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签证申请表 APPLICATION FOR VISA ∝ 签证发给认定号码[反签号] (CONFIRMATION OF VISA ISSUANCE NO.

) :照片PHOTO 3.5Н】 4.5Н1.姓(拼音) Surname ZHANG3.汉字姓名 张三4.性别 Gender [√]M [ ]F2.名(拼音) Given Names SAN5.出生日期 Date of Birth 1980年1月1日6.国籍 Nationality 中国7.出生地点 Country of Birth 江苏上海8.现住所 Home Address 上海市XX市XX路XX号XX室9.固定电话号码 Phone NO. 021-1234567810.手机号码 Cell Phone 1390000000011.电子邮箱 E-mail [email protected].身份证号 National Identity Number 320105198001011421护照 Passport13.护照号码 Passport NO. G1234567814.护照类型 Classification外交, 公务, 公务普通, 因私, 其他 DP, OF OF, OR√, OTHERS15.签发地点 Place of Issue 江苏16.签发日期 Date of Issue 2011年4月30日17.有效期至 Date Of Expiry 2021年4月29日职业 Occupation18.职业 Occupation 医生19.单位电话 Business Phone NO. 021-8765432120.单位名称 Name of Present Employer 上海第一医院 单位地址 Address of Present Employer 上海市XX市XX路XX号婚姻状况 Martial status21.[ ]未婚 Single [√ ]已婚 Married [ ]丧偶 Widowed [ ]离婚 Divorced22.配偶者姓名 Spouse's Name 李四23.配偶者出生日期 Spouse's Date of Birth 1982.5.224.配偶者国籍 Spouse's Nationality 中国25.配偶者联系电话 Spouse's TEL 1380000000026.赴韩目的 Purpose of Entry 旅游27.在韩停留时间 Potential Length of Stay 9天28.预定赴韩日期 Potential Date of Entry 2011.5.129.过去有无访韩经历 Previous Visit (If Any) 有无30.韩国内停留地 Address in Korea 首尔,济州岛31.韩国内联系电话 Phone NO. in Korea 010-9698-052132.此次赴韩费用支付者 Who Will Pay For The Expense For Your Stay? 自己33.最近5年内旅行过的国家 Countries You Have Traveled During The Past

5 Years 泰国,美国,澳大利亚34. 同伴家族 Accompanying Family关系 Relationship国籍 Nationality姓名 Name出生日期 Date of Birth性别 Gender妻子中国李四1982年5月2日女35. 韩国内担保人 Guarantor or Reference in Korea关系 Relationship国籍 Nationality姓名 Name出生日期 Date of Birth性别 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.收入印纸(签证邮票)粘贴处 荐涝牢瘤 何馒鄂汩请祉 DATE OF APPLICATION~~~~~~~~~~~ ~~汩请煅唼伲 SIGNATURE OF APPLICANT 傍侩鄂 FOR OFFICIAL USE ONLY B/L:~ 免涝惫荤亲: 汗荐措惑荤蜡: 荤扒何: 阂倾版仿: 扁~~~ 鸥: 荤刘辆幅S~ D~ M立荐老磊眉幅磊拜立荐锅龋眉幅扁埃倾啊老磊蜡瓤扁埃淬 寸搬 犁啊 ・ 何阂倾矫 荤蜡 : 绊瘤荤亲: