate either “normal” or “rush” processing time/fees on the Visa Order Form for either one or two travelers.

NOTE: If you have traveled to the country(ies) indicated as requiring visa(s) in this Visa Information Brochure, please review your passport for an existing multiple-entry visa that may still be valid for the dates of this trip. Please be advised that upon receipt of your documentation package in the CIBT office, CIBT will either obtain the requested visa(s), or, should we find that you already have a valid, multiple entry visa(s), applicable consular fees may be charged, and a $25CIBT "stop process" fee will be assessed, per passport.

CIBT will not be able to provide guidance on the validity of visas without actually receiving and reviewing your passport.

APPLICATION INSTRUCTIONS: The following information is meant to serve as a guide in completing certain questions on your visa application form.

Please provide your full name as it appears in your passport.

Please provide street address, no P.O. boxes.

If retired, please so indicate; otherwise, please provide your current occupation or profession.

Please provide the address of your employer.

Please provide the name of your employer.

Please provide the date of entry and the name of the first city you will visit in Brazil.

Please provide the names of other cities/points of interest you will visit in Brazil, if applicable.

Please provide the exact number of days of your stay in Brazil, according to your itinerary.

DID YOU SIGN AND DATE YOUR APPLICATIONS?

HEALTH REQUIREMENTS: Vaccinations are not required unless travel is through an infected area.We recommend that you consult with your personal physician for his/her health recommendations for your entire trip.

By sending applications to CIBT for processing, you accept all of the requirements, restrictions and limitations on liability set forth herein and specifically agree and confirm that neither CIBT nor your travel company shall be liable to you for any failure to comply with the necessary visa requirements for your travel, for the action or inaction of any government body and/or for the performance by any third party delivery company. At all times and under all circumstances, CIBT's total liability to you for any all claims, causes of action, liabilities and damages of any kind shall not, in any circumstance or for any reason, exceed the lesser of the fees actually paid by you to CIBT or $500. In no event shall CIBT be liable to you for any indirect, special, consequential or incidental losses or damages, including, without limitation, lost profits, or for punitive damages, and that your sole and exclusive remedy against CIBT for damages in connection with the failure to obtain a requested visa or visas in a timely manner shall be the return of the CIBT service fees actually paid by you or $500, whichever is less.

Important jurisdictional information!!

Effective June 1, 2005, the Brazilian Consulates in the United States are now jurisdictional. Application forms and requirements may vary from consulate to consulate, so please select the consulate that has jurisdiction over the state in which you reside.

After locating your state of residence and determining which consulate has jurisdiction over your state of residency, please complete the appropriate visa application and send along with your passport and copy of your travel itinerary to the appropriate CIBT location.

If you reside in: States of Oregon, Washington, Alaska and in the State of California, the counties of Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Fresno, Glenn, Humboldt, Inyo, Kings, Lake, Lassen, Ladera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benedito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskyou, Solano, Sonoma, Stanislau, Sutter,Tehama, Trinity, Tulare, Tuolunme, Yolo,and Yuma, complete the online application (San Francisco) and send your completed documents to: CIBT – 165 Post Street, 3rd Floor, San Francisco, CA 94108

If you reside in: Arkansas, Colorado, Kansas, Louisiana, New Mexico, Oklahoma, Texas, complete the onlineapplication (Houston) and send your completed documents to: CIBT – Two Greenway Plaza, Suite 610, Houston,TX 77046

If you reside in: District of Columbia, States of Kentucky, Maryland, Ohio, Virginia, and West Virginia,complete the online application (DC) and send your completed documents to:CIBT – 4301 Connecticut Ave, NW, Suite 250, Washington, DC 20008

If you reside in: Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, use the Boston application and send your completed documents to: CIBT – 60 East 42nd Street, Suite 1250, New York, NY 10165

If you reside in: Connecticut, Delaware, New Jersey, New York, Pennsylvania and the Bermuda Islands, complete the online application (NY) and send your completed documents to: CIBT – 60 East 42nd Street, Suite 1250, New York, NY 10165

