APPLICATION FORM FOR ISSUANCE/REISSUANCE OF A VISA EXEMPTION CERTIFICATE

1.Full name, as it appears in your Passport/Permanent Residence Document issued by foreign country

Full name will be printed in Visa Exemption. Please verify if this matches your full name in your Passport / Permanent Residence Document:

Vietnamese full name

2.Gender:

3.Date of birth *

4.Place of birth *

5.Nationality at birth*

6.Current nationality *

8.Occupation *

Entry date *

7.Passport

9.Current residential, business address abroad *

10.Previous residential address in Viet Nam before residing abroad (if any)

11.Contact address in Viet Nam *

12.Accompanying Children (under 14 years old) included in the applicant's Passport/Permanent Residence Document travelling with

# Fullname Gender Date of birth
1
2

13.Supporting documents to prove the eligibility for a Visa Exemption Certificate

For the Vietnamese residing abroad

For foreigners who are spouses, children of Vietnamese overseas or Vietnamese citizens

For cases of reissuance of visa exemption certificate

Reason for reissuance:

Requesting for a Visa Exemption Certificate in form of: *

Submit dossiers to apply for Certificate of visa exemption in *

Total: $80.00 USD