1.姓 Surname                                      漢字姓名

2.名 Given Names

3.生年月日 Date of Birth

  Y年    M月    D日

4.性別  Sex

□ M   □ F

5.國籍 Nationality

6.出生地 Place of Birth

7.旅券番號

Passport Number

8.種類 Classification

外交. 官用. 一般. 其他

DP    OF    OR

9.發給日

Date of Issue

10.發給地

Place of Issue

11.發給機關

Issuing Authority

12.滿了日

Expiry Date

13.婚姻與否 Marital Status

   □ 旣婚 married     □ 未婚 single

14.配偶者姓名 Spouse’s Name

15.配偶者國籍 Spouse’s Nationality

16.職業 Occupation

17.職場名 및 住所 Name and Address of Present Employer

18.職場電話番號 Business Phone Number

19.入國 目的 Purpose of Entry

 (Explain fully)

20.入國豫定日 Probable Date of Entry

21.滯留豫定期間 Desired Length of Stay

22.現住所 Home Address                                         電話番號 Phone No.

23.國內 滯留地 Address in Korea        電話番號 Phone No.

24.訪韓事實 Previous Visit(If Any)

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

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.旅行費用支付者 Who Will Pay For Your Trip?

28.過去 査證取消與否

Has Your Korean Visa Ever Been Cancelled or Revoked?

□ Yes        □ No

29.最近 5年間 旅行國家 Countries Where You Have Lived or Travelled During The Past 5 Years

30.同伴家族

Accompanying Family

國籍 Nationality

姓名 Name

性別 Sex

生年月日 Date of Birth

31.國內 保證人 連絡處

Guarantor or Reference in Korea

姓名 Name

住所 Address

電話番號 Phone No.

關係 Relationship

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 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

접수번호

접수일시

결

재

승인번호

처 리 과

사증종류

복수단수

담 당 자

체류자격

체류기간

고지사항