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Visa Application Form To Enter-Japan

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VISA APPLICATION FORM TO ENTER JAPAN

TRAN

Name in full

(Photo)

(Surname)

approx. 45mm 45mm

DUC LONG

2in2in

(Given and middle name)


Different name used, if any

Date and place of birth

18

10

(Day)

(Month)

male

Sex

1961

Nam Dinh Nam Dinh

(Year)

(City)

Marital status: married Married

Nationality or citizenship

(Province)

Viet Nam
(Country)

single

VIETNAMESE

Former nationality, if any


Purpose of journey to Japan

BUSINESS TRIP

Length of stay in Japan intended

4 DAYS

Route of present journey : Probable date of entry

KANSAI

Port of entry into Japan


Passport
No.

08/09/2011
Name of ship or airline

VIETNAM AIRLINES

(Refugee or stateless should note the title of Travel Document)

B5693198

Issuing authority

Diplomatic, Official, Ordinary Issued at

Immigration Department

Valid until

Viet Nam

on

18/8/2011

18/8/2021

Criminal record, if any


Home address

11D4 Phan Ke Binh Street, 9 ward, Vung Tau City, Viet Nam
Tel.

Profession or occupation

+84 643 833 170

Engineer

Name and address of firm or organization to which applicant belongs PETROVIETNAM CONSTRUCTION JOINT STOCK CORP.

PETROLEUM EQUIPMENT ASSEMBLY & METAL STRUCTURE JSC (PVC-MS)


Post or rank held at present

Tel.

Manager QA/QC & HSE Department

Principal former positions


Partners Profession/occupation (or ParentsProfession/occupation)
Address of hotels or names and addresses of persons with whom applicant intends to stay

CROWNE PLAZA HOTEL KOBE, 1-CHOME, KITANO-CHO CHUO-KU KOBE


Dates and duration of previous stays in Japan NONE
Guarantor or reference in Japan : Name
Address

EMIKO ISHIKAWA

Oval Court Ohsaki Mark West Bldg., 17-1, Higashigotanda 2-chome, Shinagawa-ku TOKYO, 141-8626 JAPAN

Relationship to applicant

Tel.

(03) 5789-2121

BUSINESS PARTNER

(Remarks) Special circumstances, if any


I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to be granted
are decided by the Japanese immigration authorities upon my arrival. I understand that possession of a visa does not entitle the bearer to enter
Japan upon arrival at port of entry if he or she is found inadmissible.
Date of application

29
(Day)

*These items are not essential to be filled

8
(Month)

2011
(Year)
Signature of applicant

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