Type of visa * -- Single Entry Visa

Where are you making this application from? * -- AFGHANISTAN (AFG) ALBANIA (ALB) ALGERIA (DZA) AMERICAN SAMOA (ASM) ANDORRA (AND) ANGOLA (AGO) ANGUILLA (AIA) ANTARCTICA (ATA) ANTIGUA AND BARBUDA (ATG) ARGENTINA (ARG) ARMENIA (ARM) ARUBA (ABW) AUSTRALIA (AUS) AUSTRIA (AUT) AZERBAIJAN (AZE) BAHAMAS (BHS) BAHRAIN (BHR) BANGLADESH (BGD) BARBADOS (BRB) BELARUS (BLR) BELGIUM (BEL) BELIZE (BLZ) BENIN (BEN) BERMUDA (BMU) BHUTAN (BTN) BOLIVIA (BOL) BOSNIA AND HERZEGOVINA (BIH) BOTSWANA (BWA) BOUVET ISLAND (BVT) BRAZIL (BRA) BRITISH INDIAN OCEAN TERRITORY (IOT) BRUNEI (BRN) BULGARIA (BGR) BURKINA FASO (BFA) BURMA (BUR) BURUNDI (BDI) CAMBODIA (KHM) CAMEROON (CMR) CANADA (CAN) CANTON AND ENDERBURY ISLANDS (CTE) CAPE VERDE (CPV) CAYMAN ISLANDS (CYM) CENTRAL AFRICAN REPUBLIC (CAF) CHAD (TCD) CHILE (CHL) CHINA (CHN) CHRISTMAS ISLAND (CXR) COCOS (KEELING) ISLANDS (CCK) COLOMBIA (COL) COMOROS (COM) CONGO (COG) COOK ISLANDS (COK) COSTA RICA (CRI) COTE D IVOIRE (CIV) CROATIA (HRV) CUBA (CUB) CYPRUS (CYP) CZECH REPUBLIC (CZE) DEMOCRATIC YEMEN (YMD) DENMARK (DNK) DJIBOUTI (DJI) DOMINICA (DMA) DOMINICAN REPUBLIC (DOM) DRONNING MAUD LAND (DML) EAST TIMOR (TMP) ECUADOR (ECU) EGYPT (EGY) EL SALVADOR (SLV) EQUATORIAL GUINEA (GNQ) ERITREA (ERI) ESTONIA (EST) ETHIOPIA (ETH) FALKLAND ISLANDS (FLK) FAROE ISLANDS (FRO) FIJI (FJI) FINLAND (FIN) FRANCE (FRA) FRANCE METROPOLITAN (FXX) FRENCH GUIANA (GUF) FRENCH POLYNESIA (PYF) FRENCH SOUTHERN TERRITORIES (ATF) GABON (GAB) GAMBIA (GMB) GEORGIA (GEO) GERMANY (DEU) GHANA (GHA) GIBRALTAR (GIB) GREECE (GRC) GREENLAND (GRL) GRENADA (GRD) GUADELOUPE (GLP) GUAM (GUM) GUATEMALA (GTM) GUINEA (GIN) GUINEA-BISSAU (GNB) GUYANA (GUY) HAITI (HTI) HEARD AND MC DONALD ISLANDS (HMD) HONDURAS (HND) HONG KONG (HKG) HUNGARY (HUN) ICELAND (ISL) INDIA (IND) INDONESIA (IDN) IRAN (IRN) IRAQ (IRQ) IRELAND (IRL) ISRAEL (ISR) ITALY (ITA) JAMAICA (JAM) JAPAN (JPN) JOHNSTON ISLAND (JTN) JORDAN (JOR) KAZAKHSTAN (KAZ) KENYA (KEN) KIRIBATI (KIR) KOSOVO (KVV) KUWAIT (KWT) KYRGYZSTAN (KGZ) LAOS (LAO) LATVIA (LVA) LEBANON (LBN) LESOTHO (LSO) LIBERIA (LBR) LIBYA (LBY) LIECHTENSTEIN (LIE) LITHUANIA (LTU) LUXEMBOURG (LUX) MACAU (MAC) MACEDONIA (MKD) MADAGASCAR (MDG) MALAWI (MWI) MALAYSIA (MYS) MALDIVES (MDV) MALI (MLI) MALTA (MLT) MARSHALL ISLANDS (MHL) MARTINIQUE (MTQ) MAURITANIA (MRT) MAURITIUS (MUS) MAYOTTE (MYT) MEXICO (MEX) MICRONESIA - FEDERATED STATES OF (FSM) MIDWAY ISLANDS (MID) MOLDOVA (MDA) MONACO (MCO) MONGOLIA (MNG) MONTSERRAT (MSR) MOROCCO (MAR) MOZAMBIQUE (MOZ) MYANMAR (MMR) NAMIBIA (NAM) NAURU (NRU) NEPAL (NPL) NETHERLANDS (NLD) NETHERLANDS ANTILLES (ANT) NEUTRAL ZONE (NTZ) NEW CALEDONIA (NCL) NEW ZEALAND (NZL) NICARAGUA (NIC) NIGER (NER) NIGERIA (NGA) NIUE (NIU) NORFOLK ISLAND (NFK) NORTH KOREA (PRK) NORTHERN MARIANA ISLANDS (MNP) NORWAY (NOR) OMAN (OMN) PAKISTAN (PAK) PALAU (PLW) PALESTINIAN TERRITORIES (PSE) PANAMA (PAN) PAPUA NEW GUINEA (PNG) PARAGUAY (PRY) PERU (PER) PHILIPPINES (PHL) PITCAIRN ISLANDS (PCN) POLAND (POL) PORTUGAL (PRT) PUERTO RICO (PRI) QATAR (QAT) REUNION (REU) ROMANIA (ROM) RUSSIA (RUS) RWANDA (RWA) SAINT KITTS AND NEVIS (KNA) SAINT LUCIA (LCA) SAINT VINCENT AND THE GRENADINES (VCT) SAMOA (WSM) SAN MARINO (SMR) SAO TOME AND PRINCIPE (STP) SAUDI ARABIA (SAU) SENEGAL (SEN) SERBIA (SRB) SERBIA AND MONTENEGRO (SCG) SEYCHELLES (SYC) SIERRA LEONE (SLE) SINGAPORE (SGP) SLOVAKIA (SVK) SLOVENIA (SVN) SOLOMON ISLANDS (SLB) SOMALIA (SOM) SOUTH AFRICA (ZAF) SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) SOUTH KOREA (KOR) SPAIN (ESP) SRI LANKA (LKA) ST. HELENA (SHN) ST. PIERRE AND MIQUELON (SPM) SUDAN (SDN) SURINAME (SUR) SVALBARD AND JAN MAYEN ISLANDS (SJM) SWAZILAND (SWZ) SWEDEN (SWE) SWITZERLAND (CHE) SYRIA (SYR) TAIWAN (TWN) TAJIKISTAN (TJK) TANZANIA (TZA) THAILAND (THA) TIMOR-LESTE (TLS) TOGO (TGO) TOKELAU (TKL) TONGA (TON) TRINIDAD AND TOBAGO (TTO) TUNISIA (TUN) TURKEY (TUR) TURKMENISTAN (TKM) TURKS AND CAICOS ISLANDS (TCA) TUVALU (TUV) UGANDA (UGA) UKRAINE (UKR) UNITED ARAB EMIRATES (ARE) UNITED KINGDOM (GBR) UNITED STATES (USA) UNITED STATES MINOR OUTLYING ISLANDS (UMI) URUGUAY (URY) UZBEKISTAN (UZB) VANUATU (VUT) VATICAN CITY STATE (HOLY SEE) (VAT) VENEZUELA (VEN) VIETNAM (VNM) VIRGIN ISLANDS (BRITISH) (VGB) VIRGIN ISLANDS (U.S.) (VIR) WAKE ISLAND (WAK) WALLIS AND FUTUNA ISLANDS (WLF) WESTERN SAHARA (ESH) YEMEN (YEM) ZAIRE (ZAR) ZAMBIA (ZMB) ZIMBABWE (ZWE)

Are you A * -- Adult Child

Are you travelling with a Minor? * Yes No

Minor Name * Minor Passport Number *

Who are you travelling with? * Parent Guardian Alone

Evisa Number of the Parent/Guardian *

You must be 18 years old or above in order to use the Service.

TRAVELER INFORMATION

Surname / Family Name *

First Name / Other Names in Full *

Gender Male Female

Date of Birth *

Place of Birth*

Country of Birth * -- AFGHANISTAN (AFG) ALBANIA (ALB) ALGERIA (DZA) AMERICAN SAMOA (ASM) ANDORRA (AND) ANGOLA (AGO) ANGUILLA (AIA) ANTARCTICA (ATA) ANTIGUA AND BARBUDA (ATG) ARGENTINA (ARG) ARMENIA (ARM) ARUBA (ABW) AUSTRALIA (AUS) AUSTRIA (AUT) AZERBAIJAN (AZE) BAHAMAS (BHS) BAHRAIN (BHR) BANGLADESH (BGD) BARBADOS (BRB) BELARUS (BLR) BELGIUM (BEL) BELIZE (BLZ) BENIN (BEN) BERMUDA (BMU) BHUTAN (BTN) BOLIVIA (BOL) BOSNIA AND HERZEGOVINA (BIH) BOTSWANA (BWA) BOUVET ISLAND (BVT) BRAZIL (BRA) BRITISH INDIAN OCEAN TERRITORY (IOT) BRUNEI (BRN) BULGARIA (BGR) BURKINA FASO (BFA) BURMA (BUR) BURUNDI (BDI) CAMBODIA (KHM) CAMEROON (CMR) CANADA (CAN) CANTON AND ENDERBURY ISLANDS (CTE) CAPE VERDE (CPV) CAYMAN ISLANDS (CYM) CENTRAL AFRICAN REPUBLIC (CAF) CHAD (TCD) CHILE (CHL) CHINA (CHN) CHRISTMAS ISLAND (CXR) COCOS (KEELING) ISLANDS (CCK) COLOMBIA (COL) COMOROS (COM) CONGO (COG) COOK ISLANDS (COK) COSTA RICA (CRI) COTE D IVOIRE (CIV) CROATIA (HRV) CUBA (CUB) CYPRUS (CYP) CZECH REPUBLIC (CZE) DEMOCRATIC YEMEN (YMD) DENMARK (DNK) DJIBOUTI (DJI) DOMINICA (DMA) DOMINICAN REPUBLIC (DOM) DRONNING MAUD LAND (DML) EAST TIMOR (TMP) ECUADOR (ECU) EGYPT (EGY) EL SALVADOR (SLV) EQUATORIAL GUINEA (GNQ) ERITREA (ERI) ESTONIA (EST) ETHIOPIA (ETH) FALKLAND ISLANDS (FLK) FAROE ISLANDS (FRO) FIJI (FJI) FINLAND (FIN) FRANCE (FRA) FRANCE METROPOLITAN (FXX) FRENCH GUIANA (GUF) FRENCH POLYNESIA (PYF) FRENCH SOUTHERN TERRITORIES (ATF) GABON (GAB) GAMBIA (GMB) GEORGIA (GEO) GERMANY (DEU) GHANA (GHA) GIBRALTAR (GIB) GREECE (GRC) GREENLAND (GRL) GRENADA (GRD) GUADELOUPE (GLP) GUAM (GUM) GUATEMALA (GTM) GUINEA (GIN) GUINEA-BISSAU (GNB) GUYANA (GUY) HAITI (HTI) HEARD AND MC DONALD ISLANDS (HMD) HONDURAS (HND) HONG KONG (HKG) HUNGARY (HUN) ICELAND (ISL) INDIA (IND) INDONESIA (IDN) IRAN (IRN) IRAQ (IRQ) IRELAND (IRL) ISRAEL (ISR) ITALY (ITA) JAMAICA (JAM) JAPAN (JPN) JOHNSTON ISLAND (JTN) JORDAN (JOR) KAZAKHSTAN (KAZ) KENYA (KEN) KIRIBATI (KIR) KOSOVO (KVV) KUWAIT (KWT) KYRGYZSTAN (KGZ) LAOS (LAO) LATVIA (LVA) LEBANON (LBN) LESOTHO (LSO) LIBERIA (LBR) LIBYA (LBY) LIECHTENSTEIN (LIE) LITHUANIA (LTU) LUXEMBOURG (LUX) MACAU (MAC) MACEDONIA (MKD) MADAGASCAR (MDG) MALAWI (MWI) MALAYSIA (MYS) MALDIVES (MDV) MALI (MLI) MALTA (MLT) MARSHALL ISLANDS (MHL) MARTINIQUE (MTQ) MAURITANIA (MRT) MAURITIUS (MUS) MAYOTTE (MYT) MEXICO (MEX) MICRONESIA - FEDERATED STATES OF (FSM) MIDWAY ISLANDS (MID) MOLDOVA (MDA) MONACO (MCO) MONGOLIA (MNG) MONTSERRAT (MSR) MOROCCO (MAR) MOZAMBIQUE (MOZ) MYANMAR (MMR) NAMIBIA (NAM) NAURU (NRU) NEPAL (NPL) NETHERLANDS (NLD) NETHERLANDS ANTILLES (ANT) NEUTRAL ZONE (NTZ) NEW CALEDONIA (NCL) NEW ZEALAND (NZL) NICARAGUA (NIC) NIGER (NER) NIGERIA (NGA) NIUE (NIU) NORFOLK ISLAND (NFK) NORTH KOREA (PRK) NORTHERN MARIANA ISLANDS (MNP) NORWAY (NOR) OMAN (OMN) PAKISTAN (PAK) PALAU (PLW) PALESTINIAN TERRITORIES (PSE) PANAMA (PAN) PAPUA NEW GUINEA (PNG) PARAGUAY (PRY) PERU (PER) PHILIPPINES (PHL) PITCAIRN ISLANDS (PCN) POLAND (POL) PORTUGAL (PRT) PUERTO RICO (PRI) QATAR (QAT) REUNION (REU) ROMANIA (ROM) RUSSIA (RUS) RWANDA (RWA) SAINT KITTS AND NEVIS (KNA) SAINT LUCIA (LCA) SAINT VINCENT AND THE GRENADINES (VCT) SAMOA (WSM) SAN MARINO (SMR) SAO TOME AND PRINCIPE (STP) SAUDI ARABIA (SAU) SENEGAL (SEN) SERBIA (SRB) SERBIA AND MONTENEGRO (SCG) SEYCHELLES (SYC) SIERRA LEONE (SLE) SINGAPORE (SGP) SLOVAKIA (SVK) SLOVENIA (SVN) SOLOMON ISLANDS (SLB) SOMALIA (SOM) SOUTH AFRICA (ZAF) SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) SOUTH KOREA (KOR) SPAIN (ESP) SRI LANKA (LKA) ST. HELENA (SHN) ST. PIERRE AND MIQUELON (SPM) SUDAN (SDN) SURINAME (SUR) SVALBARD AND JAN MAYEN ISLANDS (SJM) SWAZILAND (SWZ) SWEDEN (SWE) SWITZERLAND (CHE) SYRIA (SYR) TAIWAN (TWN) TAJIKISTAN (TJK) TANZANIA (TZA) THAILAND (THA) TIMOR-LESTE (TLS) TOGO (TGO) TOKELAU (TKL) TONGA (TON) TRINIDAD AND TOBAGO (TTO) TUNISIA (TUN) TURKEY (TUR) TURKMENISTAN (TKM) TURKS AND CAICOS ISLANDS (TCA) TUVALU (TUV) UGANDA (UGA) UKRAINE (UKR) UNITED ARAB EMIRATES (ARE) UNITED KINGDOM (GBR) UNITED STATES (USA) UNITED STATES MINOR OUTLYING ISLANDS (UMI) URUGUAY (URY) UZBEKISTAN (UZB) VANUATU (VUT) VATICAN CITY STATE (HOLY SEE) (VAT) VENEZUELA (VEN) VIETNAM (VNM) VIRGIN ISLANDS (BRITISH) (VGB) VIRGIN ISLANDS (U.S.) (VIR) WAKE ISLAND (WAK) WALLIS AND FUTUNA ISLANDS (WLF) WESTERN SAHARA (ESH) YEMEN (YEM) ZAIRE (ZAR) ZAMBIA (ZMB) ZIMBABWE (ZWE)

