Please Indicate Type of Visa Requested Please attach 2 Photographis taken within the last 6 months (3.5 X 4.

5 ern)

o Diplomatic Visa o Official Visa o Courtesy Visa

VISA APPLICATION FORM
Ministry Of Foreign Affairs of Thailand

o Non-Immigrant Visa
o Tourist Visa o Transit Visa
(in BLOCK letters) _

Number of Entries Requested __

o Mr. 0 Mrs. 0 Miss

FonnaNwne(ifany)
Nationali~ Nationality at Birth Birth Place Date of Birth

_--,:::--:-::-__ First Name

--::-::-:-::--:-:Middle Name

-;::---::-:-::--_-:;--;:-;-=:;;-;--::---;--

Family Name

_
_ _ Marital Status _

Countries for which tarvel document is valid Proposed Address in Thailand

------------

Name and Address of Local Guarantor

--------------------------------TellFax, Issued at _

Type of Travel Document No.

-------------

--------------------

Name and Address of Guarantor in Thailand

Date of Issue Occupation

------------

Expiry Date

------------TellFax, _ Signature Date

(Specify present position and name of employer)

Current Address

------------------------------E-mail
(if different from above)

Tel. Permanent Address

Attention to Tourist and Transit Visas Applicants I hereby declare that the purpose of my visit to Thailand is for pleasure or transit only and that in no case shall i engage myself in any profession or occupation whilein the country. signature Date _

FOR OFFICIAL USE

Tel. Names. dates and places of birth of minor children
(if accompanying)

ApplicationlReference No. Visa No. Type of Visa. ODiplomatic Visa Non-immigrantVisa Category of Visa :

_ _

Date of arrival in Thailand Traveling by

o
_
_

o Official Visa o Courtesy Visa o Tourist Visa o Transit Visa

_

---------------------------------0 0 0

Flight No. or Vessel's name Duration of Proposed Stay Date of Previous Visit to Thailand __ -=::;-Purpose of Visit Tourism Transit

Namber of Entries: Single 0 Double Date of Issue Expiry Date Documents Submitted

o Multiple o
_
Fee

Entries
_

Business Other

Diplomatic/Official

(please specify)

------------------------Authorized Signature and Seal 0 Other 0 FPT

REMARK: Applicants are required to pay a visa fee which is non. refundable. regardless of whether the visa is approved or rejected. FOR OFFICIAL USE ONI.. DUG OPp OAF DRD Y O~OCMrnlliO~O~O~O~O~OOOa OFPV OlAF OF OFP DSR ONF DOT OECBS OECWC OECFL DMultiple

Del

ORR date

DSNOHT

OWPOOther DADR DVL DWLDBL

o
1

ORC DMFA

DWP3 OPPP DpAFDTRCDITV

12

13

14

Is

16

Application Form - Page 2

I. About You and Your Family and Contact Details:

Father's full name(s) Profession Current Address Tel. Mother's full narne(s) Profession Tel Spouse's full narne(s) _ Ermail Brnail

_ _

If you are not a national of Bangladesh, provide evidence of your residence permit or visa status issued by Bangladesh authority, i.e. type of visa D transit D tourist 0 business D employment D diplomatic/ official D courtesy 0 other (specify) _ Visa valid until (day/month/year) Your Education Qualification Marital Status Number D Single 0 Married D Divorced 0 Separate 0 None D One NoneD D Two 0 ~Three ~Tbree _

of children

Profession Tel Ermail _ Number ofbrother(s) / sister(s)0

o-n Two 0

Important:

Please ensure that all contact details and references given below are accessible at any moment during the visa process.

Contact details of two reference persons close to you: 1. Full name Tel.(landline): 2. Full name Tel (landline): _ Tel(Office) _ Tel(Office) Relation ofriend ________

Relation ofriend

0 relative 0 familymemberD
(Mobile): ------------

other(spe~ify)

0 relative 0 familymember
(Mobile):

oother(specify)

_ _

What language do you speak?

DThai o English

o Bengali

o Other (specify)

Have you used an agent or representative _______________

to complete this application? Address

oNo 0 Yes If yes, give the name of the agent /representative Tel _ Fax _

II. Occupation, Employment & Finances:

Current occupation: Dstudent

0 unemployed 0 self-employed 0
retired

Your employer's full name Tel Email _ _ USD USD USD

o employed

part-time

employed full time

D supported by spouse / family member Office Name/Orgnization (If you are a student, give details of the institution instead) address Tel Your current position/class You have worked/studied _ Email _ _ _

Your total monthly income from all sources You receive monthly income from other person(s) Total costs of your stay in Thailand Who will sponsor your trip to Thailand?

yourself

parent(s) _ USD

-------------there since DTaka DUSD _ _

employer

0 friend

(s)

other (specify)

How much money will they sponsor your Now you are living with o Family

Your monthly salary/fee is Your Previous employmentfmstitution: ---------Tel ----------

Parent(s) (specify)

Relative(s)

0 Friend(s)
_

0 Alone 0 Other

Application Form - Page 3 Ill. Travel History:

Have you been refused a visa for any country. including Thailand? If yes, list country & when 0 No 0 Yes _

Have you ever been deported, removed or otherwise required to leave any country, including Thailand? If yes, list country & when Have you ever traveled outside your country of residence 0 No

No -0 Yes _

On what purposes have you been in Thailand? Types of Thai visa granted previously

o Yes (list country/year)

0 transit 0 tourist

o non-immigrant
Your longest stay outside your country of residence is in country duratioru., _ Have you ever traveled to Thailand in last 10 years? ONoDYes How many times have you ever traveled to Thailand? 0 None DOne

0 official 0 diplomatic 0 courtesy

month(s) __ day(s)

Duration of your last stay in Thailand __ Your longest visit to Thailand was in (year)

0 two

0 three

0 ~four times
_

Your last visit to Thailand was 0 Tourism 0 Transit 0 Business

Where have your been in Thailand?

Diplomatic/Official 0 Medical 0 Other

IV. Visit Information:

Main purpose of your visit to Thailand 0 Tourism 0 Transit

How many persons are traveling with you? Duration of proposed stay in Thailand Who invited you to Thailand? Name of Business/Organization _ Address Tel _ _ Email

Person(s) days

o Business

0 Diplomatic / Official 0 Medical

o Other (please specify)

If it is tourism, specify destination If it is medical, specify the names of hospital and doctor and date of appointment Tel _ Emllil

_ _ _ _ Fax. _

Where will you stay in Thailand? Address? Tel.

Tbis is your first medical appointment in Thailand 0 No 0 Yes Name of your local doctor(s) in Bangladesh _______ Tel _ _

Do you have family, friends or relatives in Thailand? 0 No 0 Yes if yes, provide address details ------------Tel. _ _

Are you travelingwith 0 Spouse 0 CbildrenO FatherlMother

o Brother(s)/Sister(s)0
Important Note

Friend(s)/CoUeague(s) 0 Relative(s)orO Alone

"Please complete all questions, put A cross (x) in the relevant box and ensure to submit all relevant documents, "The Royal Thai Embassy reserves the right to ask for particular documents or interview the applicant, if necessary, "Any false statement or forged or altered "documents given would result in denial of visa requested. "The Thai immigration reserves all rights to grant or deny the entry clearance into the Kingdom of Thailand.
I declare that information I have given is complete and true to the best of my knowledge and the documents I have supplied with this application are genuine and the statements I have made are truthful. However, I am aware that all relevant information can be checked to confirm accuracy and authenticity of evidence I have provided and documents I have submitted.

Applicant's Signature

Date

___

11

__