A. Personal data &  Employment 	1.	Surname	

Recent
Passport Photograph

Please, do not staple!

FOR OFFICIAL USE ONLY
Êîíñóëûí àæèëòàí áºãëºíº
ÄÒÃ-ûí êîä 

À.Âèç îëãîñîí ¿íäýñëýë
ÃÕß-íû çºâøººðºë
Äóãààð  :
Îãíîî	 :

ÃÈÕÀÝÀ-íû çºâøººðºë
Äóãààð  :
Îãíîî    : 

Áóñàä ¿íäýñëýë:	
	2.	Given names		
	3.	Other names 
		( Name assumed/ previous/ maiden etc) 		
	4.	Date of  birth
	5.	Country of birth		
	6.	Nationality	7.	Sex   Male  Female		
	8.	Address
Street	
City
Country		

	9.	Phone/Fax

10.	E-mail
		
	11.	Your father’s full name		
	12.	Your mother’s full name		
	13.	Profession & Occupation
	14.	Employer/University
		
	15.	Employer/University’s  address 

16.	Phone/Fax					
B. Family record	17.	Marital Status	  Single  Married  Divorced  Widowed		
	18.	Spouse’s name
	19.	Spouse’s Nationality
		
	Children (Complete this section if children included on your passport and traveling with you)		
	20.	Names 	21.	Date & place of birth	22.	Nationalities		

					
					
C. Passport	23.	TypeDiplomatic
Official Ordinary	24.	Number 
	25.	Issuing authority
		
	26.	Date of Issue
	27.	Validity
	28.	Place of issue
	Á. Øèéäâýð
Îëãîõ âèçèéí àíãèëàë	

          	    _______

	ßëãàà
îðîõ
òðàíçèò 
õî¸ð óäàà òðàíçèò
îðîõ/ãàðàõ 
õî¸ð óäàà îðîõ/ãàðàõ
îëîí óäàà îðîõ/ãàðàõ
  6 ñàð / 1 æèë (äîîãóóð çóð)

________________

ãàðûí ¿ñýã	
	29.	Dependents included on your passport (if different from above)

D. Purpose of traveling	30.	Purpose of stay (explain details) 

	31.	Do you have work permit or acceptance for study in Mongolia?
		
	32.	Reference in Mongolia 
Name

Address

Phone	33.	Address & Phone (during your stay)

		
	34.	Means of support (during your stay)
Cash Credit Card Other	35.	Proposed duration of stay		
	36.	Entry permit for the final country of destination (for transit passengers only)
		
	37.	Arrival date
 	38.	Departure date 
	39.	Means of transport
		
E. Visa	40.	Visa requested: 
      Entry					Transit  Double Transit

     Entry& Exit  Double Entry & Exit  		Multiple Entry & Exit

F. Background info	41.	Have you visited Mongolia before?	 Yes  No

	If yes, please give dates and lengths of each stay

	42.	Have you ever been refused a visa or entry? 	 Yes  No
	If yes, please explain the reasons.
	
	43.	Have you ever been deported or otherwise required to leave Mongolia?	 Yes  No
	If yes, please give the details
 	
	44.	Have you ever been deported from another country?	 Yes  No
	If yes, please give details.	
	45.	Have you ever had any infectious disease?	 Yes  No
	If yes, please give details. 

	46.	Have you done HIV test during the last six months? 	 Yes  No
	If yes, please give the results.
	
	47.	Emergency  contact in applicant’s country 	Name 

Address 

Phone / Fax 	
G. Commitments 	•	I agree to my  personal data on this application form being communicated to the appropriate authorities of Mongolia if necessary for the issue of visa

•	I declare that to the best of my knowledge the above particulars are correct and complete. I am aware that any false statements will lead to my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the law of Mongolia.

•	I undertake to leave the territory of Mongolia upon the expiring date of the visa, if granted. 

•	I realize that possession of a visa is only on or the prerequisites for entry into the territory of Mongolia. If entry is refused I will have no claim to compensation.

•	I would get registered within a week after my arrival in Mongolia at the Foreign Citizens and Naturalization Office and get deregistered before the departure at same office, if my stay lengths over thirty days. 
 	
H. Applicants statement	

	
J. Control sector	Ýíý õýñýãò âèçèéí õóóäàñíû òàñàëáàðûã íààíà				Òóñãàé òýìäýãëýë	

Place _______________			Date ________________

Applicant’s signature	 _______________________________________
(In case of minors, signature of parents or guardian)