南非共和国签证英文版-中文翻译

BI-84) Form 11

DEPARTMENT OF HOME AFFAIRS

REPUBLIC OF SOUTH AFRICA

APPLICATION FOR VISA OR TRANSIT VISA

[Section 7(1)(g) read with section 10A and 10B; Regulation 8(1)]

Failure to complete this application form in full may result in the visa being delayed or refused. 信息不全可能导致延迟或拒

签

Please use block letters and black ink only. 请用黑色印刷体填写

PERSONAL PARTICULARS 个人信息

Surname:姓

First names (in

full):名

Maiden name:婚

前姓

Previous

surname(s):

Y Y Y Y M M D D

Date of birth:生日2 0 1 0 0 8 2 8

City of birth:出生

地………………………………………………

Country of birth:出生国家………..…………………………………………………………………………………………………………….

Gender 性别: Male

男

Female

女

Nationality民

族: …………………….…………………………………………......If acquired by naturalisation, state original nationality:如果已经获得，指明原始国籍……………….…………………….

Where and when was present nationality obtained:何时何地获得现在国籍………………………………………………………………………….…..

Passport/Travel Document Number护照号

码: ………….………………….………..

Type of document: Diplomatic/Official/Ordinary Passport/Travel Document/other (specify) 护照类型：外交/公务/普通护照/旅行护照/其它……………………..……………………..………Issuing authority:签发机关……………………………. Date of expiry:有效期…………………………….…

Permanent residential address:永久住址………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Period resident at this address:暂住地址……………………………………………..Telephone number电话号码:(…..……) (code)区号……………………………………… (number)号码

Country of permanent residence:国籍……………………………………………………………Period resident in that country: ………………………………………………….

Occupation or profession:职业……

Name, address and telephone no. of employer, university, organisation, etc. to which you are attached, or that you attend or wh ich you represent: ………你的老板的姓名、地址、电话、大学等等你需要说明的的.…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………

If self-employed, state name, address, telephone no. and nature of business:如果自己经营，请说明公司名字，电话和业务范围………………………………………………………………………………………….…………………………………………………………………….………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Marital status:婚姻状况Never

married

未婚

Married已婚Widowed寡

居

Separated

分居

Divorced

离婚

First name(s) of spouse:配偶名

Maiden name:配偶姓

Y Y Y Y M M D D

Date of birth:配偶出生日期Nationality国籍………………………………...…………………

NB: SEPARATE FORMS MUST BE COMPLETED IN RESPECT OF PERSONS OVER THE AGE OF 16 AND CHILDREN UNDER THE AGE OF 16 TRAVELLING ON THEIR OWN PASSPORTS.

Particulars of children endorsed on your passport accompanying you:你的护照上关于子女的情况：

Surname

姓First name(s)名Date of birth出生日期Place of birth

出生地

(1)

(2)

(3)

(4)

VISIT TO SOUTH AFRICA南非行程

Expected date of arrival in the Republic: 预计到达日期Y …………..……………….. M ………….……………………..

D …….………………..

Place of arrival到达地址:………………………………..……………………………………………..…………………………………………….

Purpose of visit:旅行目的……………………………………….……….…….…………………………………………………………………….

Duration of stay (months, weeks or days)停留时

间 .………………….…………………………………………………………………………..

Number of entries required:

Single

Multiple

Two

Proposed residential address (physical) in the Republic, including the full name(s) of your host or hotel:在南非你的亲戚或宾

馆的名字和地址………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Names of organisations or persons you will be contacting during your stay in the Republic:你在南非停留期间可以联系的机构或人员名字

Name名字Address地址Relationship与你关系

Identity document number or permanent residence permit number of South African host: 南非主人的省份证件号码…………………………….……………………………………………………………………………………………….………………. Indicate by means of an X whichever is applicable请在选项后打X

Have you at any time applied for a permit to settle permanently in South Africa?以前你申请过南非签证吗？yes no

X

Have you ever been restricted or refused entry into South Africa?你是否曾被限制或拒签南非？yes no

Have you ever been deported from or ordered to leave South Africa?你是否曾被驱逐出南非？yes no Have you ever been convicted of any crime in any country?你是否曾被任何国家宣布有罪？yes no Is a criminal action pending against you in any country?你是否有未判决的指控？yes no Are you an unrehabilitated insolvent? yes no Are you suffering from tuberculosis or any other infectious or contagious disease or any mental or

physical deficiency? 是否肺结核或其他传染病或精神或身体缺陷？

yes no Have you ever been judicially declared incompetent?是否曾被公开宣布不合格？yes no

Are you a member of, or adherent to an association or organisation advocating the practice of

social violence or racial hatred or are you or have you been a member of an organisation or

yes no

association utilizing crime or terrorism to pursue its ends?是否是任何组织协会的成员或组织者，是

否有暴力倾向或种族歧视，是否犯罪组织成员？

Give particulars if reply to one or more of the questions above is in the affirmative:如果属于上面一

条或者多条请给出详细说

明。……………………………………………………………………………………………….……………………………………………………………………………………………….……………………………………………………………………………………………………………………………………………….

To be completed by applicants applying for visitor’s permits exceeding three months:申请停留超过3个月请完成下面表格

In the case of a spouse or dependant minor child of the holder of a permit issued in terms of section 11, 13, 14, 15, 17, 19 or 22, submission of a marriage certificate or an unabridged birth certificate.

Proof of academic sabbatical, if applicable.

Proof of non-remunerative voluntary or charitable activities to be undertaken, if applicable.

Proof of research to be undertaken, if applicable.

Proof of funds available for subsistence during period of visit.

To be completed by applicants applying for diplomatic, official or courtesy visas:外交或公务签证请完成：

In the case of an official visit, submission of a note verbale.

In the case of a diplomatic placing in the Republic, proof of such placing.

To be completed only by passengers in transit to another country:中转旅客请完成：

Destination after leaving the Republic: ……………………………………………………..……………………………………………

Mode of travel to destination: …………………………………………………………..…………………………………………………Intended date and port of departure from the Republic to that destination: …………………………………………………………

Do you hold a visa or permit for temporary or permanent residence in the country of your destination? (Proof must be submitted)…………………………………………………………………………………………………………………………………..

To be completed by persons wishing to work in the Republic:希望在南非工作Yes ………………………..…

No ……………………….…

If the answer is yes, please provide details:如果回答“是”，请提供详细：……………………………………………………………………………………………. ………………………………………………………………………………………………………………………………………………..

I SOLEMNLY DECLARE THAT THE ABOVE PARTICULARS PROVIDED BY ME ARE TRUE IN SUBSTANCE AND IN FACT AND THAT I FULLY UNDERSTAND THE MEANING THEREOF. I FURTHER DECLARE THAT I DO NOT CONTEMPLATE CHANGING THE PURPOSE OF MY VISIT WHILST IN THE REPUBLIC.我庄严宣告上述我提供的信息是真实的，我确信它的意义。比外我还声明我不改变我的出行目的。

………………………………………. ……………………………………..

Signature of applicant 申请者签名 Date日期

FOR OFFICIAL USE官方使用

Approved/not approved by批准或拒绝…………...………

on ……………………………………...............Type of visa:签证类

型………………………………………………………………………………………………………………………………

Reasons for decision:

…………………………..........

…………………………………

…………………………………

…………………………………