
THE EMBASSY OF THE UNITED REPUBLIC OF TANZANIA
1232 22nd St. NW, Washington DC, 20037
Tel. (202) 939-6125 and (202) 884-1080 Fax (202) 797-7408
FOR OFFICIAL USE ONLY
VISA APPLICATION FORM
(Visa Regulations on the next page)
2 Passport Size
GRR NO.___________________
Photograph
VISA NO.___________________
Size: 2x2
Do not paste or
Ref. NO.____________________
staple
1. Surname or Family Name (Mr./Mrs./Miss/Ms/Dr./Prof.)___________________________________
First Names in Full_______________________________________________________________
Former or Maiden Name (if different from above) _______________________________________
2. Date of Birth (DD/MM/YY)_______________________________________Sex (M/F)___________
3. Place of Birth____________________________Country of Birth___________________________
Current Nationality (State if Dual Nationality) ___________________________________________
Nationality at Birth________________________________________________________________
4. Marital Status (Mark): � Single � Married � Divorced � Widowed � Legally Separated.
5. Passport No _________________Date Issued ______________Valid Until ___________________
Issued At ___________________Issuing Authority______________________________________
6. Profession/Occupation_____________________________________________________________
Employer Address: _______________________________________________________________
7. Current Address__________________________________________________________________
Tel.__________________Fax__________________E-mail________________________________
8. Name of Travel Agent/Tour Operator__________________________________________________
9. Contact Person(s) in Tanzania_______________________________________________________
Address_________________________________________________________________________
10. Date of Entry___________________________Depature Date______________________________
Duration of Stay_________________________ (Max. 90 Days)
Type of Visa Requested Travel Visa Transit Visa
11. Purpose of visit
Visiting friends, relatives
12. Requested Number of Entries: � Single � Double � Multiple.
13.
In
Case Of Transit: Do you have an Entry Permit for the Final Country of Destination?
�
No
�
Yes Valid Until:
14.
Budget Available For Your Stay
_________________________________
15. I Hereby Declare That The Information Stated Above Is True And Correct :
S
ignature of Applicant___________________________________________Date________________________________