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* Tick (√) where appropriate
** Delete where appropriate
APPLICATION FOR
A* VISIT PASS VISA & VISIT PASS ENTRY VISA
PART I
–
PARTICULARS OF APPLICANT
Foreign
Identification No. (FIN):
(leave blank if not applicable)
Sex:*
Male Female
Date of Birth:
D D
M M Y Y Y Y
For Malaysians Only (including old or
new Malaysian IC)
Identity
Card No.:
Colour:* Red Blue
Marital Status:* Single
Married
Separated Divorced Widowed
Name:
Family Name/Surname
Given Name
Alias:
Family
Name/Surname
Given Name
(leave blank if not applicable)
Name in Chinese
Characters:
(If applicable)
Country of Birth:
State/Province of Birth:
Race: (e.g.
Malay, Indian,
Chinese, Caucasian, etc)
Nationality:
Religion/Denomination: :
Type of Travel
Document Held:
(e.g. Passport, Certificate of
Identity,
Document of Identity, etc)
Travel Document No.:
Travel Document
Issued Date:
Expiry Date:
D D M M Y Y Y Y D D M M Y Y Y Y
Country of
Issue:
Place of
Issue: