VISA APPLICATION FORM

1.	Name (in block letters, as appeared in passport):
                                    ................………………………………………………………………...
First name		Family name		Middle name

2. Date of birth:........................................................
                                      dd.          mm            yy
3. Male:                                  Female  
4. Place of birth:......................................................
5. Nationality at birth:............................................
    Nationality at present:........................................
6. Passport number:.   ......................……….:……
    Date of issue: …….........Date of expiry:……….
7. Profession:…........................................................
    Place of employment: …….........……................
    Telephone ............................................................
8. Present address: (please do not give P.O. Box)
...................................................................................
    Telephone ............................................................

9. Accompanying children included in your same passport (full name, date of birth, gender):
...................................................................................
…...................…..................................................……                                                       	10. Purpose of visit to Vietnam: 
Attend ATVA 2013 conference.
11. Name, address of your contact in Vietnam:  
Truong Anh Hoang (ATVA 2013 local organizer)
VNU University of Engineering and Technology,
E3 Building, 144 Xuan Thuy Road 
Cau Giay, Hanoi, Vietnam
                                                   
12. Proposed date of entry and exit Vietnam:
 from  ……/……/2009 to ……/……/2009
 	DD/MM          	   DD/MM
                                                                          
13. Number of entries: 
 Single                            Multiple     

14. Port of arrival and departure: 
All international air ports of entry in Vietnam.	
15. Place you want to pick up your visa 
(please give the name, address, telephone and fax number of the Vietnamese Embassy or Consulate in your nearest neighbourhood you can bring (or send) in your passport to get the official visa stamped on, or you can choose to collect the visa on arrival)

I solemnly declare that the statements made in this application are true and correct.

Place:…………...………………………………………….
Date (dd/mm/yyyy):……………………………………..
Signature: ............................................................................