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1、第第第第1 1 1 1页页页页 共共共共 4 4 4 4 页页页页/PagePagePagePage 1 1 1 1 of of of of 4 4 4 4FormFormFormFormV.201V.201V.201V.2013 3 3 3中 华 人 民 共 和 国 签 证 申 请 表中 华 人 民 共 和 国 签 证 申 请 表VisaVisaVisaVisaApplicationApplicationApplicationApplicationFormFormFormFormofofofof thethethethe PeoplePeoplePeoplePeople s s s s Re
2、publicRepublicRepublicRepublicofofofof ChinaChinaChinaChina(For(For(For(For thethethethe MainlandMainlandMainlandMainland ofofofof ChinaChinaChinaChina only)only)only)only)申请人必须如实、申请人必须如实、申请人必须如实、申请人必须如实、完整、清楚地完整、清楚地完整、清楚地完整、清楚地填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在填写本表格。请逐项在空白
3、处用中文或英文大写字母打印填写，或在填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在内内内内打打打打 选择选择选择选择。如有关项目。如有关项目。如有关项目。如有关项目不适用，请写不适用，请写不适用，请写不适用，请写“无无无无”。TheTheTheThe a a a applicantpplicantpplicantpplicant shouldshouldshouldshould fillfillfillfill inininin thisthisthisthis formformformform trutrutrutruthfulthfulthfulthfully ly ly l
4、y，completelycompletelycompletelycompletely andandandand clearlyclearlyclearlyclearly.PleasePleasePleasePleasetypetypetypetypethethethetheansweransweransweranswer inininin capitalcapitalcapitalcapital EnglisEnglisEnglisEnglish h h hlettersletterslettersletters inininin thethethethespacespacespacespac
5、eprovidedprovidedprovidedprovided orororor ticktickticktick()thethethetherelevantrelevantrelevantrelevant boxboxboxbox totototo select.select.select.select.If If If If somesomesomesome ofofofof thethethetheitemsitemsitemsitems dodododo notnotnotnot apply,apply,apply,apply,pleasepleasepleasepleasetyp
6、etypetypetypeN N N N/A/A/A/A orororor None.None.None.None.一、一、个人个人信息信息 PartPartPartPart1 1 1 1:PersonalPersonalPersonalPersonalI I I Informationnformationnformationnformation1.11.1 英文姓名英文姓名FullFullFullFullEnglishEnglishEnglishEnglish n n n nameameameameasasasas inininin passportpassportpassportpassp
7、ort姓姓 LastLastLastLastnamenamenamename粘贴一张粘贴一张近期正面免冠、浅色近期正面免冠、浅色背背景的彩色护照景的彩色护照照片照片。照片照片/Photo/Photo/Photo/PhotoA A A Affixffixffixffixoneoneoneone recentrecentrecentrecentcolorcolorcolorcolor passportpassportpassportpassportphotophotophotophoto(full(full(full(fullfacefacefaceface,frontfrontfrontfron
8、tviewviewviewview,bareheadedbareheadedbareheadedbareheadedandandandand againstagainstagainstagainsta a a a plainplainplainplainlightlightlightlightcoloredcoloredcoloredcolored background).background).background).background).中间名中间名 MiddleMiddleMiddleMiddle namenamenamename名名 FirstFirstFirstFirstnamen
9、amenamename1.1.1.1.2 2 中文姓名中文姓名N N N Nameameameame inininin ChineseChineseChineseChinese1.1.1.1.3 3 3 3 别名或曾用名别名或曾用名OtherOtherOtherOther n n n nameameameame(s s s s)1.1.1.1.4 4 4 4 性别性别 SexSexSexSex 男男 MMMM 女女 F F F F1.1.1.1.5 5 5 5 出生日期出生日期D D D DOBOBOBOB(yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd)1.