If you reside in: Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, and Wisconsin, complete the online application (Chicago) and send your completed documents to: CIBT – 180 N Stetson Avenue, Suite 3170, Chicago, IL 60601

If you reside in: States of Arizona, Hawaii, Idaho, Montana, Nevada, Utah, Wyoming, and in the State of California, the counties of Imperial, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura, complete the online application (Los Angeles) and send your completed documents to: CIBT – 6300 Wilshire Boulevard, Suite 1520, Los Angeles, CA 90048

If you reside in: Alabama, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee, completethe online application (Atlanta) and send your completed documents to: CIBT – 3340 Peachtree Road, Suite 1800,Atlanta, GA 30326

If you reside in: Florida, Puerto Rico or the US Virgin Islands, complete the online application (Miami) and send completed documents to: CIBT - 169 E Flagler Street, Suite 1522, Miami, FL 33131

CHICAGO BRAZIL VISA APPLICATION

The Consulate of Brazil has instituted a web-based visa application form. The application must be completed on line at: https://scedv.serpro.gov.br. Click or “cut and paste” the link into your web browser. Follow all instructions for completing/printing the Chicago Brazil visa application form. CIBT cannot process the visa request if the traveler does not complete the application using this method.

The attached waiver form must also be completed and submitted along with your visa paperwork to the CIBT Chicago Office.

Use this form if you reside in the following states: If you reside in: Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, and Wisconsin, send your completed and signed documents to: CIBT – 180 N Stetson Avenue, Suite 3170, Chicago, IL 60601.

Applicant’s Sworn Statement Waiver

I certify that the information provided by me on the Visa Application Form are complete and accurate.

___________________ ______________ __________Printed Name Signature Date

WASHINGTON DC BRAZIL VISA FORM

The Consulate of Brazil has instituted a web-based visa application form. The application must be completed on line at: https://scedv.serpro.gov.br. Click or “cut and paste” the link into your web browser. Follow all instructions for completing/printing the Washington, DC Brazil visaapplication form. CIBT cannot process the visa request if the traveler doesnot complete the application using this method. If you are entering Brazil via land, you must submit a copy of your bank statement along with your paperwork in order to receive a visa.

Use this form if you reside in the following states: District of Columbia, States of Kentucky, Maryland, Ohio, Virginia, and West Virginia, send your completed and signed documents to: CIBT – 2233 Wisconsin Avenue, Suite 215, Washington, DC 20007 Photos must be glued to the application - stapled or clipped photos will berejected. Applications cannot be folded. The visa fee for Washington, DCjurisdiction has increased by $10.00.

NEW YORK BRAZIL VISA FORM

The Consulate of Brazil has instituted a web-based visa application form. The application must be completed on line at: https://scedv.serpro.gov.br.Click or “cut and paste” the link into your web browser. Follow all instructions for completing/printing the New York Brazil visa application form. CIBT cannot process the visa request if the traveler doesnot complete the application using this method. Use this form if you reside in the following states: Connecticut, Delaware, New Jersey, New York, Pennsylvania and the Bermuda Islands, send your completed and signed documents to: CIBT – 60 East 42nd Street, Suite 1250, New York, NY 10165

HOUSTON BRAZIL VISA FORM

The Consulate of Brazil has instituted a web-based visa application form. The application must be completed on line at: https://scedv.serpro.gov.br. Click or “cut and paste” the link into your web browser. Follow all instructions for completing/printing the Houston Brazil visa application form. CIBT cannot process the visa request if the traveler does not complete the application using this method.

Use this form if you reside in the following states: Arkansas, Colorado, Kansas, Louisiana, New Mexico, Oklahoma, Texas, send your completed and signed documents to: CIBT – Two Greenway Plaza, Suite 610,Houston, TX 77046

SAN FRANCISCO BRAZIL VISA FORM

The Consulate of Brazil has instituted a web-based visa application form. The application must be completed on line at: https://scedv.serpro.gov.br. Click or “cut and paste” the link into your web browser. Follow all instructions for completing/printing the San Francisco Brazil visa application form. CIBT cannot process the visa request if the traveler does not complete the application using this method.

