APPLICATION FOR VISA
英文填写
Name (Mr. / Mrs. /Ms.)
姓名（大写字母）_________________________________ Countries for which passport is valid
护照适用国_____________________________________
Nationality
国籍__________________________________________ Date of previous visits to Thailand
上次赴泰日期___________________________________
Date of Birth
出生日期______________________________________ Purpose of visit
访问目的_______________________________________
Place of Birth
出生地________________________________________ Date of arrival in Thailand
入泰时间_______________________________________
Profession (present)
现职业________________________________________ By Flight No.
班机号_________________________________________
Marital Status
婚姻状况______________________________________ Duration of proposed stay
停留时间_______________________________________
Present address
现住址________________________________________ _______________________________________________ Local guarantor and address
本国担保人姓名及地址___________________________ ________________________________________________
Permanent address (if different from above) 永久地址（如与现住址不同，请注明）Reference person and/or address in Thailand 泰国联系人及/ 或地址
_______________________________________________ ________________________________________________ _______________________________________________ ________________________________________________
Passport No.
护照号码______________________________________ Name, dates and places of birth of minor children holding the same passport and if accompanying you
Issued at
签发地________________________________________ 有否用本护照儿童随行，如有请填写姓名，出生地
及出生日期_____________________________________
Date of issue
签发日期______________________________________ ________________________________________________ Signature
Expiry date
有效日期至____________________________________ 签名______________________________________ Date
日期______________________________________
ATTENTION FOR APPLICANT : I hereby declare that the above mentioned information is correct and
that in no case shall I violate Thai laws and regulation in the country. 在此我声明所填内容属实，并保
证不违反泰国的法规.
_____________________________________________________________________________________________________ FOR OFFICIAL USE （以下由使馆填写）FEE PAID Type of visa and No. ______________________Expiry
date___________________________
Date of issue ____________________________Signature
____________________________
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