Embassy of the Republic of The Gambia - PDF document

4 4 Embassy of the Republic of The Gambia http://gambiaembassy.us/ Suite 240, Georgetown Plaza Tel. (202) 785 1399 2233 Wisconsin Avenue, NW Fax (202) 785 1430 Washington, DC 20007 info@gambiaembassy.us APPLICATION FORM FOR VISALast Name or Surname Office Use Only First Name Receiving OfficerNameDate 3. Place and Date of Birth (mm/dd/yyyy) 4. Nationality at Birth 5. Current Nationality Mode of Receipt1. Visa Service2. Registered Mail3. Ordinary Mail4. In Person 6. Profession/Occupation 7. Present Address and Ph one No 8. Names and Nationalities of Handling OfficerNameAction Taken1. Approved2. Refused3. RejectedSignature 9. Marital Status □ Married □ Single □ Divorced 10. Purpo se of Visi t □ Official □ Business □ Tourism 11 . Address in The Gambia 1 2 . Passport No. Issue Date Expiry Date Place of Issue 1 3 . Previous Visits to The Gambia Date of Entry 1 4 . Refere nces in The Gambia (Name, Address & Telephone No.) A. B. Visa Type/No. MultipleSingle 1 5 . Emergency Address and Phone No 1 6 . knowledge . I understand that I could be denied a visa to enter The Gambia if the information is found to be incorrect. Signature ______________________________________ Date _______________ VISA APPLICATION REQUIREMENTS(please note that we canNOTprocess unless requirements are complete)Valid assportOne passportsize photograph(taken in the last six monthslease write name and passport number on the back and sign)ompleted and signed applicationformA nonrefundable application fee of 00.00in money order only, payable to the Embassy of The Gambia Express Ser vice available for an additional fee of $50.00.