伊朗签证申请表表格(可填写)

ForOfficeUseOnly/یﺮﺘﻓدﺖﻤﺴﻗصﻮﺼﺨﻣﺪﻳداورﻩرﺎﻤﺷ:روﺪﺻﺦﻳرﺎﺗ:ﺪﻳداورزﻮﺠﻣ:ﺪﻳداورعﻮﻧ:ﮓﻨﮐﮓﻨهناﺮﻳاﯽﻣﻼﺳایرﻮﻬﻤﺟیﺮﮕﻟﻮﺴﻨﮐﺮﺳConsulateGeneralofIslamicRepublicofIranHongKongﺪﻳداورﺖﺳاﻮﺧردمﺮﻓVisaApplicationFormNo.101-2004/١٣٨٢-ﻩرﺎﻤﺷمﺮﻓ١٠١Page1of2/ﻪﺤﻔﺻ١زا٢PLEASETypeinandAnswerallQuestionsinFull.IncompleteApplicationsWillNotBeProcessed.ﻞﻣﺎﮐرﻮﻃﻪﺑارمﺮﻓﻦﻳاًﺎﻔﻄﻟﺪﻴﺋﺎﻤﻧﻞﻴﻤﮑﺗ.دﺮﻴﮔﯽﻤﻧراﺮﻗﯽﺳرﺮﺑدرﻮﻣﺺﻗﺎﻧیﺎﻬﻣﺮﻓ.1.FirstName:١.مﺎﻧ:5.Sex:MaleFemaleﺖﻴﺴﻨﺟ:۵.دﺮﻣنز2.Surname:٢.ﯽﮔداﻮﻧﺎﺧمﺎﻧ:6.DateofBirth:(yyyy/mm/dd)۶.ﺪﻟﻮﺗﺦﻳرﺎﺗ):زور/ﻩﺎﻣ/لﺎﺳ(3.FormerNames:ﯽﻠﺒﻗمﺎﻧ:٣.7.PlaceofBirth:ﺪﻟﻮﺗﻞﺤﻣ:CityProvinceCountryﺮﻬﺷنﺎﺘﺳارﻮﺸﮐ4.Father'sName:۴.رﺪﭘمﺎﻧ:8.Occupation::ﻞﻐﺷ٨.9.AncestralName*::٩.ﺪﺟمﺎﻧ**(ObligatoryforNaionalsofArabCountriesorOtherNaionalsofArabOrigin)ﺪﺷﺎﺑﯽﻣﯽﻣاﺰﻟاﺖﺳاﯽﺑﺮﻋﺎﻬﻧﺁﺖﻴﻠﺻاﻪﮐﺎهرﻮﺸﮐﺮﮕﻳدعﺎﺒﺗاوﯽﺑﺮﻋیﺎهرﻮﺸﮐعﺎﺒﺗاﺖﻬﺟ(.)*tt10.Education(ForStatisticalPurposes)(تﻼﻴﺼﺤﺗ)یرﺎﻣﺁﻩدﺎﻔﺘﺳاﺖﻬﺟ١٠.University/ﻩﺎﮕﺸﻧادPostSecondary/نﺎﺘﺳﺮﻴﺑدSecondary/ﯽﻳﺎﻤﻨهارPrimary/ﯽﻳاﺪﺘﺑا11.Nationality:ﺖﻴﻌﺑﺎﺗ:١١.a)Present:ﯽﻠﻌﻓb)Former:ﯽﻠﺒﻗc)Other(Optional):(ﻞﻳﺎﻤﺗترﻮﺻرد)ﺮﮕﻳددراﻮﻣﺎﻳدرﻮﻣ12.Passport:ترﻮﭙﺳﺎﭘ:١٢.Number:ﻩرﺎﻤﺷType:عﻮﻧDateofIssue:روﺪﺻﺦﻳرﺎﺗPlaceofIssue:روﺪﺻﻞﺤﻣDateofExpiry:رﺎﺒﺘﻋانﺎﻳﺎﭘﺦﻳرﺎﺗ(AtLeastWithSixMonthsValidity))رﺎﺒﺘﻋاﻩﺎﻣﺶﺷﺎﺑﻞﻗاﺪﺣ(13.MaritalStatus:Married*SingleDivorcedSeparatedWidowed:ﻞهﺄﺗﺖﻴﻌﺿو:١٣.ﻞهﺄﺘﻣدﺮﺠﻣﻪﻘﻠﻄﻣﻩﺪﺷاﺪﺟﻩﻮﻴﺑ*IfMarried,NameandNationalityoftheSpouse:ﺮﺴﻤهﺖﻴﻌﺑﺎﺗومﺎﻧ،ﻞهﺄﺗترﻮﺻرد*Name:Surname:Nationality:مﺎﻧﯽﮔداﻮﻧﺎﺧمﺎﻧﺖﻴﻌﺑﺎﺗ14.CompleteThisSectionONLYIfDependantsIncludedinYourPassportAreTravelingWithYou:(IfAny)ترﻮﺻردﺎﻤﺷﻪﻣﺎﻧرﺬﮔﺎﺑنﺎهاﺮﻤهتﺮﻓﺎﺴﻣ،ﺪﻴﺋﺎﻤﻧﻞﻴﻤﮑﺗارﺖﻤﺴﻗﻦﻳا.