[별지 제17호서식]
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사증발급신청서 APPLICATION FOR VISA
※ 사증발급인정번호(CONFIRMATION OF VISA ISSUANCE No : )

사 진
PHOTO
3.5㎝  4.5㎝

1.성 Surname

3.漢字姓名

4.성별 Gender 
M F

2.명 Given Names

5.생년월일 Date of Birth

6.국적 Nationality

7.출생국가 Country of Birth

8.현주소 Home Address

9.전화번호 Phone No.

10.휴대전화 Mobile Phone No.

11.이메일 E-mail

12.신분증번호 National Identity No.

여권

13.여권번호 Passport No.

14.여권종류 Classification

外交, 公務, 公務普通, 因私, 其他
DP(外交), OF(官用), OR(一般), OTHERS(其他)

15.발급지 Place of Issue

16.발급일자 Date of Issue

17.기간만료일 Date Of Expiry

직업

18.직업 Occupation

19.직장전화번호 Business Phone No.

20.직장명 및 주소 Name and Address of Present Employer

결혼여부
Marital status

21. 기혼 married     배우자사망 widowed         미혼 Single         이혼 divorced

22.배우자 성명 Spouse's Name

23.배우자 생년월일 Spouse's Date of Birth

24.배우자 국적 Spouse's Nationality

25.배우자 연락처 Spouse's Phone No.

26.입국 목적 Purpose of Entry

27.체류예정기간 Potential Length of Stay

28.입국예정일 Potential Date of Entry

29.방한사실 Previous Visit (If Any)

30.국내체류지 Address in Korea

31.국내전화번호 Phone No. in Korea

32.국내 체류비용 지불자 Who Will Pay For The Expense For Your Stay?

33.과거 5년간 여행국가 Countries You Have Travelled During The Past 5 Years

※ Please note that C-series visa holders are not able to change their residential status after entry into Republic of Korea pursuant to the first clause of article 9 of Immigration Regulation

34.동반가족
Accompanying Family

관계 Relationship

국적 Nationality

성명 Name

생년월일 Date of birth

성별 Gender

mm dd yy

M F

M F

35.국내 보증인
Guarantor or Reference in Korea

관계Relationship

국적 Nationality

성명 Name

생년월일 Date of birth

성별 Gender

M F

  I declare that the statements made in this application are true and correct to the best of my knowledge and belief, that I will observe the provisions of the Immigration Law of the Republic of Korea and that I will not engage in any activities irrelevant to the purpose of entry stated herein. Besides, I am fully aware that any false or misleading statement may result in the refusal of a visa, and that possession of a visa does not entitle the bearer to enter the Republic of Korea upon arrival at the port of entry if he/she is found inadmissible.

신청일자 DATE OF APPLICATION   mm dd yy                             신청인 서명 SIGNATURE OF APPLICANT

공용란 FOR OFFICIAL USE ONLY

기본사항

체류자격

체류기간

사증종류

단수ㆍ복수(2회, 3회 이상)

접수사항

접수일자

접수번호

처리과

허가사항

허가일자

허가번호

고지사항

결 재

   담당자

가  ㆍ  부

〈심사의견〉

수입인지 부착란

210mm  297mm(인쇄용지(2급) 60g/㎡)