THE UNITED REPUBLIC OF
TANZANIATHE UNITED REPUBLIC OF
TANZANIA
Ref: No _______________
TO:
Tanzania Embassy,
________________________________________
____________________
(Country)--------------------------------------------------------------
1. Surname or Family Name: ___________________________________
First Names: ______________________________________________
2. Former or Maiden Name: ____________________________________
3. Present Nationality: ______________________________________
Nationality at Birth: __________________ Sex: ____________
4. Date and Place of Birth: __________________________________
5. Countries resided since birth:
___________________________________________________________
6. Names date and place of birth of minor children
accompanying you: _________________________________________
7. Present Address: __________________________________________
Phone No.: ________________________________________________
8. Permanent Address (if different from above):
___________________________________________________________
9. Marital Status: (Married/Single/widowed/Divorced) _________
10. Dates of previous visits to Tanzania:
__________________________________________________________
11. Occupation, specifying employer, and post held:
__________________________________________________________
12. Reason for the journey: __________________________________
13. Duration of proposed stay: _______________________________
14. Proposed date of starting journey: _______________________
15. Proposed date of entering Tanzania: ______________________
16. Means at your disposal for proposed visit: _______________
17. References in Tanzania (with address):
(l): ______________________________________________________
(2): ______________________________________________________
Passport No.: ________________________________________________
Place of issue: ______________________________________________
Date of issue: _______________________________________________
Valid until: _________________________________________________
Date: ________________________________________________________
Signature of applicant: ______________________________________
--------------------------------------------------------------FOR OFFICIAL USE ONLY:
TYPE OF VISA: ________________________ FEE: __________________
CASH/P.ORDERS TO BE COLLECTED: _______ TO BE POSTED: _________
OFFICIAL: ______ COLLECTED BY: _______ DATE: _________________