簽證發給認定號碼[反簽號] (CONFIRMATION OF VISA ISSUANCE NO. ) :

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1.姓(拼音) Surname

3.漢字姓名

4.性別 Gender

[  ]M   [  ]F

2.名(拼音) Given Names

5.出生日期 Date of Birth

6.國籍 Nationality

7.出生地點 Country of Birth

8.現住所 Home Address

9.固定電話號碼 Phone NO.

10.手機號碼 Cell Phone

11.電子郵箱 E-mail

12.身份證號 National Identity Number

護照

Passport

13.護照號碼 Passport NO.

14.護照類型 Classification

外交,    公務,   公務普通,    因私,      其他

 DP,      OF          OF,       OR,      OTHERS

15.簽發地點 Place of Issue

16.簽發日期 Date of Issue

17.有效期至 Date Of Expiry

職業

Occupation

18.職業 Occupation

19.單位電話 Business Phone NO.

20.單位名稱  Name of Present Employer

   單位地址  Address of Present Employer

婚姻狀況

Martial status

21.[  ]未婚 Single           [  ]已婚 Married            [  ]喪偶 Widowed            [  ]離婚 Divorced

22.配偶者姓名 Spouse's Name

23.配偶者出生日期 Spouse's Date of Birth

24.配偶者國籍 Spouse's Nationality

25.配偶者聯系電話 Spouse's TEL

26.赴韓目的 Purpose of Entry

27.在韓停留時間 Potential Length of Stay

28.預定赴韓日期 Potential Date of Entry

29.過去有無訪韓經歷 Previous Visit (If Any)       有     無

30.韓國內停留地 Address in Korea

31.韓國內聯系電話 Phone NO. in Korea

32.此次赴韓費用支付者 Who Will Pay For The Expense For Your Stay?

33.最近5年內旅行過的國家 Countries You Have Traveled During The Past 5 Years

34.  同伴家族

Accompanying

Family

關系 Relationship

國籍 Nationality

姓名 Name

出生日期 Date of Birth

性別 Gender

35. 韓國內擔保人

     Guarantor or

Reference in Korea

關系 Relationship

國籍 Nationality

姓名 Name

出生日期 Date of Birth

性別 Gender

  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.

收入印紙（簽證郵票）粘貼處

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申請日 DATE OF APPLICATION                           申請人署名 SIGNATURE OF APPLICANT

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