a be A BE St Form 2013 iE He Visa Application Form of the People's Republic of China (For the Mainland of China only) PHAR IOR. TA ARB ARH. EAE LORMPLARLAST RT PRE, RAOAI VA, A XAR Zi, +3 “AK. Tho applicant should fillin this form truthfully , completely and clearly, Pease type the answer in capital English letters in the space provided or tick (\) the relevant box to select. If some of the items do not apply, please type N/A or None. st Part 1: Personal Information Lastname 11S : ee bomen, new ae” a wbecemen’ | #Fintmame tts on cet olor phos (a fic fut ter 12 PH 13 WZ RAS bareheaded and against: | Name in Chinese Other name(s) fehvelred estan 1s he AM Labhies 1.6 RAH 1.7 #7183 Former nationality(ies) Lanse HA. BD ia 19 ee = 1.10 4° Fic 47 UE A 2S Passport/Travel document type M2 Diplomatic C24, 5 Service or Official iM Ordinary CILLA (WEBI) Other (Please specify): ress waa 13 728 114 RCE — es z 2 C /AR{T OL Formerfincumbent member of parliament 1D FIBA Company employce ‘8141 Posten ________ nadia 1 WAR{EHICAS DA Formerfincumbent goveramen 1D TAPE Induseial/Ageeutaral worker OM z Epersinoim Bi Poston 15 208M ben OF A Mitary personnel TRE H) 0 RASH Crew member ln Corrent, 1 Ait Settemployed epee cceupation(s) Bia cael ESHA AR NGO stat apeerdonaey 0 8A + Religious personnel ceiate CRRA R Stat of media 1 SRHLGA ERD Omer (Please specify: 116 0H eae BREE a7 ctr Phone namber i‘ ay Poa seb: Address fe1.18 9 is 1.20 eis FAL 1.22 14Ri9, Marital status Gj Married 4 Single JEfh Other(Please specify): 64 Name | FAR Nationality 1.23 $B H = vk ocepoation | F Relaonsip EB. Fe. LAG 51 3A) La 124 He Fo. seme Ata | Name Mobile phone number a oo SPAM applicant 1.25 Hit AGREE Fz A SALILEE Country or territory where the applicant i located when applying fr this visa = _liefi(6i @. Part 2: Travel Information the Nefirerlarcls. C HA Official Visit © ffeil? Tourism CPR. APR. UN Nom-business vite ‘CT WHS Business & Trade AAD Asintroduced talent 1 BUTS Ascrew member CS Transit 0 a, SH. ARAB Asresident diplomat, consul or staff of international organization AAT As permanent resident 5 Tift Work P®9F As child in foster care CSR FATS AAA AT BE UH GRRE) Other (Please specity): aa in Ol Sf ER 2S FR ae ae SLT OR ak a LA Suse Major | 2 ELA: Short-term visit to Chinese citizen or | 3H 5/8 HiME it 180 F1 Family reunion for over orcas foreigner with Chinese permanent residence status | 180 days with Chinese citizen or foreigner with of your vist ‘Chinese permanent residence status C GARB LH. FUSSHETHER EAH | O KMPER SASHA PRA Stl A Short-term visit to foreigner residing in| As accompanying family member of foreigner ‘China due to work, study or other ressons ‘esing in China due to work, study or other reatons [F_$20i7 21 Short-term study for less than 180 days | 1) {Wi Long-term study for over 180 days C SMA VHAE As journalist for temporary news | OH HAE HRM ULM ICS As resident journalist coverage SEACH) Other (Please specify): —U(E SL ALE 3 19 4) One entry valid for 3 months from the date of issue 22 ith) C = k(ASRZ A 3-6 +A 7A) Two entries valid for 3 to 6 months from the date of issue RR mer | CEES I (AZ Ele 6 BATA) Multiple entries valid for 6 months from the date of faswe of entries: CT 4F Sk (63822 ike 1 477%) Multiple entries valid for 1 year from the date of issue 23-71) iR INGE Are you applying for express service? Be MBM RteM ne I. Noe: Expresservice