General in Houston, Texas - Visa-Vietnam.org

General in Houston, Texas Office use only Reference Code: Date: CONSULATE GENERAL OF VIETNAM IN HOUSTON, TEXAS 5251 Westheimer Rd, Suite 1100 Houston,...

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VISA APPLICATION CONSULATE GENERAL OF VIETNAM IN HOUSTON, TEXAS

NON-VIETNAMESE PASSPORT HOLDERS

2 Passport Size Pictures: White Background No Headwear No Glasses

5251 Westheimer Rd, Suite 1100 Houston, Texas 77056 Tel: 713-850-1233 Fax: 713-810-0159 http://www.vietnamconsulateinhouston.org

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9. Name, address of contact (sponsor, host, hotel…) in Vietnam (if any) __________________________________ __________________________________ __________________________________ __________________________________

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2. Date of birth: 3. 4. 5.

___________________ Date / Month / Year Place of birth: ___________________ Nationality: ___________________ Passport number: _________________ Date of issue: ___________________ Occupation: ___________________ Place of employment: __________________________________ __________________________________ Telephone (Office): _________________ Mailing address: (No P.O Box) __________________________________ __________________________________ Telephone (Home): _________________ Email: ___________________________ Purpose of visit: Tourism __________________________________ __________________________________

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1. Full Name (in CAPITALS): ___________________________________________________________ Family name First name Middle name Male Female

10. Estimated date of entry: __________________________________ Date / Month / Year Estimated date of exit: __________________________________ Date / Month / Year 11. Type of requested Visa:  Type of entries: ✔ - Single - Multiple  Length of stay: ✔ - Less than one month - Up to three months - Other: ____________________

I solemnly declare that the statements made in this application are true and correct to my best knowledge and belief. 07/11/2014 Date: Signature Check list: Before submission, make sure followings are included:  Passport (copy if loose-leaf visa is requested);  Completed and signed Application with Two Photos attached;  Fee: Money Order (or Cashier’s Check); and  Prepaid Envelope with complete address for return purposes.

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