Use this form if you reside in the following states: States of Oregon, Washington, Alaska and in the State of California, the counties of Alameda, Alpine, Amador, Butte, Calaveras, Colusa, Contra Costa, Del Norte, El Dorado, Fresno, Glenn Humboldt, Inyo, Kings, Lake, Lassen, Ladera, Marin, Mariposa, Mendocino, Merced, Modoc, Mono, Monterey, Napa, Nevada, Placer, Plumas, Sacramento, San Benedito, San Francisco, San Joaquin, San Mateo, Santa Clara, Santa Cruz, Shasta, Sierra, Siskyou, Solano, Sonoma, Stanislau, Sutter,Tehama, Trinity, Tulare, Tuolunme, Yolo,and Yuma, send your completed and signed documents to: CIBT – 165 Post Street, 3rd Floor, San Francisco, CA 94108

IMPORTANT INFORMATION REGARDING YOUR TRIP TO BRAZIL RECENT CONSULAR CHANGES On September 1, 2009 the Consulate of Brazil in Los Angeles imposed restrictions on visa processing via third parties. Due to this and their continuing transition to an electronic processing system, CIBT is currently unable to dependably submit visa applications for the Brazilian Consulate Los Angeles jurisdiction. We hope that these restrictions are temporary and that once their system is fully implemented CIBT will resume regular processing. The Los Angeles consulate in Brazil has not offered any timeline on the lifting of their restrictions on third party submittals. Please check the consulate’s website as information changes frequently. The website is http://www.brazilian-consulate.org/ . To obtain a Brazil visa through the Los Angeles Consulate, travelers must complete an on-line application and then schedule an appointment to deliver required documents to the consulate in person. Unfortunately, we are not able to submit applications to the other Brazil Consulates in the United States. Each consulate strictly enforces jurisdiction and only accepts applications from residents in their states. The Consulate of Brazil in Los Angeles serves the following areas:

Arizona, Hawaii, Idaho, Montana, Nevada, Utah, Wyoming, U.S. Minor Outlying Islands in the Pacific (Johnston, Midway, Wake, Howland, Jarvis, Baker, Palmyra and Kingman), and in the following counties in California: Imperial, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura.

THE VISA PROCESS Please visit: http://www.brazilian-consulate.org/ to fill out the visa application online and obtain requirements. Detailed instructions on the visa process can be found there as well as information on how to secure a visa appointment at the Consulate of Brazil in Los Angeles. You must use your visa within 90 days of its issue date, or it becomes invalid. YOUR PASSPORT A passport, valid for at least six (6) months beyond the completion of your trip, is required for a trip to Brazil. If your passport is not valid for 6 months beyond your trip dates, or if you do not have a passport, please contact us for further instructions. Requirements and forms will be provided to you at the time of your call. Your passport must contain at least one completely clear, blank, unused visa page for the Brazil visa, not including any amendment pages. Visa pages with stains or ink from other pages in the passport are not usable. We offer passport replacement insurance which will replace one lost, stolen or damaged passport free of charge. See: {PassportInsuranceLink} for more information on this service. VACCINATION INFORMATION All people traveling to Manaus or through interior areas of South America prior to entering Brazil must submit a copy of their valid International Certificate of Yellow Fever vaccination to the Consulate of Brazil in Los Angeles, along the other visa requirements. Travelers must also carry a copy of an International Certificate of Yellow Fever Vaccination during their trip to Brazil. Anyone traveling to the Amazon basin or through Peru prior to entering Brazil must also submit a copy of the Yellow Fever Vaccination certificate. A letter from your physician exempting you from the Yellow Fever vaccination for medical reasons may be substituted. Since requirements and recommendations are subject to change, please consult your private physician or local health department for current information. Please go to http://wwwn.cdc.gov/travel/contentVaccinations.aspx for the most up-to-date health requirements.

ATLANTA BRAZIL VISA FORM

The Consulate of Brazil has instituted a web-based visa application form. The application must be completed on line at: https://scedv.serpro.gov.br. Click or “cut and paste” the link into your web browser. Follow all instructions for completing/printing the Atlanta Brazil visa application form. CIBT cannot process the visa request if the traveler does not complete the application using this method.