Current occupation *

Father Details* -- Alive Deceased Unknown

Fathers Name*

Fathers Phone Number*

Mother Details* -- Alive Deceased Unknown

Mothers Name *

Mothers Phone Number*

Marital Status* -- Single Widow Married Divorced

Spouse Name

Spouse Number

Next of Kin Name *

Next of Kin Phone Number *

NATIONALITY AND RESIDENCE

Current Nationality * -- Albania Algeria Andorra Angola Antigua and Bermuda Argentina Australia Austria Bahrain Bangladesh Belarus Belgium Benin Bhutan Bolivia Bosnia Herzegovina Brazil Bulgaria Burkina Faso Cambodia Canada Cape Verde Central African Rep Chad Chile China {P.R} Colombia Comoros Congo {Brazzaville} Congo {Democratic Rep} Costa Rica Croatia Cuba Czech Republic Denmark Djibouti Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Estonia Finland France Gabon Georgia Germany Greece Greenland Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong {SAR} Hungary Iceland India Indonesia Iran Ireland {Republic} Israel Italy Ivory Coast Japan Jordan Kampuchea Kazakhstan Kirghizistan Korea South Kuwait Laos Latvia Liberia Liechtenstein Lithuania Luxembourg Macedonia Macau {SAR} Madagascar Malagasy Malta Marshall Islands Mauritania Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar {Burma} Nepal Netherlands New Zealand Nicaragua Niger Nigeria norway Oman Pacific Isles Pakistan Palau Panama Paraguay Peru Philippines Poland Portugal Qatar Reunion Romania Russian Federation Salvador Saint Christopher Cape Sao Tome & Principe Saudi Arabia Serbia Slovakia Slovenia South Sudan Spain Sri Lanka Sudan Suriname Sweden Switzerland Taiwan Thailand Togo Tunisia Turkey Turkmenistan Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vatican City Venezuela Vietnam Yugoslavia and former States of Yugoslavia

Continent of Residence * -- Africa South America North America Europe Asia Australia/Oceania Antartica

Country of Residence * -- AFGHANISTAN (AFG) ALBANIA (ALB) ALGERIA (DZA) AMERICAN SAMOA (ASM) ANDORRA (AND) ANGOLA (AGO) ANGUILLA (AIA) ANTARCTICA (ATA) ANTIGUA AND BARBUDA (ATG) ARGENTINA (ARG) ARMENIA (ARM) ARUBA (ABW) AUSTRALIA (AUS) AUSTRIA (AUT) AZERBAIJAN (AZE) BAHAMAS (BHS) BAHRAIN (BHR) BANGLADESH (BGD) BARBADOS (BRB) BELARUS (BLR) BELGIUM (BEL) BELIZE (BLZ) BENIN (BEN) BERMUDA (BMU) BHUTAN (BTN) BOLIVIA (BOL) BOSNIA AND HERZEGOVINA (BIH) BOTSWANA (BWA) BOUVET ISLAND (BVT) BRAZIL (BRA) BRITISH INDIAN OCEAN TERRITORY (IOT) BRUNEI (BRN) BULGARIA (BGR) BURKINA FASO (BFA) BURMA (BUR) BURUNDI (BDI) CAMBODIA (KHM) CAMEROON (CMR) CANADA (CAN) CANTON AND ENDERBURY ISLANDS (CTE) CAPE VERDE (CPV) CAYMAN ISLANDS (CYM) CENTRAL AFRICAN REPUBLIC (CAF) CHAD (TCD) CHILE (CHL) CHINA (CHN) CHRISTMAS ISLAND (CXR) COCOS (KEELING) ISLANDS (CCK) COLOMBIA (COL) COMOROS (COM) CONGO (COG) COOK ISLANDS (COK) COSTA RICA (CRI) COTE D IVOIRE (CIV) CROATIA (HRV) CUBA (CUB) CYPRUS (CYP) CZECH REPUBLIC (CZE) DEMOCRATIC YEMEN (YMD) DENMARK (DNK) DJIBOUTI (DJI) DOMINICA (DMA) DOMINICAN REPUBLIC (DOM) DRONNING MAUD LAND (DML) EAST TIMOR (TMP) ECUADOR (ECU) EGYPT (EGY) EL SALVADOR (SLV) EQUATORIAL GUINEA (GNQ) ERITREA (ERI) ESTONIA (EST) ETHIOPIA (ETH) FALKLAND ISLANDS (FLK) FAROE ISLANDS (FRO) FIJI (FJI) FINLAND (FIN) FRANCE (FRA) FRANCE METROPOLITAN (FXX) FRENCH GUIANA (GUF) FRENCH POLYNESIA (PYF) FRENCH SOUTHERN TERRITORIES (ATF) GABON (GAB) GAMBIA (GMB) GEORGIA (GEO) GERMANY (DEU) GHANA (GHA) GIBRALTAR (GIB) GREECE (GRC) GREENLAND (GRL) GRENADA (GRD) GUADELOUPE (GLP) GUAM (GUM) GUATEMALA (GTM) GUINEA (GIN) GUINEA-BISSAU (GNB) GUYANA (GUY) HAITI (HTI) HEARD AND MC DONALD ISLANDS (HMD) HONDURAS (HND) HONG KONG (HKG) HUNGARY (HUN) ICELAND (ISL) INDIA (IND) INDONESIA (IDN) IRAN (IRN) IRAQ (IRQ) IRELAND (IRL) ISRAEL (ISR) ITALY (ITA) JAMAICA (JAM) JAPAN (JPN) JOHNSTON ISLAND (JTN) JORDAN (JOR) KAZAKHSTAN (KAZ) KENYA (KEN) KIRIBATI (KIR) KOSOVO (KVV) KUWAIT (KWT) KYRGYZSTAN (KGZ) LAOS (LAO) LATVIA (LVA) LEBANON (LBN) LESOTHO (LSO) LIBERIA (LBR) LIBYA (LBY) LIECHTENSTEIN (LIE) LITHUANIA (LTU) LUXEMBOURG (LUX) MACAU (MAC) MACEDONIA (MKD) MADAGASCAR (MDG) MALAWI (MWI) MALAYSIA (MYS) MALDIVES (MDV) MALI (MLI) MALTA (MLT) MARSHALL ISLANDS (MHL) MARTINIQUE (MTQ) MAURITANIA (MRT) MAURITIUS (MUS) MAYOTTE (MYT) MEXICO (MEX) MICRONESIA - FEDERATED STATES OF (FSM) MIDWAY ISLANDS (MID) MOLDOVA (MDA) MONACO (MCO) MONGOLIA (MNG) MONTSERRAT (MSR) MOROCCO (MAR) MOZAMBIQUE (MOZ) MYANMAR (MMR) NAMIBIA (NAM) NAURU (NRU) NEPAL (NPL) NETHERLANDS (NLD) NETHERLANDS ANTILLES (ANT) NEUTRAL ZONE (NTZ) NEW CALEDONIA (NCL) NEW ZEALAND (NZL) NICARAGUA (NIC) NIGER (NER) NIGERIA (NGA) NIUE (NIU) NORFOLK ISLAND (NFK) NORTH KOREA (PRK) NORTHERN MARIANA ISLANDS (MNP) NORWAY (NOR) OMAN (OMN) PAKISTAN (PAK) PALAU (PLW) PALESTINIAN TERRITORIES (PSE) PANAMA (PAN) PAPUA NEW GUINEA (PNG) PARAGUAY (PRY) PERU (PER) PHILIPPINES (PHL) PITCAIRN ISLANDS (PCN) POLAND (POL) PORTUGAL (PRT) PUERTO RICO (PRI) QATAR (QAT) REUNION (REU) ROMANIA (ROM) RUSSIA (RUS) RWANDA (RWA) SAINT KITTS AND NEVIS (KNA) SAINT LUCIA (LCA) SAINT VINCENT AND THE GRENADINES (VCT) SAMOA (WSM) SAN MARINO (SMR) SAO TOME AND PRINCIPE (STP) SAUDI ARABIA (SAU) SENEGAL (SEN) SERBIA (SRB) SERBIA AND MONTENEGRO (SCG) SEYCHELLES (SYC) SIERRA LEONE (SLE) SINGAPORE (SGP) SLOVAKIA (SVK) SLOVENIA (SVN) SOLOMON ISLANDS (SLB) SOMALIA (SOM) SOUTH AFRICA (ZAF) SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) SOUTH KOREA (KOR) SPAIN (ESP) SRI LANKA (LKA) ST. HELENA (SHN) ST. PIERRE AND MIQUELON (SPM) SUDAN (SDN) SURINAME (SUR) SVALBARD AND JAN MAYEN ISLANDS (SJM) SWAZILAND (SWZ) SWEDEN (SWE) SWITZERLAND (CHE) SYRIA (SYR) TAIWAN (TWN) TAJIKISTAN (TJK) TANZANIA (TZA) THAILAND (THA) TIMOR-LESTE (TLS) TOGO (TGO) TOKELAU (TKL) TONGA (TON) TRINIDAD AND TOBAGO (TTO) TUNISIA (TUN) TURKEY (TUR) TURKMENISTAN (TKM) TURKS AND CAICOS ISLANDS (TCA) TUVALU (TUV) UGANDA (UGA) UKRAINE (UKR) UNITED ARAB EMIRATES (ARE) UNITED KINGDOM (GBR) UNITED STATES (USA) UNITED STATES MINOR OUTLYING ISLANDS (UMI) URUGUAY (URY) UZBEKISTAN (UZB) VANUATU (VUT) VATICAN CITY STATE (HOLY SEE) (VAT) VENEZUELA (VEN) VIETNAM (VNM) VIRGIN ISLANDS (BRITISH) (VGB) VIRGIN ISLANDS (U.S.) (VIR) WAKE ISLAND (WAK) WALLIS AND FUTUNA ISLANDS (WLF) WESTERN SAHARA (ESH) YEMEN (YEM) ZAIRE (ZAR) ZAMBIA (ZMB) ZIMBABWE (ZWE)

