Embassy of Pakis Embassy of Pakistan

Embassy of Pakistan
Ulica Wiertnicza 63
02-952 Warsaw
http://www.mofa.gov.pk/poland
Your photograph must be:
Passport size (2 x 1.5)
A recent and likeness, showing
full face with no hat, helmet or
sunglasses although you can
wear every day glasses.
Please paste one photo here.
Visa Application Form
Section-I (Visa Details)
1.
Type of visa applied for (Tick the appropriate box):
Diplomatic
Official
Military
Business
Family
Transit
Journalist
Others
Tourist
(specify)_______
2.
Purpose of Visit: ________________________________________________
3.
Duration of Stay (Please specify the correct days or months of stay in Pakistan):
______________________________________________________________
4.
5.
Visa Required for (the period in which the journey will be made):
01 Month
03 Months
02 Years
05 Years
Entries:
Single
06 Months
Double
01 Year
Multiple
i. Port of Entry (in Pakistan)_______________________________________
ii. Port of Departure (from Pakistan)________________________________
iii. Places to be visited in Pakistan: _________________________________
6.
Tentative Date of Departure from Poland:____________________________
7.
Mode of Transport:
8.
Route:
_____________________________________________
______________________________________________________
Page 2 of 7
Section-II
Part-I (Applicant’s Details)
1.
Name as in Passport: _____________ _______________
2.
Date of Birth:
3.
Place of Birth: City:________________
4.
Sex: Male
5.
Marital Status: Single
6.
Native Language: _________________
7.
Nationality: (a) Present ________________ (b) Previous ________________
8.
PESEL/Citizenship No: _______________
(First)
(Tick the box)
(Middle)
______________
(Last)
_____ _____ _______
DD
MM
Female
YYYY
Country: ___________________
Blood Group: ________________________
Married
Divorced
09.
Religion: ______________
Part-II (Passport Details)
10. Type of Passport: Diplomatic
Official/Service
(Tick the box)
UN Travel Document
Ordinary
11. Passport No: __________________
Issued by: ______________________
12. Date of Issue:_________________
Date of Expiry: __________________
Part-III (Address & Email)
13. (a)Address in Poland/Latvia/Estonia:________________________________
____________________________________________________________________
Telephone: Home______________ Work: ______________ Mobile_____________
(b)
In Pakistan: _____________________________________________________
____________________________________________________________________
Telephone: Home______________ Work: ______________ Mobile_____________
Email Address: _______________________________________________________
Page 3 of 7
14. Is your visit sponsored?
If yes, give details.
Name of
Sponsor
Nationality
Yes
No
Profession
Citizenship
No
Address
Contact
Number
Part-IV (Details of Profession),
Please attach a certificate from your company that you are employee of the company
15. Company/Organization Name: _______________________________________
16. Address of Company: _____________________________________________
17. Working as (Designation): __________________________________________
18. Date of Appointment: ______________________________________________
19. Details of Jobs Held in the Past:
Designation
From
To
Duties
Company
Name
Address &
Phone No.
20. Are you applying visa from a third country? Yes
No
If yes, please provide the copy of the resident/work permit
Resident/Work permit No: ___________________________________________
Duration of Stay: From: ____________
To: _______________
Page 4 of 7
Section-III
Part-I (Applicant’s Family Details)
1. Name of Spouse: ____________
Nationality: _________________________
Date of Birth: _______________
Place of Birth: _______________________
Profession: ______________________________________________________
Name, address and contact No. of employer of spouse: ___________________
_______________________________________________________________
2. Children:
Name
3.
4.
Date of Birth
Nationality
Profession
Parents:
Father’s Name
Age
Profession
Address
Mother’s Name
Age
Profession
Address
Brothers & Sisters
Name
Relatio
nship
Date of
Birth
Nationality
Profession
Address
Page 5 of 7
5.
Any accompanying person/family member (including children) travelling with you
to Pakistan:
Name
6.
Relatio
nship
Date of
Birth
Nationality
Do you have any bank account in Pakistan:
If yes, please provide details.
Bank name
Branch
Passport
No
Yes
Address
No
A/C Number
Address
Part-II (Travel History)
7.
Have you visited Pakistan during last five years?
If yes, please provide details.
Visa No.
8.
Place of
Issue
Date of
Issue
Date
of
Entry
Yes
Date of
Exit
No
Places
visited
Purpose
Details of other Countries visited during last two years:
Country
Name
Date of
Entry
Date of Exit
Places visited
Purpose
Page 6 of 7
9.
Have you ever been refused a visa for any country, including Pakistan: Yes
10. Have you ever been refused entry on arrival to Pakistan: Yes
if yes, provide details of refusal:
No
No
______________________________________________________________
______________________________________________________________
11. Have you ever been deported, removed or otherwise required to leave any
country, including Pakistan: Yes
No
If yes, provide details:
Date
Country
Reason
Reference No
(For Pakistan)
12. Do you have any criminal convictions or charged in any country: Yes
If yes, provide details:
Date
Country
Offence
No
Sentence
Declaration:
I hereby declare that the information given in this form is correct to the best of my
knowledge and belief and if any of the particulars furnished above are found to be
incorrect or withheld the visa is liable to be rejected/cancelled at any time.
Date:_______________
_____________________
(Signature of Applicant)
Page 7 of 7