1. Name in Full (Fill in Blocks) / _ / _ (First Name) (Middle Name) (Last Name)
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1 EMBASSY OF THE REPUBLIC OF THE UNION OF MYANMAR, WASHINGTON D.C. APPLICATION FOR ENTRY VISA (SOCIAL) (Social Visa Form for Ex-Myanmar Citizens and Immediate Family only) မန မ င င သ ဖစ ခ ဖ သ မ င ၄င တ ႕ မ သ စ ဝင မ လ မ ရ ဗ ဇ လ က ထ ရန ပ စ ( ပည စ စ ဖည စ က ရန လ ပ မည ) (မ တ ခ က ) Social Visa က င ဆ င သ သ ဆ မ သ ခ င A မ တ င တည ခ င ပ သည 1. Name in Full (Fill in Blocks) / _ / _ 2. Father s Full Name _ / / mm color photo 3. Date of Birth (dd/mm/yy): / _ / 4. Place of Birth (City / State / Country): / / _ With full face, front view, no hat and against a plain light (Official Name : Country is Myanmar, City is Yangon) background 5. Nationality: U.S. / (other): _ 4. Sex (F) / (M) 6. Present Occupation : _ (If retired write retired, if student write student, If self employ : mention specifically) 7. Marital Status : Married / Separated / Divorced / Widowed / Single (Never Married) 8. Spouse s Full Name : _ Passport 9. (a) Number (b) Date of Issue (dd/mm/yy): / / (c) Place of Issue : (d) Issuing Authority : United States, United States, Department of State Other : National Passport Center/ Other : (e) Date of Expiration (dd/mm/yy): / _ / 10. Present Address in U.S. (Include apartment number, street, city, state or province & postal zone) 11. Contact Phn. No. (Res.) ( _ ) _ (Work) ( _ ) _ Address in Myanmar _ 13. *Are you an Ex-Myanmar : Yes No, (If No) Are you an immediate family of a Myanmar Citizen/ Ex-Myanmar Citizen : Yes No, (If Yes) Mention : Name, Relationship & Address : *If you Answer No to both questions, you should apply for Tourist Visa (You are not eligible to apply Social Visa ) 14. Have you ever been to Myanmar : Yes No (If Yes) Date of Last Visit : (dd/mm/yy): _ / _ / _ 15. Have you ever been refused to enter Myanmar : Yes No (If Yes) When : (dd/mm/yy): _ / _ / Why: 16. Expected date of Arrival : (dd/mm/yy): _ / _ / & Departure : (dd/mm/yy): _ / _ / _ 17. Name and Address of Guarantor during stay in Myanmar _ 18. Attention for Applicant : PHOTO Recently taken 35 mm X 45 (a) Apart from the professions mentioned in this visa application form applicants are not to engage in any sort of work with or without charges. (b) Applicants shall abide by the Law of the Republic of the Union of Myanmar and shall not interfere in the Internal Affairs of the Republic of the Union of Myanmar. (c) Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of the Republic of the Union of Myanmar. I hereby declare that I fully understand the above mentioned conditions, that the particulars given above are true and correct and that I will not engage in any activities irrelevant to the purpose of entry stated herein. Signature of Applicant Date (dd/mm/yy): _ / _ / _ (FOR OFFICIAL USE ONLY) _ Visa No. Date : Visa Authority : MOFA Lt. No (66) Dated : 26 January 1993 (If other) : : MOFA Lt. No. _, Dated : _ Signature of Officer in-charge Embassy of the Republic of the Union of Myanmar (Washington D.C) Contact : Tel. (202) , (202) Fax. (202) , info@mewashingtondc.com
2 Embassy of the Republic of the Union of Myanmar Washington D.C. Work History for Visa Applicant 1. Name in Full (Full in block letter) : _ / _ / 2. Date of birth (dd/mm/yy): / _ / 3. Place of Birth : Myanmar/ U.S. (other): 4. Permanent Home Address : 5. Tel. (Res.) ( ) (Work Place) 6. Work Discription (Current) (a) Job Title : From (dd/mm/yy) : / / - To (dd/mm/yy) : / / (b) Office Section Division Describe your Duties 8. Work Description (Previous) (a) Job Title : From (dd/mm/yy) : / / - To (dd/mm/yy) : / / (b) Office Section Division Describe your Duties I hereby declare that the particulars given above are true and correct and that I will not engage in any activities irrelevant to the purpose of my entry. Signature of Applicant Date : (dd/mm/yy) : / /
3 To Ambassador Embassy of the Republic of the Union of Myanmar Washington D.C. Date : Dear Sir, I, was living in the Republic of the Union of Myanmar and left in 19 / 20. I became a citizen of _ in 19 / 20. I left the Union of Myanmar for social and personal purposes. I have never committed and never been or would be involved in negotiation, movement or activities that is intended to oppose the ideals of the Government of the Republic of the Union of Myanmar. I would like to visit the Republic of the Union Myanmar for the sole of seeing relatives, friends, interesting places and business. Sincerely, Signature _ Date (dd/mm/yy): _ / _ / _ Full Name Address Phone : Home ( ) Work ( ) _
4 သ ႕ သ Aမတ ႀက မန မ သ ရ ဝ ရ င တန ဒ စ ရက စ A ၾက င Aရ လ မ ရ ဗ ဇ (Social Visa) လ က ထ ခင ၁ ကၽ န တ / ကၽ န မသည မန မ င င မ ဖ ခ ၿပ _ ခ စ တ င A မရ ကန င င သ ႕ ရ က ရ ခ က _ ခ စ တ င A မရ ကန င င သ A ဖစ ပ င လ ခ ယ ခ ပ သည ၂ ကၽ န တ / ကၽ န မ မန မ င င သ ႕ သ ရ က ခင သည မ သ စ ဆ မ မ တ သဂ ဟမ A သ ရ က တ ႕ဆ ခင သ ဖစ ပ င င ရ လ ပ ရ မ မ င သ လည က င င င ရ လ ႕ ဆ သ မ င သ လည က င ပ ဝင ပတ သက ဆ င ရ က မ မ ပ လ ပ မည မဟ တ ၾက င A က တ င ခ ဝန ကတ ပ လက မ တ ရ ထ ပ သည ၃ သ ႕ ဖစ ပ မန မ င င တ င ရ သည ဆ မ သ ခ င မ A သ ရ က တ ႕ဆ လ ပ သ ဖင ကၽ န တ / ကၽ န မ A လ မ ရ ဗ ဇ (social visa) လ က ထ ခ င ပ ပ ရန A က ဖ ပပ စ ရ က စ တမ မ င Aတ တင ပ လ က ထ ပ သည (က) 35 mm X 45 mm ရ င စ ဓ တ ပ ကပ ထ သည ဖည စ က ၿပ Visa Form (1) set (ခ) Aလ ပ လ ပ က င ခ သည လ ပ ငန ရ ဇဝင Aက U ခ ပ (Work History)- (1) (ဂ) Social Visa က သင င Money Order MO (US$ 30 န ) (ဃ) Package ပန လည ပ ပ ႕ရန စရ တ က ခ ၿပ စ A ပ (Prepaid Envelope/ FedEx Standard Overnight Service) ၄ A ခ ဖ ပလ သည Aခ က (ရ ပ က) လ စ စ ဖင _ (လက မ တ ) Aမည င င က လက မ တ Aမ တ ထ တ ပ ရက စ _ တယ လ ဖ န န ပ တ ဆက သ ယ င မည နရပ လ ပ စ သ Aမတ ႀက ထ လ ပ မ သည စ A မန မ / Aဂ လ ပ စ ဘ သ ဖင ဖ ပထ ပ သည (၁)မ သ သ ရန လ ပ သည (မ တ ခ က ) - လ မ ရ Aလည Aပတ ဗ ဇ (၂၈)ရက သက တမ က န သည Aခ ရန က န သ ထပ မ သက တမ တ င ပ သည - လ ဝင မ ႀက ၾကပ ရ စည မ U စည ကမ Aရ Social Visa က င ဆ င သ မ သ ဆ မ သ ခ င A မ တ င တည ခ င ပ သည - ဖည စ က ထ သ ဗ ဇ ပ စ A မ တ (၃)စ ခန ႕ က ၿပ မ မ င Aတ ဆ င ထ သင ပ သည
5 က ယ ရ ရ ဇဝင Aက U ခ ပ ( မန မ င င သ ႕ ပထမAႀက မ ပန မည Ex-Myanmar မ ဖည စ က ရမည ပ စ ) လ က ထ သ A ၾက င Aရ ၁ Aမည A ပည Aစ ( မန မ )/ (Aဂ လ ပ ) Fill with Block Letter ၂ မ သက ရ ဇ / မ ဖ ရ ဒသ ၃ င င သ က က ယ သည ဘ သ ၄ င င က လက မ တ ထ တ ပ ရက စ နရ _ _ ၅ Aမ / Aဘ Aမည _ _ ၆ မ ဘမ နရပ လ ပ စ _ ၇ မန မ သ ရ တ င ဝင င ခ န ထမ ဆ င ခ ဖ ခင ရ - မရ ရ ပ က ဖ ပပ ရန (US$) _ ၈ မန မ င င က လက မ တ A သ ရ သ ႕ ပန လည Aပ ထ ခင ရ - မရ ရ ပ က Aပ သည ရက စ / / _ ၉ ပည ပသ ႕ထ က ခ လ သည န႕ _ ၁၀ မ မ ပည Aရည Aခ င ၁၁ မ မ Aလ ပ Aက င _ ၁၂ လက ရ နရပ လ ပ စ (Address) Phn. ( ) _ ည Aစ က မ င မAရင Aခ မ ၁၃ (က) Aမည Aလ ပ Aက င _ (ခ) Aမည Aလ ပ Aက င _ (ဂ) Aမည Aလ ပ Aက င _ ၁၄ A မ ထ င ရ - မရ ရ ပ က လ က ထ သ ဇန /ခင ပ န A ၾက င Aရ (က) Aမည A ပည Aစ (ခ) မ သက ရ ဇ / မ ဖ ရ ဒသ (ဂ) င င သ က က ယ သည ဘ သ _ (ဃ) င င က လက မ တ ထ တ ပ ရက စ နရ _ _ _ (င) ဇန / ခင ပ န Aမ / Aဘ Aမည _ (စ) ဇန / ခင ပ န မ ဘမ နရပ လ ပ စ _ _ (ဆ) ပည ပသ ႕ထ က ခ လ သည န႕ _ (ဇ) ဇန / ခင ပ န ပည Aရည Aခ င _ (ဈ) ဇန / ခင ပ န Aလ ပ Aက င _ ၁၅ ဇန /ခင ပ န ည Aစ က မ င မAရင Aခ မ (က) Aမည Aလ ပ Aက င _ (ခ) Aမည Aလ ပ Aက င _ (ဂ) Aမည Aလ ပ Aက င _ မ မ သ သမ မ ၁၆ (က) Aမည Aသက Aတန _ (ခ) Aမည Aသက Aတန _ (ဂ) Aမည Aသက Aတန _ PHOTO Recently taken 35 mm X 45 mm color photo With full face, front view, no hat and against a plain light background ရက စ (လက မ တ )
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