Nearest Kenyan Embassy * -- BERLIN, Germany LAGOS, Nigeria ISLAMABAD, Pakistan ROME, Italy GENEVA, Switzerland THE HAGUE, Netherlands LONDON, England MOGADISHU, Somalia PRETORIA, South Africa STOCKHOLM, Sweden WASHINGTON, D.C, USA BRUSSELS, Belgium DAR ES SALAAM, Tanzania DOHA, Qatar JUBA, South Sudan LUSAKA, Zambia TEL AVIV, Israel RIYADH, Saudi Arabia CAIRO, Egypt ANKARA, Turkey OTTAWA, Canada TEHRAN, Iran LOS ANGELES, USA MADRID, Spain KIGALI, Rwanda KAMPALA, Uganda PARIS, France BEIJING, China TOKYO, Japan CANBERRA, Australia NEWYORK, USA NEW DELHI, India DUBAI, UAE

Physical address in the Country of Residence *

Phone Number * in the Country of Residence

City / Town *

Email * in the Country of Residence

PASSPORT / TRAVEL DOCUMENT INFO

Passport Number *

Place of issue * Must Match Passport

Date of Issue *

Must Match Passport

Expiry date *

Passport must be valid for atleast next 6 months

Issued by * Must Match Passport

TRAVEL INFORMATION

Previous visits to Kenya * -- Yes No

Date of previous visits * Duration * < 1 week < 2 weeks < 3 weeks < 1 month < 2 month < 3 month Previous Evisa Number*

Reason For Travel * Tourism Visit Medical Business Work

Proposed Date of Entry *

Proposed Date of Departure from Kenya *

Host Details * Hotel Firm Friend Relative

Full names and Physical address of Hotels / Places / Firms / Friends or Relatives to be visited in Kenya *

Host Telephone/Cell no. of Hotels/Places/Firms/Friends or Relatives to be visited in Kenya

Host Email Of Hotels/Places/Firms/Friends or Relatives to be visited in Kenya (Physical address)