10、1.1.1.6 6 6 6 现有国籍现有国籍CurrentCurrentCurrentCurrentn n n nationalityationalityationalityationality(ies)(ies)(ies)(ies)1.71.71.71.7 曾有国曾有国籍籍 FormerFormerFormerFormer n n n nationalityationalityationalityationality(ies)(ies)(ies)(ies)1.1.1.1.8 8 8 8 出生地点出生地点(市市、省、省/州、国州、国)PlacePlacePlacePlaceofofofof b
11、 b b birth(irth(irth(irth(c c c cityityityity,provinceprovinceprovinceprovince/s/s/s/statetatetatetate,c,c,c,countryountryountryountry)1.1.1.1.9 9 9 9 身份证身份证/公民证公民证号码号码LocalLocalLocalLocalIDIDIDID/CitizenshipCitizenshipCitizenshipCitizenship numbernumbernumbernumber1.1.1.1.10101010 护照护照/旅行证件旅行证件种种类类
12、 PassportPassportPassportPassport/Travel/Travel/Travel/Travel documentdocumentdocumentdocumentt t t typeypeypeype 外交外交 DiplomaticDiplomaticDiplomaticDiplomatic 公务、官员公务、官员 ServiceServiceServiceServiceororororO O O Officialfficialfficialfficial 普通普通 OrdinaryOrdinaryOrdinaryOrdinary 其他证件其他证件(请说明请说明)Oth
13、erOtherOtherOther(Please(Please(Please(Pleasespecify)specify)specify)specify):1.11.11.11.11 1 1 1 护照号码护照号码PassportPassportPassportPassportnumbernumbernumbernumber1.11.11.11.12 2 2 2 签发日期签发日期DateDateDateDateofofofof i i i issue(ssue(ssue(ssue(yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd)1.11.11.11.13 3 3
14、 3 签发地点签发地点PlacePlacePlacePlaceofofofof i i i issuessuessuessue1.11.11.11.14 4 4 4 失效日失效日期期D D D Dateateateateofofofof e e e expirxpirxpirxpiry y y y(yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd)1.11.11.11.15 5 5 5 当前当前职业职业（可选（可选多项多项）CurrentCurrentCurrentCurrento o o occupation(s)ccupation(s)ccupation(s
15、)ccupation(s)商人商人 BusinessBusinessBusinessBusinesspersonpersonpersonperson 公司职员公司职员 CompanyCompanyCompanyCompany employeeemployeeemployeeemployee 演艺人员演艺人员 EntertainerEntertainerEntertainerEntertainer 工人工人/农民农民 Industrial/AgriculturalIndustrial/AgriculturalIndustrial/AgriculturalIndustrial/Agricultur
16、al workerworkerworkerworker 学学生生 StudentStudentStudentStudent 乘务人员乘务人员 CrewCrewCrewCrew membermembermembermember 自雇自雇 Self-employedSelf-employedSelf-employedSelf-employed 无业无业 UnemployedUnemployedUnemployedUnemployed 退休退休 RetiredRetiredRetiredRetired 前前/现任现任议员议员 Former/incumbentFormer/incumbentForme
17、r/incumbentFormer/incumbent mmmmemberemberemberember ofofofof parliamentparliamentparliamentparliament职位职位 PositionPositionPositionPosition_ 前前/现任现任政府官员政府官员 Former/incumbentFormer/incumbentFormer/incumbentFormer/incumbent g g g governmentovernmentovernmentovernmentofficialofficialofficialofficial职位职
18、位 Position_Position_Position_Position_军人军人 MMMMilitaryilitaryilitaryilitary personnelpersonnelpersonnelpersonnel职位职位 Position_Position_Position_Position_ 非政府组织人员非政府组织人员 NGONGONGONGO staffstaffstaffstaff 宗教人士宗教人士 ReligiousReligiousReligiousReligious personnelpersonnelpersonnelpersonnel 新闻从业人员新闻从业人员 S
19、taffStaffStaffStaff ofofofof mediamediamediamedia 其他其他(请说明请说明)OtherOtherOtherOther(Please(Please(Please(Pleasespecify):specify):specify):specify):1.161.161.161.16 受教育程度受教育程度EducationEducationEducationEducation 研究生研究生 PostgraduatePostgraduatePostgraduatePostgraduate 大学大学 CollegeCollegeCollegeCollege
