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REPUBLICA FEDERATIVA DO BRASIL Pedido de Visto MINISTERIO DAS RELAGOES EXTERIORES VISA APPLICATION FORM EMBAIXADA DO BRASIL EM NOVA DELHI INSTRUCTIONS Ifa question does not apply, please type N/A. + INCOMPLETE FORMS! FORMS WITH ANY CORRECTIONS WILL BE RETURNED. A - DADOS PESSOAIS (PERSONAL INFORMATION) ‘Name (Firs Middie/Family Name us on passport Paste Place of Birth (city sateleounitny) OF ~ Date of birth DDNBOTY) 5x 4m Photo Nationality W3- Sexy 1 Status Gigle dawned Drow - : (Not more than six months old and with a clear background) Passport No. ‘OR Issuing Country | 09 Passport Expiry Date @oneav™) Here Parcar's Namo and Nationality (No abixeviationsy Navona Father's: ! Mother's 1 Residential Addese TZ - Telephone no, 15 = Profession Business Address TS - Telephone no. 16- Employer Sicphonena) 17 Job Position or Title TS- Email Draft Details (Hank, Drait No, Date, Amount) PARA USO OFICIAL (FOR OFFICIAL USE ONLY) Re Consuhaa 5 - Autorizagio da SERE Tipo do Visio OF 0 TEL DESP_0_DESPTEL 0 No. D- 0 Concessio redas F - Prazo de Entrada Denegagsio Uma ee Renovaga Maltiptas ~snowid Ti Observagies T> Assinaturas 19 = Purpose of trip (check one item that is the most applicable (0 the circumstances of your trip, Specify / Underline) In Brazil - engaged in services of temporary or permanent nature, including in-field services under contract and/or intra company activities such as project management, technical support, training, auditing/sccounting in Brazil Headquurters-based business development activities, including negotiating contracts, executive meetings, marketing assessment, specifying orders in contracts, customer relations related activities, performance assessment, establishing framework for doing business in Brazil, Import/Export business. ‘Work on offshore platfornyship. ‘Work under an employment contract with @ eompany/onganization in Brazil Atiend conference, seminar or workshop (attendee? Paid/unpaid speaker? Trainer? Name event sponsor). Professional training as an inter. Provide religious or missionary serviees andlor assistance. Provide community andlor medical services ‘Attend schoo! or pursue studies. ‘Conduct research or pursue scientific-technologic activities under an intemational cooperation program, Pursue professional studies/research/teaching and/or pursue scientificitechnologic activities at an university, research of similar organization (employment contract? Short term pro-labore? Research scholarship?) Participation in athletic or performing arts events (paid/mpaid participation”) Joumalism activities and/or film maki Official government mission business Visit friend(s) and/or relatives (inform below relationship; provide name and address on item 20), Tourism (inform below location, nature of trip, ete.) Others: Comments H 20 Name and address of person, institution or company where you can be contacted in Brazil 21- Address while in Brazil Telephone # 23- Place and date of amival 24- Destination] 25- Dufation of intended stay (in days or years) 26- Hlave you ever been to Brazil? O Yes O wo Iyes, inform when, place and duration of stay B- TERMO DE RESPONSABILIDADE (FORMAL STATEMENT TO BE FILLED AND SIGNED BY APPLICANT ONLY}