١۴.SexﺖﻴﺴﻨﺟFullNameﯽﮔداﻮﻧﺎﺧمﺎﻧومﺎﻧDateofBirthﺪﻟﻮﺗﺦﻳرﺎﺗRelationshipﺖﺒﺴﻧRemarksتﺎﻈﺣﻼﻣM/دﺮﻣF/نزM/دﺮﻣF/نزM/دﺮﻣF/نزM/دﺮﻣF/نزفﺪهزاﺎﻤﺷ؟ﺪﺷﺎﺑﯽﻣﻪﭼناﺮﻳاﻪﺑﺮﻔﺳ١۵.15.WhatisThePurposeofYourTriptoIran?نﺁﺖﻠﻋوﺦﻳرﺎﺗﺖﺳاﺖﺒﺜﻣﺎﻤﺷﺦﺳﺎﭘﺮﮔا؟ﺪﻳاﻪﺘﺷادتﺮﻓﺎﺴﻣناﺮﻳاﻪﺑلﺎﺣﻪﺑﺎﺗﺎﻳﺁ:١۶.16.HaveYouEverBeeninIran?IfYes,WhenandWhy?١٧.ﺑﺎﺗﺎﻳﺁﻪﺪﻴﺋﺎﻤﻧﺮﮐذارنﺁﻞﺤﻣوﺦﻳرﺎﺗًﺎﻔﻄﻟ؟ﺖﺳاﻩﺪﺷﺖﻔﻟﺎﺨﻣناﺮﻳاﻪﺑتﺮﻓﺎﺴﻣﺖﻬﺟﺎﻤﺷﺪﻳداورروﺪﺻﺖﺳاﻮﺧردﺎﺑلﺎﺣ.17.HasYourVisaApplicationtoIranEverBeenRejected?IfYes,WhenandWhere?No/ﺮﻴﺧYes/ﯽﻠﺑ18.WhatCountriesHaveYouTraveledBefore?١٨.؟ﺪﻳاﻪﺘﺷادﺮﻔﺳﯽﻳﺎهرﻮﺸﮐﻪﭼﻪﺑنﻮﻨﮐﺎﺗPhotoFormNo.101/ﻩرﺎﻤﺷمﺮﻓ١٠١Page2of2/ﻪﺤﻔﺻ٢زا٢19.Haveyoustayedinacountrymorethansixmonths?١٩.؟ﺪﻳاﻪﺘﺷادﺖﻣﺎﻗاﻩﺎﻣﺶﺷزاﺶﻴﺑیرﻮﺸﮐردﺎﻳﺁCountry:/رﻮﺸﮐDate:/ﺦﻳرﺎﺗReason:/ﻞﻴﻟد20.HaveYouEverBeenInfectedWithAnyContagiousDisease?(Name)٢٠.؟ﺪﻳاﻩدﻮﺑﻼﺘﺒﻣلﺎﻘﺘﻧاﻞﺑﺎﻗیﺎﻬﻳرﺎﻤﻴﺑﻪﺑنﻮﻨﮐﺎﺗﺎﻳﺁ)یرﺎﻤﻴﺑمﺎﻧﺮﮐذﺎﺑ(No/ﺮﻴﺧYes/ﯽﻠﺑ21.WhowillbeYourHostinIran?PleaseGiveCompleteName:٢١.ناﺮﻳاردﺎﻤﺷنﺎﺑﺰﻴﻣﮏﻳماﺪﮐ؟ﺪﺷﺎﺑﯽﻣﺪﻴﺋﺎﻤﻧﺮﮐذﻞﻣﺎﮐرﻮﻄﺑاﺮﻧﺁمﺎﻧَﺎﻔﻄﻟ.Ministry/ﻪﻧﺎﺨﺗرازوOrganization/نﺎﻣزﺎﺳInstitutionﻪﺴﺳﺆﻣ/Foundation/دﺎﻴﻨﺑCompany/ﺖﮐﺮﺷTravelAgency/ﯽﺗﺮﻓﺎﺴﻣﺲﻧاژﺁIndividual(s)/ﺨﺷصﺎﺨﺷاﺎﻳﺺOthers/ﻩﺮﻴﻏName,TitleandTel:،مﺎﻧناﻮﻨﻋﻦﻔﻠﺗو:22.TypeofVisarequested:*ﯽﺘﺳاﻮﺧردﺪﻳداورعﻮﻧ*٢٢.*PleasecheckOneBoxFromEachSection(A&B)*ﺖﻤﺴﻗﺮهزاًﺎﻔﻄﻟ)بوﻒﻟا(ﺪﻴﺋﺎﻤﻧبﺎﺨﺘﻧااردرﻮﻣﮏﻳ.A/ﻒﻟاEntry/دوروTourist/یدﺮﮕﻧﺎﻬﺟPilgrimage/ﯽﺗرﺎﻳزJournalist/ﯽﺗﺎﻋﻮﺒﻄﻣDiplomat/ﯽﺳﺎﻴﺳWorkPermit/رﺎﮐﻖﺣﺎﺑTransit/ﺖﻳﺰﻧاﺮﺗStudent/ﯽﻠﻴﺼﺤﺗService/ﺖﻣﺪﺧOther/ﻩﺮﻴﻏ***********B/بSingle/رﺎﺒﮑﻳDouble/رﺎﺑودMultiple/دﺪﻌﺘﻣ٢٣.؟