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4 Form V.

2013 Visa Application Form of the People'

s Republic of China (For the Mainland of China only) 申请人必须如实、完整、清楚地填写本表格.请逐项在空白处用中文或英文大写字母打印填写,或在内打√选择. 如有关项目不适用, 请写 无 . The applicant should fill in this form truthfully, completely and clearly. Please type the answer in capital English letters in the space provided or tick (√) the relevant box to select. If some of the items do not apply, please type N/A or None.

一、个人信息 Part 1: Personal Information 1.1 英文姓名 Full English name as in passport 姓Last name 请在此粘贴一张近期正 面免冠、白色背景的彩色 护照照片. 照片/Photo Please affixone recent color passport photo (full face, front view, bareheaded and against a plain white background). 中间名 Middle name 名First name 1.2 中文姓名 Name in Chinese 1.3 别名或曾用名 Other name(s) 1.4 性别 Sex 男M女F1.5 出生日期 DOB (yyyy-mm-dd) 1.6 现有国籍 Current nationality(ies) ① ② 1.7 曾有国籍 Former nationality(ies) 1.8 出生地点(市、省/州、国) Place of birth(city, province/state, country) 1.9 驾照号码 Driver license 1.10 护照/旅行证件种类 Type of passport/travel document 外交 Diplomatic 公务、官员 Service or Official 普通 Ordinary 其他证件(请说明) Other (Please specify): 1.11 护照号码 Passport number 1.12 签发日期Date of issue(yyyy-mm-dd) 1.13 签发地点 Place of issue 1.14 失效日期 Date of expiry(yyyy-mm-dd) 1.15 当前职 业(可选多 项) Current occupation (s) 商人 Business person 公司职员 Company employee 演艺人员 Entertainer 工人/农民 Industrial/Agricultural worker 教师/学生 Teacher/Student 乘务人员 Crew member 自雇 Self-employed 无业 Unemployed 退休 Retired 前/现任议员 Former/incumbent member of parliament 职位 Position 前/现任政府官员 Former/incumbent government official 职位 Position 军人 Military personnel 职位 Position 非政府组织人员 NGO staff 宗教人士 Religious personnel 新闻从业人员 Staff of media 其他(请说明) Other (Please specify): 1.16 受教育程度 Education 研究生 Postgraduate 大学 College 其他(请说明) Other (Please specify): 1.17 工作单位或在 读学校Employer or school for student 全称 Full name 联系电话 Phone number 地址 Address 邮政编码 Zip Code 1.18 家庭住址 Home address 1.19 邮政编码 Zip Code 第2页共4页/Page

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二、旅行信息 Part 2: Travel Information 1.20 电话/手机 Home/mobile phone number 1.21 电子邮箱 E-mail 1.22 婚姻状况 Marital status 已婚 Married 单身 Single 其他 Other (Please specify): 1.23 主要家庭成员(配偶、 子女、父母等,可另纸) Major family members(spouse, children, parents etc., may type on a separate paper) 姓名 Name 国籍 Nationality 职业 Occupation 关系 Relationship 1.24 紧急联络人信息 Emergency Contact 姓名 Name 手机 Mobile phone number 与申请人的关系 Relationship with the applicant 1.25 申请人申请签证时所在的国家或地区 Country or territory where the applicant is located when applying for this visa 中国 China 美国 USA 其他国家或地区 Other country or territory 2.1 申请入 境事由 (请选一) Major purpose of your visit (Please select one.) 官方访问 Official Visit 旅游 Tourism 交流、考察、访问 Non-business visit 商业贸易 Business trip 执行乘务 As crew member 过境 Transit 常驻外交、领事、国际组织人员 As resident diplomat, consul or staff of international organization 永久居留 As permanent resident 人才引进 As introduced talent 工作 Work 寄养 As child in foster care 短期探望中国公民或者具有中国永久 居留资格的外国人 Short-term visit to Chinese citizen or foreigner with Chinese permanent residence status 与中国公民或者具有中国永久居留资格的外国人家庭团 聚居留超过

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

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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

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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

12 个月中访问的其他国 家或地区 Other countries or territories you visited in the last

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4 3.7 如果有本表未涉及而需专门陈述的其他与签证申请相关的事项,请在此或另纸说明.If you have more information about your visa application other than the above to declare, please give details below or type on a separate paper. 3.8 如申请人护照中的偕行人与申请人一同旅行,请将偕行人照片粘贴在下面并填写偕行人信息.If someone else travels and shares the same passport with the applican........