Please Indicate Type of Visa Requested

Diplomatic Visa
Please attach Official Visa
2 photographs Courtesy Visa
taken within Non-Immigrant Visa
the last 6 months APPLICATION FOR VISA X Tourist Visa
(3.5 x 4.5 cm) Transit Visa
Royal Thai Embassy of Kuala Lumpur
1
Number of Entries Requested _____

Mr. Mrs. Miss CARLOS ANDRES GUALDRON GOMEZ

First Name Middle Name Family Name (in BLOCK letters)

Former Name (if any) Countries for which travel document is valid

Nationality COLOMBIA
Nationality at Birth COLOMBIA
Birth Place B/MANGA
Date of Birth 10-06-1989
Proposed Address in Thailand
83/7 PRACHATHIPATAI RD, BAANTHOMCATE,
Marital Status SINGLE PRANAKORN, 10200 BANGKOK
Name and Address of Local Guarantor

Type of Travel Document PASSPORT

No.AV169450 Issued at C. KUALA LUMPUR Tel./Fax.

Date of Issue 31-07-2018 Expiry Date 30-07-2018 Name and Address of Guarantor in Thailand
R1 HOSTEL - 83/7 PRACHATHIPATAI RD,
Occupation (specify present position and name of employer) BAANTHOMCATE, PRANAKORN, 10200 BANGKOK
SUPPLY ANALYST - BHP BILLITON SHARED Tel./Fax. +66850585980
SHARED SERVICES MALAYSIA SDN BHD
I hereby declare that I will not request any refund from
Current Address UNIT 1-4, BLOCK 21, BANGSAR my paid visa fee even if my application has been declined.
PERMAI, 59100, KUALA LUMPUR Signature Date

Tel. 0173281012
Attention for Tourist and Transit Visas Applicants
E-mail CAANGUGO@HOTMAIL.COM
I hereby declare that the purpose of my visit to Thailand
is for pleasure or transit only and that in no case shall I engage
Permanent Address (if different from above)
myself in any profession or occupation while in the country.
UNIT 1-4, BLOCK 21, BANGSAR
Signature Date

Tel. 0173281012 FOR OFFICIAL USE mfavisaform10092007

Names, dates and places of birth of minor children (if accompanying) Application/Reference No.
Visa No.
Type of Visa:
Diplomatic Visa Official Visa Courtesy Visa
Date of Arrival in Thailand 07-11-2018 Non-Immigrant Visa Tourist Visa Transit Visa
Traveling by AIR ASIA Category of Visa:
Flight No. or Vessel’s name AK 896 Number of Entries:

Duration of Proposed Stay 7 DAYS

Single Double Multiple Entries
Date of Issue Fee
Date of Previous Visit to Thailand N/A
Expiry Date
Purpose of Visit: X Tourism Transit Documents Submitted
Business Diplomatic/Official
Other (please specify)
Authorized Signature and Seal