Last Name
First Name
Middle Name(s)
Previous Legal Names
Date of Birth
Country of Birth
City of Birth
State/Province of Birth
Gender MaleFemale
Marital Status SingleMarriedDivorcedSeparatedWidowed
Street Address
City
State
Zip Code
Home Phone
Mobile Phone
Email
Full Name
Relationship
Current Nationality
ID Number
Do you have another nationality? NoYes
Other Nationality
Other Nationality ID Number
Other Nationality Passport Number
Previous Nationality
Date of Obtaining Current Nationality
Permanent Residence in Another Country? NoYes
Permanent Residence Country
Are you a former Chinese national? NoYes
Chinese Name (if applicable)
Former Chinese Passport #
Former Chinese ID #
Passport Type OrdinaryServiceDiplomaticOfficialOther
Passport Number
Issuing Country
Place of Issue
Date of Issue
Date of Expiry
Have you ever had a stolen passport? NoYes
Stolen Passport Number
Issue Date
Issuing Authority
Where was it lost?
When was it lost?
Purpose of Visit Tourist (L)Business (M)Employment (Z)Crew (C)Other
Number of Entries SingleDoubleMultiple
Requested Visa Validity (months)
Max Duration of Stay (days)
Employer Name
Job Title
Job Description
Employer Address
Supervisor Name
Supervisor Phone
Employment Start Date
Employment Dates
School Name
Degree/Diploma
Major
Place of Birth
Citizenship
Occupation
Nationality
Date of Entry
City/Port of Arrival
Date of Departure
City/Port of Departure
Who Pays for Trip? SelfEmployerOther
Contact Person
Company Name
Full Address
Province
Postal Code
Phone
Have you visited China? NoYes
Cities Visited
Prior Entry Date
Prior Exit Date
Previous Visa Type
Visa Number
Have you ever had a Chinese visa cancelled? NoYes
Have you ever entered China illegally? NoYes
Have you ever been convicted of a crime? NoYes
If yes, explain
Have you served in the military? NoYes
Country
Branch
Highest Rank
Specialization
Dates of Service to
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