FEDERAL REPUBLIC OF NIGERIA

VISA APPLICATION FORM

NOTE: i) ii) iii) iv)
Please complete the form in black ink and tick the boxes which apply J I Short stay applicants must complete all the questions on this form Temporary employment applicants to omit questions 22 - 26, and 28 For diplomatic passport holders, questions 19 - 20, 24 - 25 are not applicable

PASSPORT PHOTO

PLEASE SEND WITH THIS FORM: The original letter of invitation from Nigeria/Diplomatic Note Verbale i) One passporr-sized photograph (not more than sir months old) and ii) Your current passport with at least 6 months validity iii) iv) A letter from your employer/sponsor(not applicable to diplomats) C$ A Separate form should be completed by every person intending to travel including children endorsed on their parent5 Passports.
1) Reason for travelling to Nigeria (please tick appropriate boxes) Visitor c l

a) Short Stay:

Student

Private Official Business Diplomatic Other

: 0 0 q

,(Please

specify)

Type of entry clearance required Transit 0 Single Entry 0 Double Entry0 Multiple Entry

q
cl cl

b) Long Stay:

Temporary Employment:

Work permit by Nigerian immigration authorities Accompanying spouse

2)

Full Name (as written in your passport)

I
I

3)

Other Names used now or in the past (eg name before marriage) I

4)

Date of Birth

5) Sex

male

female
1

6)

Town and Country of Birth

7)

Your Fathers Full Name

8)

Your Mothers Full Name

CGJHBFGP 01.1832

No. 2

9) Passport or Travel Issuing government/authority

Document Details I

Number

Nationality as shown in passport

II

Document type (eg ordinary passport)

Place of issue

Valid Until Date of Issue Day Month Year Day Month Year

If you are not travelling on your own passport give the following details: Your relationship to passport holder Name of passport holder

IIjII

II Is this your first passport? If not please provide details of previous passport(s) Number Date and Place of Issue

L5El

II Only complete this section if dependants included on your passport are travelling with you. Full name of dependant Place of birth Date of birth Relationship to Yourself Nationality

10) Occupation

11) Place of work

12) What is your

Present address?

13) Please give your permanent address if different from above

14) Are you?

Married 0 Single 0 Divorced 0 Widowed 0 Separated 0

No. 3

15) If married, please

give details of spouse

Full name of spouse

Date of birth day month year

II Where is your spouse now? Where is your spouse normally resident?

16) Have you applied

to go to Nigeria before?

If so, please give dates and places of application

17) Have you visited

Nigeria before?

If so, please give dates and lengths of each stay

18) 4 Have you ever been refused a visa or entry clearance

at a Nigerian diplomatic mission or Post?

b) Have you ever been refused leave to enter on

arrival in Nigeria?

Yes

4 Have you ever been deported, removed or otherwise

required to leave Nigeria?

[j Yes

4 Have you ever been refused a visa for another country? 4 Have you ever been deported from another country? f)
Have you ever been served with notice of illegal entry or intention to deport from Nigeria?

g) Have you ever worked in Nigeria? h) Do you have any criminal convictions in Nigeria
or elsewhere? (excluding any spent convictions) 19) Country of normal residence

Residence Permit number (if any)

Date of Issue Day Month Year

Valid until Day Month Year

20) Re-entry Visa (if applicable)

Visa
Number

Date of Issue Day Month Year

Valid until Day Month Year

No. 4

21) How long do you intend

to stay in Nigeria? I Day Month Year 1 23) How will you travel to Nigeria?
I

22) What is your proposed date of arrival in Nigeria?

24) Have you bought your ticket already

If yes attach photocopy

Status

25) How much money is available to you during your stay?

(Evidence of this may be required) a) From your own sources

b) From other sources

26) Where will you stay in Nigeria?

Please give details of host/sponsor/contact address If you are staying in a hotel give its name and address (It is not enough to say c/o Embassy or High Commission) Nationality of sponsor Full name of sponsor/contact address/hotel

I1 Address

Telephone Number

Resident in Nigeria since

Occupation

Relationship to you

Do you have any relatives or friends in Nigeria?

I/

/I

27) Is your visit for business or official reasons?

If so, give name of Nigerian company/organisation to be visited

No. 5

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a= c#=

This section must be read and signed by all applicants

An entry clearance can be a Visa, Entry Certificate or a Letter of Consent. Even if you hold a valid entry clearance you can still be refused entry into Nigeria by an Immigration Officer if he is satisfied that: a) your entry clearance was obtained by false representations or by concealment of relevant facts, whether or not you knew of these actions; or

b) a change in circumstances between the date of your application and your arrival in Nigeria invalidates your entry clearance; or a refusal is justified on the grounds of restricted returnability, medical grounds, criminal records, because you are subject to a deportation order, or your exclusion would be conducive to the public good.
@=

An Immigration Officer can ask anyone to be medically examined on arrival in Nigeria, if he considers it Please attach your photograph here necessary.

DECLARATION *I have read and understood the notes above

*I declare that the information given in this application is correct to the best of my knowledge and belief
Signed Date

Visa type Visa No.

I I

For office use only

Approved period of stay: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .._ ._... . . .._.._ . . . . . . . . . . . . . . . . . . . . . . . . Date: ............................................................................................................................................................ Signature: ..................................................................................................................................................... Comments: .................................................................................................................................................
,..__.......................................................................................,...................................................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........................................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..~............................................. Please attach an extra sheet of paper for additional notes Fee: (amount)

I
Document seen:

Paid/Gratis