Arriving by * Air Road Ship

Select Point of Entry by Air * Eldoret International Airport Garisa Airstrip Jomo Kenyatta Airport, Nairobi Kisumu Airport Lamu Airport Lokichogio Airport Malindi Airport Moi Airport Mombasa Wajir International Airport Wilson Airport, Nairobi

Select Point of Entry by Road * Busia Isebania Liboi Loitokitok Lungalunga Malaba Mandera Moyale Nadapal Namanga Taveta

Select Point of Entry by Ship * Kilindini Sea Port Kisumu Kuinga Lamu Malindi Mbita Point Muhuru Bay Old Port Shimoni Vanga

TRAVEL HISTORY

Did you visited other countries in the last 3 months?* -- Yes No

Date of recent visit to other countries in the last 3 months * Duration * < 1 week < 2 weeks < 3 weeks < 1 month < 2 month < 3 month Country * -- AFGHANISTAN (AFG) ALBANIA (ALB) ALGERIA (DZA) AMERICAN SAMOA (ASM) ANDORRA (AND) ANGOLA (AGO) ANGUILLA (AIA) ANTARCTICA (ATA) ANTIGUA AND BARBUDA (ATG) ARGENTINA (ARG) ARMENIA (ARM) ARUBA (ABW) AUSTRALIA (AUS) AUSTRIA (AUT) AZERBAIJAN (AZE) BAHAMAS (BHS) BAHRAIN (BHR) BANGLADESH (BGD) BARBADOS (BRB) BELARUS (BLR) BELGIUM (BEL) BELIZE (BLZ) BENIN (BEN) BERMUDA (BMU) BHUTAN (BTN) BOLIVIA (BOL) BOSNIA AND HERZEGOVINA (BIH) BOTSWANA (BWA) BOUVET ISLAND (BVT) BRAZIL (BRA) BRITISH INDIAN OCEAN TERRITORY (IOT) BRUNEI (BRN) BULGARIA (BGR) BURKINA FASO (BFA) BURMA (BUR) BURUNDI (BDI) CAMBODIA (KHM) CAMEROON (CMR) CANADA (CAN) CANTON AND ENDERBURY ISLANDS (CTE) CAPE VERDE (CPV) CAYMAN ISLANDS (CYM) CENTRAL AFRICAN REPUBLIC (CAF) CHAD (TCD) CHILE (CHL) CHINA (CHN) CHRISTMAS ISLAND (CXR) COCOS (KEELING) ISLANDS (CCK) COLOMBIA (COL) COMOROS (COM) CONGO (COG) COOK ISLANDS (COK) COSTA RICA (CRI) COTE D IVOIRE (CIV) CROATIA (HRV) CUBA (CUB) CYPRUS (CYP) CZECH REPUBLIC (CZE) DEMOCRATIC YEMEN (YMD) DENMARK (DNK) DJIBOUTI (DJI) DOMINICA (DMA) DOMINICAN REPUBLIC (DOM) DRONNING MAUD LAND (DML) EAST TIMOR (TMP) ECUADOR (ECU) EGYPT (EGY) EL SALVADOR (SLV) EQUATORIAL GUINEA (GNQ) ERITREA (ERI) ESTONIA (EST) ETHIOPIA (ETH) FALKLAND ISLANDS (FLK) FAROE ISLANDS (FRO) FIJI (FJI) FINLAND (FIN) FRANCE (FRA) FRANCE METROPOLITAN (FXX) FRENCH GUIANA (GUF) FRENCH POLYNESIA (PYF) FRENCH SOUTHERN TERRITORIES (ATF) GABON (GAB) GAMBIA (GMB) GEORGIA (GEO) GERMANY (DEU) GHANA (GHA) GIBRALTAR (GIB) GREECE (GRC) GREENLAND (GRL) GRENADA (GRD) GUADELOUPE (GLP) GUAM (GUM) GUATEMALA (GTM) GUINEA (GIN) GUINEA-BISSAU (GNB) GUYANA (GUY) HAITI (HTI) HEARD AND MC DONALD ISLANDS (HMD) HONDURAS (HND) HONG KONG (HKG) HUNGARY (HUN) ICELAND (ISL) INDIA (IND) INDONESIA (IDN) IRAN (IRN) IRAQ (IRQ) IRELAND (IRL) ISRAEL (ISR) ITALY (ITA) JAMAICA (JAM) JAPAN (JPN) JOHNSTON ISLAND (JTN) JORDAN (JOR) KAZAKHSTAN (KAZ) KENYA (KEN) KIRIBATI (KIR) KOSOVO (KVV) KUWAIT (KWT) KYRGYZSTAN (KGZ) LAOS (LAO) LATVIA (LVA) LEBANON (LBN) LESOTHO (LSO) LIBERIA (LBR) LIBYA (LBY) LIECHTENSTEIN (LIE) LITHUANIA (LTU) LUXEMBOURG (LUX) MACAU (MAC) MACEDONIA (MKD) MADAGASCAR (MDG) MALAWI (MWI) MALAYSIA (MYS) MALDIVES (MDV) MALI (MLI) MALTA (MLT) MARSHALL ISLANDS (MHL) MARTINIQUE (MTQ) MAURITANIA (MRT) MAURITIUS (MUS) MAYOTTE (MYT) MEXICO (MEX) MICRONESIA - FEDERATED STATES OF (FSM) MIDWAY ISLANDS (MID) MOLDOVA (MDA) MONACO (MCO) MONGOLIA (MNG) MONTSERRAT (MSR) MOROCCO (MAR) MOZAMBIQUE (MOZ) MYANMAR (MMR) NAMIBIA (NAM) NAURU (NRU) NEPAL (NPL) NETHERLANDS (NLD) NETHERLANDS ANTILLES (ANT) NEUTRAL ZONE (NTZ) NEW CALEDONIA (NCL) NEW ZEALAND (NZL) NICARAGUA (NIC) NIGER (NER) NIGERIA (NGA) NIUE (NIU) NORFOLK ISLAND (NFK) NORTH KOREA (PRK) NORTHERN MARIANA ISLANDS (MNP) NORWAY (NOR) OMAN (OMN) PAKISTAN (PAK) PALAU (PLW) PALESTINIAN TERRITORIES (PSE) PANAMA (PAN) PAPUA NEW GUINEA (PNG) PARAGUAY (PRY) PERU (PER) PHILIPPINES (PHL) PITCAIRN ISLANDS (PCN) POLAND (POL) PORTUGAL (PRT) PUERTO RICO (PRI) QATAR (QAT) REUNION (REU) ROMANIA (ROM) RUSSIA (RUS) RWANDA (RWA) SAINT KITTS AND NEVIS (KNA) SAINT LUCIA (LCA) SAINT VINCENT AND THE GRENADINES (VCT) SAMOA (WSM) SAN MARINO (SMR) SAO TOME AND PRINCIPE (STP) SAUDI ARABIA (SAU) SENEGAL (SEN) SERBIA (SRB) SERBIA AND MONTENEGRO (SCG) SEYCHELLES (SYC) SIERRA LEONE (SLE) SINGAPORE (SGP) SLOVAKIA (SVK) SLOVENIA (SVN) SOLOMON ISLANDS (SLB) SOMALIA (SOM) SOUTH AFRICA (ZAF) SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) SOUTH KOREA (KOR) SPAIN (ESP) SRI LANKA (LKA) ST. HELENA (SHN) ST. PIERRE AND MIQUELON (SPM) SUDAN (SDN) SURINAME (SUR) SVALBARD AND JAN MAYEN ISLANDS (SJM) SWAZILAND (SWZ) SWEDEN (SWE) SWITZERLAND (CHE) SYRIA (SYR) TAIWAN (TWN) TAJIKISTAN (TJK) TANZANIA (TZA) THAILAND (THA) TIMOR-LESTE (TLS) TOGO (TGO) TOKELAU (TKL) TONGA (TON) TRINIDAD AND TOBAGO (TTO) TUNISIA (TUN) TURKEY (TUR) TURKMENISTAN (TKM) TURKS AND CAICOS ISLANDS (TCA) TUVALU (TUV) UGANDA (UGA) UKRAINE (UKR) UNITED ARAB EMIRATES (ARE) UNITED KINGDOM (GBR) UNITED STATES (USA) UNITED STATES MINOR OUTLYING ISLANDS (UMI) URUGUAY (URY) UZBEKISTAN (UZB) VANUATU (VUT) VATICAN CITY STATE (HOLY SEE) (VAT) VENEZUELA (VEN) VIETNAM (VNM) VIRGIN ISLANDS (BRITISH) (VGB) VIRGIN ISLANDS (U.S.) (VIR) WAKE ISLAND (WAK) WALLIS AND FUTUNA ISLANDS (WLF) WESTERN SAHARA (ESH) YEMEN (YEM) ZAIRE (ZAR) ZAMBIA (ZMB) ZIMBABWE (ZWE)

