VISARITE SERVICES

(201) 445-7088 Visa Q-2007

Application Form of the People's Republic of China
www.visarite.com
Please type your answer in capital English letters in the spaces provided or
check the appropriate box to select.

Section 1. Information About Yourself

Full Name
Surname: Middle Name: None
Smith

Given Name: 1.2 Sex

John ✔

Chinese Name if Applicable Current Nationality: PHOTO

2"X2" color photo, with
None USA
full face, front view, no hat,
Other or Former Name: Former Nationality: and against a plain light
None background
None
Date of Birth (YY-MM-DD): Place (Province/State, Country) of Birth:
1950-12-01 New York, USA
Diplomatic Service or Official ✔ Regular
Passport Type Other (Please specify):
Passport Number: Date of Issue (YY-MM-DD):
123 456 789 2005-12-02

Place (Province/State, Country) of Issue: Expiration Date (YY-MM-DD):

2015-12-01
National Passport Center, USA
Your Current Occupation(s):
✔ Businessman Teacher or Student Government Official
Crew Member of Airlines, Trains or Ships Staff of Media
Member of Parliament, Congressman or Senator Clergy
Other (Please specify):

Section 2. Your Visit to China

Major Purpose(s) of Your Visit(s) to China:
Tourism As Crew Member of Airlines, Trains or Ships
Visiting Relatives As Resident Journalist
✔ Business Trip As Journalist for Temporary News Coverage
Transit As Resident Diplomat or Consul in China
Study Official Visit
Commercial Performance Employment
Other (Please specify):
Single entry valid for 6 months;
Double entry valid for 6 months;
✔ Multi-entry valid for 6 months;
Intended Number of Entries
Multi-entry valid for 12 months
Multi-entry valid for 24 months (Only for qualified applicants)

Date of Your First Possible Entry into China (YY-MM-DD) 2008-02-15

Your Longest Intended Stay in China 30 Days

Please list Counties/Cities and Provinces to visit Beijing, Shanghai, Guangzhou

in China in a time sequence:

✔ 2-3 Express for 2-3 Business Days;

Normally, visa processing takes 4-5 working days.
Do you request express or rush service Rush for 1 Working Day
by paying extra fee

Q-2007
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 Section 3. Your Health Condition and Previous Overseas Tour

✔ No Yes
Have you ever been refused a visa for China?

✔ No Yes
Have you ever been refused entry into or deported from China?

✔ No Yes
Do you have any criminal record in China or any other country?
Do you suffer from any of the following disease?
Open Tuberculosis ✔ No Yes
HIV Positive or AIDS
Other infectious diseases

No ✔ Yes
If you select Yes to any question from 3.1 to 3.4, you do
not lose eligibility for visa application. Please give detailed reasons for your answer.

Section 4. Your Contact Information

Name of Your Employer or School: Office Phone Number:

IBM Corporation (877) 426-7624

Address of Your Employer or School: Cell Phone Number:

1 New Orchard Road , Armonk, New York 10504-1722 None

Your Home Address: Home Phone Number:

123 Main Street, New York, NY 10504 (888) 839-9289

Phone Number of Your Contact in China:

Name of Inviter, Contact or Your Relative in China:
Lenova Corp (86) 10 5886-8888

At What Address will You Stay in China

Address of Inviter, Contact or Your Relative in China:
800 Industrial Road, Beijing, 12001, China Beijing Grand Hotel, 35 Dong Chang'an Street, Beijing

Section 5. Other Declaration

If there is more information to declare, please give the information below.

None

Section 6. Application Form Completed by Another Person

If this application was completed by another person on behalf of you,
please have that person complete this section
Name of Person Completing the Form: Relationship to the Applicant:

Not applicable

Address and Phone Number of that Person: Signature of that Person:

Section 7. Important

I have read and understood all the questions in this application. I shall be fully responsible for the answers and the photo,
which are true and correct. I understand that type of visa, number of entries and duration of each stay will be decided by
consuls, and any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into China.

2008-1-20

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