[별지 제17호서식]

査證發給申請書 APPLICATION FOR VISA

公館(申請)番號: 査證發給認定番號(CONFIRMATION OF VISA ISSUANCE No.)
寫 眞 1. 姓 Surname GABION 漢字姓名
PHOTO
35 × 45㎜
寫 眞 2. 名 Given Names GENER NAVEJAS
PHOTO
35 × 45㎜
寫 眞 3. 生年月日 Date of Birth 4. 性別 Sex 5. 國籍 Nationality 6. 出生地 Place of Birth
PHOTO September 12, 1978 M F Filipino Tondo, Manila
35 × 45㎜
7. 旅券番號 8. 種類Classification 9. 發給日 10. 發給地 11. 發給機關 12. 滿了日
Passport Number 外交. 官用. 一般. 其他 Date of Issue Place of Issue Issuing Expiry Date
DP OF OR Authority
ZZ143675 April 07, 2005 Manila Dept. of Foreign April 07, 2010
Affairs
13. 婚姻與否 Marital Status 14. 配偶者姓名 Spouse's Name 15. 配偶者國籍 Spouse's
旣婚 married 未婚 single ------------------- Nationality
-------------------
16. 職業 17. 職場名 및 住所 Name and Address of Present 18. 職場電話番號 Business Phone
Occupation Employer Number
Samsung Climate Control 456-4 Nae-dong Changwon-si
OFW Gyeongsangnam-do 641 050 South Korea (055) 280-27-23
19. 入國 目的 Purpose of Entry 20. 入國豫定日 Probable Date of 21. 滯留豫定期間 Desired Length of
(explain fully) Entry Stay
E-9 non-professional employment
February 2009 more than 90 days
22. 現住所 Home Address 電話番號 Phone No.
2772 M. Frilles Street Bgy. 182, Zone 16 Gagalangin Tondo, Manila 1013 TEL#: 0918-202-31-34 /(632) 233-91-21
23. 國內 滯留地 Address in Korea 電話番號 Phone No. 24. 訪韓事實 Previous Visit (If Any)
456-4 Nae-dong Changwon-si Gyeongsangnam-do 641 050 TEL#: 010-3144-2170 YES

25. 過去 査證發給 與否 Have You Ever Been Issued a Korean Visa? Yes No
언제 When? 어디서 Where? 査證種類 What Type of Visa
2005/12/19 Philippines E-9 Non-professional employment
26. 過去 査證發給 不許與否 Have You Ever Been Refused a Korean Visa? Yes No
언제 When? 어디서 Where? 査證種類 What Type of Visa
27. 旅行費用支佛者 Who Will Pay For Your Trip?
28. 過去 査證取消與否
Has Your Korean Visa Ever Been Cancelled or Revoked?
MYSELF Yes No
29. 最近 5年間 旅行國家 Countries Where You Have Lived or Traveled During The Past 5 Years
example: TAIWAN, SINGAPORE (whether tour or working purpose)
30. 同伴家族 國 籍 Nationality 姓 名 Name 性別 Sex 生年月日 Date of Birth
Accompanying Family

NONE
30. 同伴家族 -- ---- - -- ---- - -- ---- - ---- ---
Accompanying Family
30. 同伴家族 -- ---- - -- ---- - -- ---- - -- ---- -
Accompanying Family
31. 國內 保證人 連絡 姓 名 Name 住 所 Address 電話番號 Phone 關係 Relationship
處 No.
Guarantor or Reference
in Korea
31. 國內 保證人 連絡 Samsung Climate 456-4 Nae-dong Chsngwon-si
Control Gyeongsangnam-do 641 050 (055) 280-27-23 Employer
處
Guarantor or Reference
in Korea
I declare that the statements made in this application are true and correct to the best of my knowledge and belief, that I
will observe the provisions of the Immigration Law of the Republic of Korea and that I will not engage in any activities
irrelevant to the purpose of entry stated herein. Besides, I am fully aware that any false or misleading statement may result
in the refusal of a visa, and that possession of a visa does not entitle the bearer to enter the Republic of Korea upon arrival at
the port of entry if he/she is found inadmissible.
申請日 DATE OF APPLICATION 申請人 署名 SIGNATURE OF APPLICANT
공 용 란 FOR OFFICIAL USE ONLY
결
접수번호 접수일시
재
결
승인번호 처리과
재
결
사증종류 복수?단수 담당자
재
체류자격
체류기간
고지사항

210㎜ × 297㎜인
인쇄용지(2급) 60g/㎡

THE FILE CAN BE EDIT IN MS WORD

program....... afterwards you can now print.
Visit this link....
APPLICATION VISA (form)
http://www.immigration.go.kr/HP/IMM/imm_f
orms/image/visa_2.pdf

http://www.g4f.go.kr/pt/DownLoadTemplPop
upR_en.pt
http://i30.photobucket.com/albums/c347/gngabion/PhotoMail%20Uploads%201/APPLICATIONFORVISAguideblankco

py-1.jpg

http://i30.photobucket.com/albums/c347/gngabion/PhotoMail%20Uploads%201/APPLICATIONFORVISAguideblankco

py000.jpg

http://samsung3star.proboards83.com/index.cgi?board=immigration&action=display&thread=12