20、其他其他(请说明请说明)OtherOtherOtherOther(Please(Please(Please(Pleasespecify):specify):specify):specify):1.171.171.171.17 工作单位工作单位/学校学校Employer/SchoolEmployer/SchoolEmployer/SchoolEmployer/School名称名称NameNameNameName联系电话联系电话PhonePhonePhonePhone numbernumbernumbernumber地址地址 AddressAddressAddressAddress邮政编码邮政编码
21、ZipZipZipZip CodeCodeCodeCode第第第第2 2 2 2页页页页 共共共共 4 4 4 4 页页页页/PagePagePagePage 2 2 2 2 of of of of 4 4 4 4二二、旅行、旅行信息信息 PartPartPartPart2:2:2:2:T T T TravelravelravelravelI I I Informationnformationnformationnformation1.181.181.181.18 家庭住址家庭住址HomeHomeHomeHome addressaddressaddressaddress1.191.191.19
22、1.19 邮政编码邮政编码ZipZipZipZip CodeCodeCodeCode1.201.201.201.20 电话电话/手机手机Home/mobileHome/mobileHome/mobileHome/mobile phonephonephonephone numbernumbernumbernumber1.1.1.1.21212121 电电子邮箱子邮箱E-mailE-mailE-mailE-mail addressaddressaddressaddress1.1.1.1.22222222 婚姻状况婚姻状况 MaritalMaritalMaritalMarital statussta
23、tusstatusstatus 已婚已婚 MarriedMarriedMarriedMarried 单身单身 SingleSingleSingleSingle 其他其他 Other(PleaseOther(PleaseOther(PleaseOther(Please specify):specify):specify):specify):1.231.231.231.23 主要家庭成员主要家庭成员(配偶、子女、父配偶、子女、父母母等等,可另纸可另纸)MajorMajorMajorMajor familyfamilyfamilyfamilymembersmembersmembersmembers（
24、spouse,spouse,spouse,spouse,children,parents,etchildren,parents,etchildren,parents,etchildren,parents,etc.,mayc.,mayc.,mayc.,may typetypetypetype ononononseparateseparateseparateseparate paperpaperpaperpaper）姓名姓名 NameNameNameName国籍国籍 NationalityNationalityNationalityNationality职业职业 OccupationOccupat
25、ionOccupationOccupation关关系系 RelationshipRelationshipRelationshipRelationship1 1 1 1.24242424紧急紧急联络人信息联络人信息EmergencyEmergencyEmergencyEmergencyC C C Contactontactontactontact姓名姓名NameNameNameName手机手机MobileMobileMobileMobile p p p phonehonehonehone numbernumbernumbernumber与申请人的关系与申请人的关系RelationshipRela
26、tionshipRelationshipRelationship withwithwithwith thethethethe applicantapplicantapplicantapplicant1.251.251.251.25 申请人申请签证时所在的国家或地区申请人申请签证时所在的国家或地区 CountryCountryCountryCountry orororor territoryterritoryterritoryterritory wherewherewherewhere thethethetheapplicantapplicantapplicantapplicant is is
27、is is locatedlocatedlocatedlocated whenwhenwhenwhen applyingapplyingapplyingapplying forforforfor thisthisthisthis visavisavisavisa2 2 2 2.1.1.1.1 申请申请入境入境事由事由 MajorMajorMajorMajorp p p purposeurposeurposeurposeofofofof y y y yourourourour v v v visitisitisitisit 官方访问官方访问 O O O Officialfficialfficia
28、lfficial V V V Visitisitisitisit 常驻外交、领事常驻外交、领事、国际组织人员、国际组织人员AsAsAsAsr r r residentesidentesidentesident d d d diplomatiplomatiplomatiplomat，c c c consulonsulonsulonsulorororor staffstaffstaffstaff ofofofof internationinternationinternationinternational al al alorganizationorganizationorganizationor
29、ganization 旅游旅游 TourismTourismTourismTourism 交流、考察、访问交流、考察、访问 Non-businessNon-businessNon-businessNon-businessvisitvisitvisitvisit 永久居留永久居留 AsAsAsAspermanentpermanentpermanentpermanent rerereres s s sidentidentidentident 商业商业贸易贸易 BusinessBusinessBusinessBusiness&TradeTradeTradeTrade 工作工作 WorkWorkWor
30、kWork 人才引进人才引进 AsAsAsAsintroducedintroducedintroducedintroduced talenttalenttalenttalent 寄养寄养 AsAsAsAschildchildchildchild inininin fosterfosterfosterfoster carecarecarecare 执行乘务执行乘务 AsAsAsAscrcrcrcrewewewew mmmmemberemberemberember 过境过境 TransitTransitTransitTransit 短期探望中国公民或者具有中国永久居留资格的短期探望中国公民或者具有
