-
BI-84)
Form 11
DEPARTMENT OF HOME AFFAIRS
REPUBLIC OF SOUTH AFRICA
APPLICATION FOR VISA OR TRANSIT VISA
[Section 7(1)
(g)
read with section 10A and 10B;
Regulation 8(1)]
Failure to complete this application
form in full may result in the visa being delayed
or refused.
信息不全可能导致延迟或拒
签
Please use block letters and black ink
only.
请用黑色印刷体填写
PERSONAL PARTICULARS
个人信息
Surname:
姓
First names (in
full):
名
Maiden
name:
婚
前姓
Previous
surname(s):
Date of
birth:
生
日
Y
2
Y
Y
0
1
Y
0
M
0
M
8
D
2
D
8
City of
birth:
出生
地
………………………………………………
Country of
birth:
出生国
家
………..………………
……………………………………………………………
……………………………….
Gender
Male
Female
性别
:
男
女
If acquired by naturalisation, state
original
Nationality
民
nationality:
如果已经获得，指明原始国
族
: …………
………….…………………………………………
......
籍
……………….…………………….
Where and when was present
nationality obtained:
何时何地获得现在国
籍
………………………………………………………………
………….…..
Passport/Travel Document
Number
护照号
码
:
………….………………….………..
Type of document:
Diplomatic/Official/Ordinary Passport/Travel
Document/other (specify)
护照类型：外交
/
公务
/
普通护照
/
旅行护照
/
其
它
……………………
..……………………..………
Permanent residential
address:
永久住
Issuing
authority:
签发机
关
…………………………….
Date of
expiry:
有效
期
…………………………….…
址
……………………………………………………………………………………………………………
……………………………
…………………………………………………………………………
…………………………………………………………………
……………………………………
………………………………………………………………………………………………………
…
Period
resident at this
address:
暂住地
址
…………………………………………
…..
Telephone
number
电话号码
:
(…..……)
(code)
区号
………………………………………
(number)
号
码
Period resident
in that country:
………………………………………………….
Country of
permanent residence:
国籍
………
……………………………………………………
Occupation or
profession:
职业
……
Name, address and telephone no. of
employer, university, organisation, etc. to which
you are attached, or that you
attend or
wh
ich you represent: ………
你的老板
的姓名、地址、电话、大学等等你需要说明的
的
.………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
…………………………
…….……………………………………………………………………
……………………………………………………………
If self-employed, state name, address,
telephone no. and nature of business:
如果
自己经营，请说明公司名字，电话和业
务范围
………………………………………………………………………………………….……………………………
……………………
………………….……………………………………………………………
……………………………………………………………
…………………………………………
…………………………………………………………………………………………………
Marital
status:
婚姻状况
Never
married
未婚
Married
已婚
Widowed
< br>寡
居
Separated
分居
Divorced
离婚
First name(s) of
spouse:
配偶名
Maiden name:
配偶姓
Y
Y
Y
Y
Date of
birth:
配偶
出生日期
M
M
D
D
Nationality
国
籍
……………
………
…………...…………………
NB: SEPARATE FORMS MUST BE COMPLETED
IN RESPECT OF PERSONS OVER THE AGE OF 16 AND
CHILDREN UNDER THE AGE OF 16 TRAVELLING
ON THEIR OWN PASSPORTS.
Particulars of children endorsed on
your passport accompanying
you:
你的护照上关于子女的情况：
Surname
Place of
birth
First
name(s)
名
Date of
birth
出生日期
姓
出生地
(1)
(2)
(3)
(4)
VISIT TO
SOUTH AFRICA
南非行程
Expected date of arrival in the
Republic:
预计到达日期
Y …………..……………….. M ………….……………………..
D …….………………..
Place of arrival
到达地
址
:……
…………………………..…………………………
…………………..…………………………………………….
Purpose of
visit:
旅行目
的
……………………………………….……….…….…………………………………………………………
………….
Duration of stay
(months, weeks or
days)
停留时
间
.
………………….…………………………………………………………………………..
Number of entries
required:
Single
Multiple
Two
Proposed
residential address (physical) in the Republic,
including the full name(s) of your host or
hotel:
在南非你的亲戚或宾