ﺪﻳاﻩدﻮﻤﻧﺬﺧااریﺪﻌﺑرﻮﺸﮐﺪﻳداورﺎﻳﺁ،ﺪﻳرادارناﺮﻳازارﻮﺒﻋﺪﺼﻗﻪﮑﻴﺗرﻮﺻرد23.IfYouArePassingThroughIranonTransit,HaveYouObtainedEntryVisaForYourNextDestinationCountry?Yes/ﯽﻠﺑNo/ﺮﻴﺧ٢۴.؟ﺪﻳﺎﻤﻧﯽﻣﻦﻴﻣﺄﺗناﺮﻳاردرﻮﻀﺣتﺪﻣردارﺎﻤﺷجرﺎﺨﻣﯽﺴﮐﻪﭼ24.WhoWillCoverYourExpensesWhileStayinginIran?25.HowMuchCurrencyinUSDollarDoYouIntendtoHaveWithYou?؟ﺖﺷادﺪﻴهاﻮﺧدﻮﺧﻩاﺮﻤهزراراﺪﻘﻣﻪﭼﺮﻔﺳلﻮﻃرد٢۵.26.WhatPlacesorCitiesWillYouBeVisitinginIran?؟دﺮﮐﺪﻴهاﻮﺧنﺪﻳدﯽﻨﮐﺎﻣاوﺎهﺮﻬﺷﻪﭼزا٢۶.27.ApproximateDateofEntrytoIran:28.DurationofStayinIran:29.PortOfEntrytoIran:٢٧.ﺮﻔﺳﯽﺒﻳﺮﻘﺗﺦﻳرﺎﺗ)دورو(ناﺮﻳاﻪﺑ:٢٨.ناﺮﻳاردﺖﻣﺎﻗاتﺪﻣ:٢٩.روزﺮﻣدوناﺮﻳاﻪﺑی:30.ResidentialAddress٣٠.ﺖﻧﻮﮑﺳﻞﺤﻣسردﺁ:Address::سردﺁTel::ﻦﻔﻠﺗFax:ﺮﺑﺎﻤﻧ:E-Mail:ﻞﻴﻤﻳا:31.BusinessAddress٣١.رﺎﮐﻞﺤﻣسردﺁNameandAddress::ومﺎﻧسردﺁTel::ﻦﻔﻠﺗFax:.ﺮﺑﺎﻤﻧ:E-Mail:ﻞﻴﻤﻳا:32.AddressinI.R.ofIran٣٢.ﺎﻗاﻞﺤﻣسردﺁناﺮﻳارداردﻮﺧﺖﻣﺪﻴﺋﺎﻤﻧﺮﮐذ.Hotel:/ﻞﺘهHotelSuite:/نﺎﻤﺗرﺎﭘﺁﻞﺘهInn:/اﺮﺴﻧﺎﻤﻬﻣOther(s):/ﻩﺮﻴﻏNameandAddress::سردﺁومﺎﻧTel::ﻦﻔﻠﺗFax:ﺮﺑﺎﻤﻧ:E-Mail:ﻞﻴﻤﻳا:IUndertaketoObserve,DuringMyStayintheI.R.ofIran,alltheLawsandRegulationsApplicabletoForeignNationalsandIDeclaretheAboveInformationisTrueandCorrect.ﺠﻨﻳاﺪﺷﺎﺑﯽﻣﺢﻴﺤﺻقﻮﻓتﺎﻋﻼﻃاﻪﻴﻠﮐوﻢﻳﺎﻤﻨﺑﺖﻳﺎﻋرارﻪﻃﻮﺑﺮﻣﻦﻴﻧاﻮﻗﻪﻴﻠﮐناﺮﻳاردﻢﺘﻣﺎﻗالﻮﻃردﻪﮐﻢﻳﺎﻤﻨﻴﻣﺪﻬﻌﺗﺐﻧﺎ.Applicant'sSignature:………………………………………………………………………………………….ﯽﺿﺎﻘﺘﻣءﺎﻀﻣا...............................................................................:Date:(yyyy/mm/dd)………………………………………………………………………………………………………….ﺦﻳرﺎﺗ):زور/ﻩﺎﻣ/لﺎﺳ(