31、中国永久居留资格的外 国 人外 国 人 Short-termShort-termShort-termShort-term visitvisitvisitvisit totototo ChineseChineseChineseChinese citizencitizencitizencitizen ororororforeignerforeignerforeignerforeigner withwithwithwithChineseChineseChineseChinese permanentpermanentpermanentpermanent residenceresidencereside
32、nceresidence statusstatusstatusstatus 与中国公民或者具有中国永久居留资格的外国人与中国公民或者具有中国永久居留资格的外国人家庭团聚居留超家庭团聚居留超过过 180180180180 日日 FamilyFamilyFamilyFamily reunionreunionreunionreunion forforforfor overoveroverover180180180180 daysdaysdaysdays withwithwithwith ChineseChineseChineseChinese citizencitizencitizencitizen
33、 orororor foreignerforeignerforeignerforeigner withwithwithwithChineseChineseChineseChinese permanentpermanentpermanentpermanent residenceresidenceresidenceresidence statusstatusstatusstatus 短期探望因工作、学习等事由在中国停留居留的短期探望因工作、学习等事由在中国停留居留的外 国 人外 国 人Short-termShort-termShort-termShort-term visitvisitvisitv
34、isit totototo foreignerforeignerforeignerforeigner residingresidingresidingresiding ininininChinaChinaChinaChina duedueduedue totototo work,work,work,work,studystudystudystudy orororor otherotherotherother reasonsreasonsreasonsreasons 长期探望因工作、学习等事由在中国居留的外国长期探望因工作、学习等事由在中国居留的外国人人AsAsAsAsaccompanyinga
35、ccompanyingaccompanyingaccompanyingfamilyfamilyfamilyfamilymembermembermembermemberofofofofforeignerforeignerforeignerforeignerresidingresidingresidingresiding inininin ChinaChinaChinaChina duedueduedue totototo work,work,work,work,studystudystudystudy orororor otherotherotherother reasonsreasonsrea
36、sonsreasons 短期学习短期学习 Short-termShort-termShort-termShort-term studystudystudystudy forforforfor lesslesslesslessthanthanthanthan 180180180180 daysdaysdaysdays 长期学习长期学习 Long-termLong-termLong-termLong-termstudystudystudystudy forforforfor overoveroverover 180180180180 daysdaysdaysdays 短期采访报道短期采访报道 As
37、AsAsAs journalistjournalistjournalistjournalist forforforfor temporarytemporarytemporarytemporary newsnewsnewsnewscoveragecoveragecoveragecoverage外国常驻中国新闻机构记者外国常驻中国新闻机构记者 AsAsAsAsresidentresidentresidentresident j j j journalistournalistournalistournalist 其他其他(请说明请说明)Other)Other)Other)Other(Please(P
38、lease(Please(Please specify)specify)specify)specify)：2 2 2 2.2.2.2.2 计划计划入境次数入境次数IntendedIntendedIntendedIntended n n n numberumberumberumberofofofof e e e entriesntriesntriesntries 一次一次(自签发之日起自签发之日起 3 3 3 3 个月个月有效有效)OneOneOneOne entryentryentryentry validvalidvalidvalid forforforfor 3 3 3 3 monthsm
39、onthsmonthsmonths fromfromfromfromthethethethe datedatedatedate ofofofof issueissueissueissue 二次二次(自签发之日起自签发之日起 3-3-3-3-6 6 6 6 个月个月有效有效)TwoTwoTwoTwoentrentrentrentriesiesiesiesvalidvalidvalidvalid forforforfor 3 3 3 3 totototo 6 6 6 6 monthsmonthsmonthsmonths fromfromfromfromthethethethe datedateda
40、tedate ofofofof issueissueissueissue 半年半年多次（多次（自签发之日起自签发之日起 6 6 6 6 个月有效个月有效)MultiMultiMultiMultipleplepleple entrentrentrentriesiesiesiesvalidvalidvalidvalid forforforfor 6 6 6 6 monthsmonthsmonthsmonths fromfromfromfromthethethethe datedatedatedate ofofofof issueissueissueissue 一年一年多次（多次（自签发之日起自签发