Will you be returning to your Country of Residence/Domicile?. No Yes

Reasons

Have you been previously denied entry into Kenya? If yes state when and give reasons for denial * No Yes

State when and give reasons for denial of into kenya * Reasons * Port of Entry * Air Ship Road

Have you been previously denied entry into another Country? If yes state when and give reasons for denial * No Yes

State when and give reasons for denial of into another country * Reasons * Country * -- AFGHANISTAN (AFG) ALBANIA (ALB) ALGERIA (DZA) AMERICAN SAMOA (ASM) ANDORRA (AND) ANGOLA (AGO) ANGUILLA (AIA) ANTARCTICA (ATA) ANTIGUA AND BARBUDA (ATG) ARGENTINA (ARG) ARMENIA (ARM) ARUBA (ABW) AUSTRALIA (AUS) AUSTRIA (AUT) AZERBAIJAN (AZE) BAHAMAS (BHS) BAHRAIN (BHR) BANGLADESH (BGD) BARBADOS (BRB) BELARUS (BLR) BELGIUM (BEL) BELIZE (BLZ) BENIN (BEN) BERMUDA (BMU) BHUTAN (BTN) BOLIVIA (BOL) BOSNIA AND HERZEGOVINA (BIH) BOTSWANA (BWA) BOUVET ISLAND (BVT) BRAZIL (BRA) BRITISH INDIAN OCEAN TERRITORY (IOT) BRUNEI (BRN) BULGARIA (BGR) BURKINA FASO (BFA) BURMA (BUR) BURUNDI (BDI) CAMBODIA (KHM) CAMEROON (CMR) CANADA (CAN) CANTON AND ENDERBURY ISLANDS (CTE) CAPE VERDE (CPV) CAYMAN ISLANDS (CYM) CENTRAL AFRICAN REPUBLIC (CAF) CHAD (TCD) CHILE (CHL) CHINA (CHN) CHRISTMAS ISLAND (CXR) COCOS (KEELING) ISLANDS (CCK) COLOMBIA (COL) COMOROS (COM) CONGO (COG) COOK ISLANDS (COK) COSTA RICA (CRI) COTE D IVOIRE (CIV) CROATIA (HRV) CUBA (CUB) CYPRUS (CYP) CZECH REPUBLIC (CZE) DEMOCRATIC YEMEN (YMD) DENMARK (DNK) DJIBOUTI (DJI) DOMINICA (DMA) DOMINICAN REPUBLIC (DOM) DRONNING MAUD LAND (DML) EAST TIMOR (TMP) ECUADOR (ECU) EGYPT (EGY) EL SALVADOR (SLV) EQUATORIAL GUINEA (GNQ) ERITREA (ERI) ESTONIA (EST) ETHIOPIA (ETH) FALKLAND ISLANDS (FLK) FAROE ISLANDS (FRO) FIJI (FJI) FINLAND (FIN) FRANCE (FRA) FRANCE METROPOLITAN (FXX) FRENCH GUIANA (GUF) FRENCH POLYNESIA (PYF) FRENCH SOUTHERN TERRITORIES (ATF) GABON (GAB) GAMBIA (GMB) GEORGIA (GEO) GERMANY (DEU) GHANA (GHA) GIBRALTAR (GIB) GREECE (GRC) GREENLAND (GRL) GRENADA (GRD) GUADELOUPE (GLP) GUAM (GUM) GUATEMALA (GTM) GUINEA (GIN) GUINEA-BISSAU (GNB) GUYANA (GUY) HAITI (HTI) HEARD AND MC DONALD ISLANDS (HMD) HONDURAS (HND) HONG KONG (HKG) HUNGARY (HUN) ICELAND (ISL) INDIA (IND) INDONESIA (IDN) IRAN (IRN) IRAQ (IRQ) IRELAND (IRL) ISRAEL (ISR) ITALY (ITA) JAMAICA (JAM) JAPAN (JPN) JOHNSTON ISLAND (JTN) JORDAN (JOR) KAZAKHSTAN (KAZ) KENYA (KEN) KIRIBATI (KIR) KOSOVO (KVV) KUWAIT (KWT) KYRGYZSTAN (KGZ) LAOS (LAO) LATVIA (LVA) LEBANON (LBN) LESOTHO (LSO) LIBERIA (LBR) LIBYA (LBY) LIECHTENSTEIN (LIE) LITHUANIA (LTU) LUXEMBOURG (LUX) MACAU (MAC) MACEDONIA (MKD) MADAGASCAR (MDG) MALAWI (MWI) MALAYSIA (MYS) MALDIVES (MDV) MALI (MLI) MALTA (MLT) MARSHALL ISLANDS (MHL) MARTINIQUE (MTQ) MAURITANIA (MRT) MAURITIUS (MUS) MAYOTTE (MYT) MEXICO (MEX) MICRONESIA - FEDERATED STATES OF (FSM) MIDWAY ISLANDS (MID) MOLDOVA (MDA) MONACO (MCO) MONGOLIA (MNG) MONTSERRAT (MSR) MOROCCO (MAR) MOZAMBIQUE (MOZ) MYANMAR (MMR) NAMIBIA (NAM) NAURU (NRU) NEPAL (NPL) NETHERLANDS (NLD) NETHERLANDS ANTILLES (ANT) NEUTRAL ZONE (NTZ) NEW CALEDONIA (NCL) NEW ZEALAND (NZL) NICARAGUA (NIC) NIGER (NER) NIGERIA (NGA) NIUE (NIU) NORFOLK ISLAND (NFK) NORTH KOREA (PRK) NORTHERN MARIANA ISLANDS (MNP) NORWAY (NOR) OMAN (OMN) PAKISTAN (PAK) PALAU (PLW) PALESTINIAN TERRITORIES (PSE) PANAMA (PAN) PAPUA NEW GUINEA (PNG) PARAGUAY (PRY) PERU (PER) PHILIPPINES (PHL) PITCAIRN ISLANDS (PCN) POLAND (POL) PORTUGAL (PRT) PUERTO RICO (PRI) QATAR (QAT) REUNION (REU) ROMANIA (ROM) RUSSIA (RUS) RWANDA (RWA) SAINT KITTS AND NEVIS (KNA) SAINT LUCIA (LCA) SAINT VINCENT AND THE GRENADINES (VCT) SAMOA (WSM) SAN MARINO (SMR) SAO TOME AND PRINCIPE (STP) SAUDI ARABIA (SAU) SENEGAL (SEN) SERBIA (SRB) SERBIA AND MONTENEGRO (SCG) SEYCHELLES (SYC) SIERRA LEONE (SLE) SINGAPORE (SGP) SLOVAKIA (SVK) SLOVENIA (SVN) SOLOMON ISLANDS (SLB) SOMALIA (SOM) SOUTH AFRICA (ZAF) SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) SOUTH KOREA (KOR) SPAIN (ESP) SRI LANKA (LKA) ST. HELENA (SHN) ST. PIERRE AND MIQUELON (SPM) SUDAN (SDN) SURINAME (SUR) SVALBARD AND JAN MAYEN ISLANDS (SJM) SWAZILAND (SWZ) SWEDEN (SWE) SWITZERLAND (CHE) SYRIA (SYR) TAIWAN (TWN) TAJIKISTAN (TJK) TANZANIA (TZA) THAILAND (THA) TIMOR-LESTE (TLS) TOGO (TGO) TOKELAU (TKL) TONGA (TON) TRINIDAD AND TOBAGO (TTO) TUNISIA (TUN) TURKEY (TUR) TURKMENISTAN (TKM) TURKS AND CAICOS ISLANDS (TCA) TUVALU (TUV) UGANDA (UGA) UKRAINE (UKR) UNITED ARAB EMIRATES (ARE) UNITED KINGDOM (GBR) UNITED STATES (USA) UNITED STATES MINOR OUTLYING ISLANDS (UMI) URUGUAY (URY) UZBEKISTAN (UZB) VANUATU (VUT) VATICAN CITY STATE (HOLY SEE) (VAT) VENEZUELA (VEN) VIETNAM (VNM) VIRGIN ISLANDS (BRITISH) (VGB) VIRGIN ISLANDS (U.S.) (VIR) WAKE ISLAND (WAK) WALLIS AND FUTUNA ISLANDS (WLF) WESTERN SAHARA (ESH) YEMEN (YEM) ZAIRE (ZAR) ZAMBIA (ZMB) ZIMBABWE (ZWE)