DOC《新字 第号》

新字 第号外国记者证延期申请表Application Form for Renewal of Press Card 名(Given Name)姓(Surname) 中文姓名(Chinese Name) 出生日期(Date of Birth)年-月-日,Y-M-D)性别(Gender) 国籍(Nationality)护照号码(Passport No.

护照有效期(Date of Expiration of Passport)年-月-日,Y-M-D) 现持常驻记者证号(Current Press Card No. 代表机构英文名称(Name of the Media you Represent) 代表机构中文名称(Chinese Name of the Media you Represent) 来华任职开始日期(Date of Accreditation in China)年-月-日,Y-M-D) 轮换何人(Name of Your Predecessor) 使用语言(Working Language) 代表机构在华中文地址(Address of the Media you Represent in China, written in Chinese) 地址邮编(Postcode of Office Address) 办公电话(Telephone of Office)办公传真(Fax of Office) 在华中文住址(Home Address in China in Chinese) 住址邮编(Postcode of Home Address)住址电话(Home Telephone) 手机号码(Cell Phone)电子信箱(E-Mail) 同行家属(Accompanying Family Members) 姓名(Name) 关系(Relationship) 性别(Gender) 出生日期(Date of Birth,年-月-日,Y-M-D) 护照号(Passport No.) 本人是否于过去一年在中国(仅指内地)停留六个月以上?Have you stayed in China(mainland) for over

6 months?是(YES) 否(NO) 申请人签字(Signature): 以下栏由发证机关填写(For Official Use Only) 经办人: 填发日期: 是否新设分社 轮换何人 备注