41、之日起 1 1 1 1 年年有效有效)MultiMultiMultiMultipleplepleple entrentrentrentriesiesiesiesvalidvalidvalidvalid forforforfor 1 1 1 1 yearyearyearyear fromfromfromfromthethethethe datedatedatedate ofofofof issueissueissueissue 其他（请说明）其他（请说明）OtherOtherOtherOther(Please(Please(Please(Please specify)specify)specif
42、y)specify):2.32.32.32.3 是否申请加急服务是否申请加急服务 AreAreAreAre youyouyouyou applyingapplyingapplyingapplying forforforfor expressexpressexpressexpressservice?service?service?service?注：加急服务注：加急服务须经领事官员批须经领事官员批准，将加收费用。准，将加收费用。Note:Note:Note:Note:ExpressExpressExpressExpressserviceserviceserviceserviceneedsneed
43、sneedsneedsapprovalapprovalapprovalapprovalo o o of f f fconsularconsularconsularconsular officials,officials,officials,officials,andandandand extraextraextraextra feesfeesfeesfeesmaymaymaymayapply.apply.apply.apply.是是YesYesYesYes 否否 NoNoNoNo2 2 2 2.4 4 4 4 本本次次行程行程预计首次预计首次抵达中国的日期抵达中国的日期ExpectedExpe
44、ctedExpectedExpected d d d dateateateate ofofofof y y y yourourourour f f f firstirstirstirst e e e entryntryntryntry intointointointo ChinaChinaChinaChina onononon thisthisthisthistriptriptriptrip(yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd)第第第第3 3 3 3页页页页 共共共共 4 4 4 4 页页页页/PagePagePagePage 3 3 3 3 of
45、 of of of 4 4 4 4三三、其他事项其他事项 PartPartPartPart3 3 3 3:OtherOtherOtherOther InformationInformationInformationInformation3 3.1 1 是否曾在中国超过签证或居留许可允许的期限停留？是否曾在中国超过签证或居留许可允许的期限停留？HaveHaveHaveHave youyouyouyou everevereverever overstayedoverstayedoverstayedoverstayed youryouryouryour visavisavisavisa ororor
46、orresidenceresidenceresidenceresidence permitpermitpermitpermit inininin China?China?China?China?是是YesYesYesYes否否 NoNoNoNo3 3.2 2 是否曾经被拒绝是否曾经被拒绝签签发中国签证发中国签证,或被拒绝进入中国？或被拒绝进入中国？HaveHaveHaveHave youyouyouyou everevereverever beenbeenbeenbeen refusedrefusedrefusedrefused a a a a visavisavisavisa forforf
47、orfor China,China,China,China,o o o or r r rbeenbeenbeenbeen refusedrefusedrefusedrefused entryentryentryentry intointointointo China?China?China?China?是是YesYesYesYes否否 NoNoNoNo3 3.3 3 是否在中国或其他国家有是否在中国或其他国家有犯罪犯罪记录？记录？DoDoDoDo youyouyouyou havehavehavehave anyanyanyany criminalcriminalcriminalcrimina
48、l recordrecordrecordrecord inininin ChinaChinaChinaChina orororor anyanyanyany otherotherotherothercountry?country?country?country?是是YesYesYesYes否否 NoNoNoNo3 3.4 4 是否是否具有具有以下任一种以下任一种情形情形 AreAreAreAreyouyouyouyou experiencingexperiencingexperiencingexperiencing anyanyanyany ofofofof thethethethefollo
49、wingfollowingfollowingfollowing conditionsconditionsconditionsconditions?严重精神严重精神障碍障碍 SeriousSeriousSeriousSerious mmmmentalentalentalental d d d dis is is isorderorderorderorder传染性肺结核病传染性肺结核病 InfectiousInfectiousInfectiousInfectious pulmonarypulmonarypulmonarypulmonary t t t tuberculosisuberculosis
50、uberculosisuberculosis可能危害公共卫生的其他传染病可能危害公共卫生的其他传染病 OtherOtherOtherOther infectiousinfectiousinfectiousinfectious diseasediseasediseasediseaseofofofof publicpublicpublicpublic healthhealthhealthhealth hazardshazardshazardshazards是是YesYesYesYes否否 NoNoNoNo3 3.5 5 近近 3030 日内是否前往过流行性疾病传染的国家或地区？日内是否前往过流行性
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