Use this application if you reside in the following states:: Alabama, Georgia, Mississippi, North Carolina, South Carolina and Tennessee, send your completed and signed documents to: CIBT – 3340 Peachtree Road, Suite 1800, Atlanta, GA 30326.

BOSTON BRAZIL VISA FORM

Use this form if you reside in the following states: Maine, Massachusetts, New Hampshire, and Rhode Island and Vermont. Send your completed and signed documents to CIBT: 60 East 42nd

Street, Suite 1250, New York, NY 10165.

REPÚBLICA FEDERATIVA DO BRASIL

MINISTÉRIO DAS RELAÇÕES EXTERIORES

CONSULADO-GERAL DO BRASIL EM BOSTON

FORMULÁRIO DE PEDIDO DE VISTO

VISA APPLICATION FORM

DADOS PESSOAIS / PERSONAL INFORMATION PROTOCOLO Nº

01 - NOME COMPLETO (FIRST/MIDDLE/FAMILY NAME) VISTO Nº

02 - NASCIDO EM (cidade/estado/país) PLACE OF BIRTH (city/state/country)

03 - DATA DE NASCIMENTO (dia/mês/ano)

DATE OF BIRTH (day/month/year)

04 - NACIONALIDADENATIONALITY

05 - SEXOGENDER

06 - ESTADO CIVIL MARITAL STATUS

ATTACH

3 X 4 cm (2 X 2 in)

07 – NÚMERO DO DOCUMENTO DE VIAGEM

PASSPORT OR TRAVEL DOCUMENT NUMBER

08 - PAÍS EXPEDIDORISSUING COUNTRY

09 - EXPIRAÇÃO (dia/mês/ano) EXPIRATION DATE (d/m/y)

PHOTO

HERE

10 - NOME DOS PAIS /PARENTS’ NAME

do pai/father’s: _______________________________________________________________

da mãe/mother’s: _____________________________________________________________

11 - ENDEREÇO RESIDENCIAL / HOME ADDRESS 12 - TELEFONE Nº TELEPHONE #

13 - PROFISSÃOOCCUPATION

14 - ENDEREÇO PROFISSIONAL /BUSINESS ADDRESS 15 - TELEFONE Nº TELEPHONE #

16 - EMPREGADOREMPLOYER

FAVOR PREENCHER À MÁQUINA OU EM LETRA DE FORMA. RESPONDER AOS ITENS 1 A 26 (FRENTE E VERSO) E ASSINAR. OS FORMULÁRIOSINCOMPLETOS SERÃO DEVOLVIDOS.Declarações inverídicas sobre o requerente, o objetivo da visita, o periodo de estada, o endereço e contato no Brasil, ou qualqueroutra informação requerida causará a denegação do visto. A correspondente taxa de processamento não é restituível.PLEASE TYPE OR PRINT. ANSWER ITEMS 1 THROUGH 26 (FRONT AND BACK) AND SIGN. INCOMPLETE FORMS WILL BE RETURNED.False statements about the applicant, the purpose of visit, length of stay, address and contact in Brazil, or any other requiredinformation will cause the visa to be denied. Corresponding processing fees are non-refundable.

PARA USO OFICIAL / FOR OFFICIAL USE ONLY

A - Consulta à SERE

____________Nº. _________

B - Autorização da SERE

______________ Nº._________

C - Tipo do Visto

_________________________

D -

Concessão Denegação Prorrogação

E - Entradas

Uma

Múltiplas

F - Prazo de Estada

_________anos/dias

G - Data

______/______/_____ dia mês ano

H - Observações CONSULADO-GERAL DO BRASIL EM BOSTON

I - Assinaturas

Funcionário Chefia

CGBOS – Modelo NSCJ 11.1.18 Atualizado em 7/29/08

CGBOS – Modelo NSCJ 11.1.18 Atualizado em 7/29/08

DADOS PESSOAIS / PERSONAL INFORMATION (CONT.)

17 - OBJETIVO DA VIAGEM AO BRASIL /PURPOSE OF VISIT TO BRAZIL (PLEASE CHECK AS APPROPRIATE) :

VIAGEM ESTRITAMENTE DE NATUREZA TURÍSTICA (ATIVIDADES REMUNERADAS PROIBIDAS) MY VISIT WILL BE STRICTLY FOR TOURISM (NO PAID ACTIVITIES ARE ALLOWED).

VIAGEM DE NEGÓCIOS I AM GOING TO BRAZIL ON BUSINESS.

VIAGEM DE TRÂNSITO I AM IN TRANSIT .

PARTICIPAÇÃO EM SEMINÁRIOS OU CONFERÊNCIAS I WILL PARTICIPATE IN SEMINARS OR CONFERENCES.

PARTICIPAÇÃO EM PROGRAMAS CULTURAIS/CIENTÍFICOS I WILL TAKE PART IN A CULTURAL/SCIENTIFIC PROGRAM.

DESEMPENHO DE ATIVIDADES DE PESQUISA I WILL DEVELOP RESEARCH ACTIVITIES.

TRABALHO EM ATIVIDADES DE ASSISTÊNCIA SOCIAL I WILL ACCOMPANY A GROUP OF CHURCH VOLUNTEERS AND/OR TAKE PART IN COMMUNITY SOCIAL WORKS.

PARTICIPAÇÃO EM ATIVIDADES ESPORTIVAS E/OU ARTÍSTICASI INTEND TO PARTICIPATE IN SPORT AND/OR ARTISTIC ACTIVITIES.

TRABALHO COMO CORRESPONDENTE JORNALÍSTICO I INTEND TO WORK AS A MEDIA CORRESPONDENT.

TRABALHO COM CONTRATO NO BRASIL I INTEND TO HOLD A POSITION UNDER AN EMPLOYMENT CONTRACT IN BRAZIL.

TRABALHO COMO MISSIONÁRIO RELIGIOSO NO BRASIL I INTEND TO WORK AS A RELIGIOUS MISSIONARY IN BRAZIL.

ATIVIDADE EM ÁREAS HABITADAS POR POPULAÇÕES INDÍGENAS I INTEND TO VISIT AREAS INHABITED BY INDIGENOUS POPULATIONS.

CURSOS ESCOLARES NO BRASIL I WILL ATTEND SCHOOL IN BRAZIL.

VIAGEM EM MISSÃO OFICIAL I WILL TRAVEL IN AN OFFICIAL MISSION.

ACOMPANHAMENTO DE PESSOAS EM MISSÃO OFICIAL I WILL ACCOMPANY MEMBERS OF AN OFFICIAL MISSION.

SOLICITAÇÃO DE VISTO PERMANENTE I AM APPLYING FOR A PERMANENT VISA.

OUTROS (INDICAR) OTHER (EXPLAIN)

_______________________________________________________________________________________________

18 - NOME E ENDEREÇO DA PESSOA, ENTIDADE OU EMPRESA DE CONTATO NO BRASIL NAME AND ADDRESS OF PERSON, INSTITUTION OR COMPANY WHERE YOU CAN BE CONTACTED IN BRAZIL

19 - ENDEREÇO NO BRASILADDRESS IN BRAZIL

20 - TELEFONE Nº TELEPHONE #

21 - LOCAL E DATA DE DESEMBARQUE PLACE AND DATE OF ARRIVAL

22 - DESTINO DESTINATION

23 - PERÍODO DA ESTADA LENGTH OF INTENDED STAY

24 - JÁ ESTEVE NO BRASIL? HAVE YOU EVER BEEN IN BRAZIL?

SIM (YES) NÃO (NO)

25 - EM CASO AFIRMATIVO, QUANDO/LOCAL/DURAÇÃO DA ÚLTIMA ESTADA

IF YES, WHEN/PLACE /LENGTH OF LAST STAY

TERMO DE RESPONSABILIDADE / FORMAL STATEMENT

26 - DECLARO SEREM VERDADEIRAS E COMPLETAS AS INFORMAÇÕES CONTIDAS NO PRESENTE DOCUMENTO. I DECLARE THAT THE ABOVE INFORMATION IS TRUE AND ACCURATE.

NOME /NAME DATA /DATE ASSINATURA /SIGNATURE

Dia

Day

Mês

Month

Ano

Year

MIAMI BRAZIL VISA FORM The Consulate of Brazil has instituted a web-based visa application form. The application must be completed on line at: https://scedv.serpro.gov.br. Click or “cut and paste” the link into your web browser. Follow all instructions for completing/printing the Miami Brazil visa application form. CIBT cannot process the visa request if the traveler does not complete the application using this method. Use this form if you live in the following states: Florida, Puerto Rico, US Virgin Islands, and the Commonwealth of the Bahamas, send your completed and signed documents to: CIBT - 169 E Flagler Street, Suite 1522, Miami, FL 33131

CIBT VISA ORDER FORM

www.cibt.com800-406-1523

Please send the following documents to the CIBT office address based on your residence (page 3). We recommend you use an overnight shipping service that has a package tracking system, such as FedEx, UPS, Airborne, etc. Please note, whichever method of shipping you select, you are responsible for the cost of shipping your documents to CIBT.

REQUIREMENTS ARE PER PERSON:

____ YOUR PASSPORT, signed and valid for 6 months beyond your length of stay in Brazil.

____ One (1) completed and signed Brazilian visa application.

Date(s) you are entering Brazil ____________ (list ALL dates of entry). Brazilian tourist visas are valid for

(90) days from date of issue. The customer is responsible for verifying that the issued visa(s) will be valid

as of the date(s) of his or her entry into Brazil.

____ One (1) photo, in color, regular passport type (2” x 2”). Please staple the photo to the application where indicated.

____ Copy of your travel itinerary which includes air schedule.

____ Clear copy of your driver’s license or state issued ID to prove residency. In lieu of state issued ID, a copy of your recent

utility bill will be accepted.

____ This completed “VISA ORDER FORM,” for one traveler or two individuals traveling together.

____ Your check made payable to CIBT or credit card information (see GRAND TOTAL below).

____ Please note that CIBT, Inc. requires payment (credit card or check) at the time services are rendered. “A 2.49% processing fee will be assessed on all consular/government fees paid by CIBT. This amount is included In the total estimate of charges below.”

____ Credit Card Type & #: _____________________________________ Credit Card Expiration Date: _________________

Name as it appears on card: __________________________________________________

Billing address: __________________________________ City: _______________ State: _________ Zip: __________

Signature: _______________________________________________________ Date: ____________________________

RETURN SHIPPING ADDRESS: (No P.O. boxes, please) Date THIS TOUR Departs U. S.: / /

Address: Home Phone: ( )

City: State: Zip Code: Day Phone: ( ) Fax: ( )

Date I MUST have passport at above address: / / E-mail address: TRAVELER 1 Last Name First: Citizen of: Date of Birth: / / Passport #: Passport Expires: / / Mother’s Maiden Name: TRAVELER 2 Last Name First: Citizen of: Date of Birth: / / Passport #: Passport Expires: / / Mother’s Maiden Name: Processing Requirements and Fees Per Person (in U.S. dollars) are subject to change without notice:

Country Traveler

1(X)

Traveler2

(X)

Normal Processing 40 or More

Business Days

Rush Processing Less Than 40

Business Days AMOUNT

ENCLOSED

Brazil – U.S. citizen Paid by General Tours Contact CIBTIf you need additional visa pages added in your U.S. passport or need your passport renewed, please contact CIBT for current requirementsat 800-406-1523. Please mention Account #50123 when calling. Not all locations offer rush processing. Please contact CIBT for information.

Shipping 2 Day Service via Fedex(Note: up to five passports can be shipped

in one package for the fee below)

AMOUNT ENCLOSED

To single street address in the continental U.S. Paid by General Tours

Shipping & Handling fees must be included for processing and delivery of travel documents. SUB TOTAL $ GRAND TOTAL: $

Account #50123 Brazil - 2010