DOC《출입국관리법 시행규칙 [별지 제17호서식]》

?????? ???? [?? ?17???] (第一页/ Page1) 签证发给申请表 APPLICATION FOR VISA ? 申请人须以事实为根据,并将在以下空格处完整记载.

? 申请人必须用韩文,英文或中文填写以下申请表. ? 在相关选项的 [√] 内打钩. ? 如您选择 其他 ,请写具体内容. ? You must fill out this form completely and correctly. ? You must write in block letters either in English or Korean. ? For multiple-choice questions, you must check [√] all that apply. ? If you select'

Other'

, please provide us with more information in the given space. 1. 个人信息 / PERSONAL DETAILS PHOTO 护照规格照片 (35L*45L) 6个月内拍摄的正面 免冠彩色相片, 相片背景颜色须为纯白色 A color photo taken within last

6 months(full face without hat, front view against white or off-white background) 1.1 护照上的英文名/Full name in English (as shown in your passport) 姓Family Name 名Given Names 1.2 中文名字 1.3 性别 Sex 男/Male[ * ] 女/Female[ ] 1.4 出生日期 Date of Birth (yyyy/mm/dd) 1.5 国籍 Nationality 1.6 出生国 Country of Birth 1.7 国家身份证号码 National Identity No. 1.8 您以前出境或入境韩国时是否使用过其他姓名? Have you ever used any other names to enter or depart Korea? 否No [ / ] 是Yes [ ] → 如您选择 是 ,请写具体内容 If'

Yes'

please provide details (姓Family Name , 名Given Name ) 1.9 您是否拥有双重国籍? Are you a citizen of more than one country ? 否No [ /] 是Yes [ ] → 如您选择 是 ,请写具体内容 If'

Yes'

please write the countries 领馆审核栏 FOR OFFICIAL USE ONLY ? ? ? ? : ???? ?? * ??? ???? ???? ?? ?? ?? ?? ?? ?? ? ? ? ? ? ? ? ? ???? ???? 可・否???????? ???? <

???? ???/印花税票粘贴处 >

210mm*297mm[??? 80g/O(????)] (第二页 / Page2) 2. 签证发给认定书签发信息 / DETAILS OF VISA ISSUANCE CONFIRMATION 仅限于在大韩民国出入国管理事务所・办事处收到签证发给认定书的人 (Section

2 is only for those who possess confirmation of visa issuance issued by the Immigration Office of the Republic of Korea) 2.1 签证发给认定号码 Confirmation No. 2.2 签发日期 Issue Date 2.3 护照号码 Passport No 2.4 护照有效期至 Passport Expiry Date ? 签证发给认定书持有者直接移到第12部分(誓约),填写以下空格后提交申请表(不用写第3~11部分) Those who have confirmation of visa issuance must move to section

12 (Declaration) to complete this from (Those with visa issuance confirmation must not fill out section 3~11). 3. 护照信息 / PASSPORT INFORMATION 3.1 护照类型 Passport Type 外交护照 Diplomatic [ ] 公务护照 Official [ ] 普通护照 Regular[ / ] 其他 Other [ ] → 如您选择'

其他'

,请写具体内容 If'

Other'

please provide details 3.2 护照号码 Passport No. 3.3 护照签发国 Country of Passport 3.4 护照签发地 Place of Issue 3.5 签发日期 Date of Issue 3.6 护照有效期至 Date Of Expiry 3.7 您是否有其他的护照? Do you have any other valid passport ? 否No [/ ] 是Yes [ ] → 如您选择'

是'

,请写具体内容 If'

Yes'

please provide details a) 护照类型 Passport Type 外交护照 Diplomatic [ ] 公务护照 Official [ ] 普通护照 Regular[ ] 其他 Other [ ] b) 护照号码 Passport No. c) 护照签发国 Country of Passport d) 护照有效期至 Date Of Expiry 4. 联系信息 / CONTACT INFORMATION 4.1 本国地址 Address in Your Home Country 4.1 现居住地 Current Residential Address *仅限于现居住地与本国地址不同者 / Write if it is different from the above address 4.3 手机号码 Cell Phone No. 4.4 电话号码 Telephone No. 4.5 电子邮件 E-mail 4.6 紧急联系人信息 Emergency Contact Information a) 姓名 Full Name in English b) 居住国家 Country of residence c) 电话号码 Telephone No. d) 关系 Relationship to you 5. 婚姻状况 / MARITAL STATUS DETAILS 5.1 目前婚姻状况 Current Marital Status 已婚 Married [ *] 离婚 Divorced [ ] 未婚 Never married [ ] 5.2 配偶个人信息 *仅限于已婚者 If'