needs approval of consular fi an extra fesiay a9. CY mH No 2a RIA AG A A PY Expected date of your first entry into China on this trip (yyyy-mm-dd) AOR AAE rea25 HALE AT AR RAE ORK KM Longest intended stay in China among all entries Days 1198 Date ‘FSSA Detailed address 2.6 teh RATT |_ 2 Cem TN, aH HENS) Itinerary in ‘China (in time sequence, may ‘type on separate paper) 2.7 ie 4 oR 49 4 FL MEL? Who will pay for your travel and ‘expenses during your stay in China? ee aRe He Name aepramonnin | SH Buia} Informa RE Phone number SBIR Relationship withthe applicant sci adueens amt enee emese some =. 3¢fe3571_Part3: Other Information 3.1 REE PAM iE RA MIT fe VFA MALPP AY? ‘Have you ever overstayed your visa or residence permit in China? Cit Yes Ca No 3, 2 BW MIDS RP BAL, MALISLNE APE? Have you ever been refused a visa for Chins, or been refused entry into China? Deve CN 3.3 ZHEPM MAM TWH GR? Do you have any criminal record in China or any other sais Cie ves Da No 3.12 RADI PA— HIRE Areyou experiencing any of the following conditions? (OP EAH Serious mental disorder ‘fe HRHE NM BEM Infectious pulmonary tuberculosis my eek BH ae Other infectious disease of public health hazards Cit ves CANe 9,5: 90 BAM Mw LALIT HEA AG (ERIS MLIWHE? Did you visit countries or territories affected by infectious diseases inthe last 30 days? Ci Yes CANe 3.6 UE 3.1 503.5 REA TRA “E,W FT Ifyou select Yes to any questions from 3.1 to 35, please give details below.3.7 REREAD ROH SBMS SE PAINT, TAR If you have more information about your visa application other than the above to declare,please give details below or type on a separate paper. 3. 8 ANB APR ABT AS AA PURCET A RET AA RAMEE AT AYR. Wfsomeone else travels and shares ‘the same passport with the applicant , please affix their photos and give their information below. WHA 1 WTA 2 STA 3 Person 1 Person 2 Person 3 ae RUE Pat oR Ta BUA Tilt nformation Aix Photo Affix Photo Aft Photo here here — He Full mame a Sex 48 |__poseyyy-mm-ta) 1, FRO S284 Part 4: Declaration & Signature 41 AER, ROMHRLEMAARER, RRR BAA AT — eR. ‘Thereby declare that I have read and understood all the questions in this application and shall bear all the legal consequences for the authenticity ofthe Information and materials I provided. 4.2K, ERASE, RAAMBIE. MURR, PRGH ARNT ROE, EAR. RERUNS Remy Ye SBC Ei a AA AP understand that whether tissue a visa, type of visa, number of entries, valldity and duration ofeach stay willbe determined by consular official, and that any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into China. 4.3 FRM, AURORE, AOD URE TLE ON ATARI AR. understand that, according to Chinese law, applicant may be refused entry into China even ifa visa is granted. mm AR aM ie AM 18 JL A AHR AeA FRE Note The parent or guardian shall sign on behalf of «minor under 18 years of age. is fe AAU HUA FEARS ULF A Part S: If the application form is completed by another person on the applicant's behalf, please fill out the information of the one who completes the form 5.1% Name 52 BAW AIR Reaomaty 5.3 et: Address 5.4 888 Phone number 5.5 78H) Declaration BUN ER i ORTON, TERA PRIA RP ACT A IER I declare that T have assisted in the completion of this form at the request of the applicant and that the applicant understands and agrees that the Information provided is true and correct. (AS 2 (Signature: Hi iDate (yyyy-mm-dd):