ATTENTION: Fill out all headings using CAPITAL LETTERS.

Your application shall not be processed in case of error or omission.

 1. Name___________________________________________________________________________________

2. First names_______________________________________________________________________________

3. Date and place of birth___________________________________________ 4. Sex (*)      M ( )         F ( )

5. Current nationality (ies) _____________________________________________________________________

6. Permanent address, telephone No_____________________________________________________________

________________________________________________________________________________________

7. Passport number _________________________

8. Type of passport (*):    ordinary ( )      service ( )        diplomatic ( )

9. Employer_______________________________________________________________________________

10. Purpose of stay_________________________________________________________________________

11. Sponsor/host in the Kyrgyz Republic: name of person/firm, address__________________________________

_______________________________________________________________________________________

12. Visa requested for (*):  single entry; two entries ( );  several entries ( )

13. Date of entry____________________________ 14. Date of exit____________________________________

15. Previous stays in the Kyrgyz Republic___________________________________________________________

I agree to my personal data on this application form being communicated to the appropriate authorities of the Kyrgyz Republic if necessary for the issue of a visa. I declare that to the best of my knowledge the above particulars are correct and complete. I am aware that any false statements will lead to my application being rejected or to the annulment of a visa already granted.

Place____________________________Date______________Applicant’s signature_____________________