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180 日Family reunion for over

180 days with Chinese citizen or foreigner with Chinese permanent residence status 短期探望因工作、学习等事由在中国 停留居留的外国人 Short-term visit to foreigner residing in China due to work, study or other reasons 长期探望因工作、学习等事由在中国居留的外国人 As accompanying family member of foreigner residing in China due to work, study or other reasons 短期学习 Short-term study for less than

180 days 长期学习 Long-term study for over

180 days 短期采访报道 As journalist for temporary news coverage 外国常驻中国新闻机构记者 As resident journalist 其他 (请说明)Other (Please specify): 2.2 计划入 境次数 Intended number of entries 一次(3 个月有效) One entry for

3 months 一年多次 One-year multiple entries 二次(3-6 个月有效) Two entries for

3 to

6 months 十年多次 10-year multiple entries 半年多次 6-month multiple entries 注:签证自签发之日生效.Note:All visas are valid from the date of issue. 2.3 是否申请加急服务 Are you applying for expedited service? (注:加急服务须经领事 官员批准并加收费用. Note:Approval of consular officials is required for expedited service, and extra fees may apply.) 特急(第2个工作日领取) Rush-Next working day pickup 加急(第3个工作日领取) Express-3rd working day pickup 普通(第4个工作日领取) Regular-4th working day pickup 2.4 本次行程预计首次抵达中国的日期 Expected date of your first entry into China on this trip (yyyy-mm-dd) 2.5 预计行程中单次在华停留 的最长天数 Longest intended stay in China among all entries Days 第3页共4页/Page

3 of

4

三、其他事项 Part 3: Other Information 3.1 是否曾在中国超过签证或居留许可允许的期限停留?Have you ever overstayed your visa or residence permit in China? 是Yes 否No 3.2 是否曾经被拒绝签发中国签证,或被拒绝进入中国?Have you ever been refused a visa for China, or been refused entry into China? 是Yes 否No 3.3 是否在中国或其他国家有犯罪记录?Do you have any criminal record in China or any other country? 是Yes 否No 3.4 是否具有以下任一种情形 Are you experiencing any of the following conditions? ① 严重精神障碍 Serious mental disorder ② 传染性肺结核病 Infectious pulmonary tuberculosis ③ 可能危害公共卫生的其他传染病 Other infectious disease of public health hazards 是Yes 否No 3.5 近30 日内是否前往过流行性疾病传染的国家或地区?Did you visit countries or territories affected by infectious diseases in the last

30 days? 是Yes 否No 3.6 如果对 3.1 到3.5 的任何一个问题选择"是",请在下面详细说明.If you select Yes to any questions from 3.1 to 3.5, please give details below. 2.6 在中国境 内行程 (按时间 顺序,可附另纸 填写)Itinerary in China (in time sequence,may type on a separate paper) 日期 Date 省和市 Provinces & Cities 详细住址 Detailed address 2.7 谁将承担在中国期间的费用?Who will pay for your travel and expenses during your stay in China? 2.8 中国境内 邀请单位或个 人信息 Information of inviter in China 姓名或名称 Name 地址 Address 联系电话 Phone number 与申请人关系 Relationship with the applicant 2.9 是否曾经获得过中国签证?如有,请说明最近一 次获得中国签证的时间和地点.Have you ever been granted a Chinese visa? If applicable, please specify the date and place of the last time you were granted the visa. 2.10 过去