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Form V.2013

中华人民共和国签证申请表

Visa Application Form of the People’s Republic of China

(For the Mainland of China only)

申请人必须如实、完整、清楚地填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在□内打√选择。如有关项目不适用，请写“无”。The applicant should fill in this form truthfully ，completely and clearly. Please type the answer in capital English letters in the space provided or tick (√) the relevant box to select. If some of the items do not apply, please type N/A or None.

一、个人信息 Part 1: Personal Information

1.1英文姓名

Full English name as in passport

姓Last name

粘贴一张近期正面免冠、浅色背景的彩色护照照片。

照片/Photo

Affix one recent color passport photo (full face, front view, bareheaded and against a plain light colored background).





中间名Middle name







名First name





1.2中文姓名

Name in Chinese

1.3别名或曾用名

Other name(s)





1.4性别Sex □ 男 M □ 女 F

1.5出生日期

DOB(yyyy-mm-dd)





1.6现有国籍

Current nationality(ies)

1.7曾有国籍Former nationality(ies)



1.8出生地点(市、省/州、国)

Place of birth(city, province/state,country)



1.9身份证/公民证号码

Local ID/ Citizenship number



1.10护照/旅行证件种类Passport/Travel document type

□ 外交Diplomatic □ 公务、官员Service or Official

□ 普通Ordinary □ 其他证件(请说明) Other (Please specify):



1.11护照号码

Passport number

1.12签发日期

Date of issue(yyyy-mm-dd)



1.13签发地点

Place of issue

1.14失效日期

Date of expiry(yyyy-mm-dd)



1.15当前职业

（可选多项）

Current occupation(s)

□ 商人Businessperson

□ 公司职员Company employee

□ 演艺人员Entertainer

□ 工人/农民Industrial/Agricultural worker

□ 学生Student

□ 乘务人员Crew member

□ 自雇Self-employed

□ 无业Unemployed

□ 退休Retired

□ 前/现任议员Former/incumbent member of parliament

职位Position________________________

□ 前/现任政府官员Former/incumbent government official

职位Position________________________

□军人Military personnel

职位Position________________________

□ 非政府组织人员NGO staff

□ 宗教人士Religious personnel

□ 新闻从业人员Staff of media





□ 其他(请说明) Other (Please specify):



1.16受教育程度

Education

□ 研究生 Postgraduate □ 大学 College

□ 其他(请说明) Other (Please specify):



1.17工作单位/学校Employer/School

名称

Name

联系电话

Phone number





地址Address

邮政编码

Zip Code



1.18家庭住址

Home address

1.19邮政编码

Zip Code



1.20电话/手机

Home/mobile phone number

1.21电子邮箱

E-mail address



1.22婚姻状况Marital status □ 已婚Married □ 单身Single □ 其他 Other(Please specify):



1.23主要家庭成员(配偶、子女、父母等,可另纸)

Major family members（spouse,

children,parents,etc.,may type on separate paper）

姓名Name

国籍Nationality

职业Occupation

关系Relationship



















































1.24

紧急联络人信息

Emergency Contact

姓名

Name

手机

Mobile phone number





与申请人的关系

Relationship with the applicant



1.25申请人申请签证时某某在的国家或地区Country or territory where the applicant is located when applying for this visa







二、旅行信息 Part 2: Travel Information

2.1申请

入境事由Major purpose

of your visit

□ 官方访问 Official Visit

□ 常驻外交、领事、国际组织人员

As resident diplomat，consul or staff of international organization





□ 旅游 Tourism







□ 交流、考察、访问 Non-business visit

□ 永久居留 As permanent resident





□ 商业贸易 Business & Trade

□ 工作 Work





□ 人才引进 As introduced talent

□ 寄养 As child in foster care





□ 执行乘务 As crew member







□ 过境 Transit







□ 短期探望中国公民或者具有中国永久居留资格的外国人Short-term visit to Chinese citizen or foreigner with Chinese permanent residence status

□ 与中国公民或者具有中国永久居留资格的外国人家庭团聚居留超过180日 Family reunion for over 180 days with Chinese citizen or foreigner with Chinese permanent residence status





□ 短期探望因工作、学习等事由在中国停留居留的外国人 Short-term visit to foreigner residing in China due to work, study or other reasons

□ 长期探望因工作、学习等事由在中国居留的外国人As accompanying family member of foreigner residing in China due to work, study or other reasons





□ 短期学习 Short-term study for less than 180 days

□ 长期学习 Long-term study for over 180 days





□ 短期采访报道 As journalist for temporary news coverage

□外国常驻中国新闻机构记者 As resident journalist





□ 其他(请说明)Other (Please specify)：



2.2 计划

入境次数

Intended number of entries

□ 一次(自签发之日起3个月有效) One entry valid for 3 months from the date of issue

□ 二次(自签发之日起3-6个月有效) Two entries valid for 3 to 6 months from the date of issue

□ 半年多次（自签发之日起6个月有效) Multiple entries valid for 6 months from the date of issue

□ 一年多次（自签发之日起1年有效) Multiple entries valid for 1 year from the date of issue

□ 其他（请说明）Other (Please specify):



2.3 是否申请加急服务Are you applying for express service?

注：加急服务须经领事官员批准，将加收费用。Note: Express service needs approval of consular officials, and extra fees may apply.

 □ 是Yes □ 否 No



2.4本次行程预计首次抵达中国的日期

Expected date of your first entry into China on this trip (yyyy-mm-dd)





2.5预计行程中单次在华停留的最长天数

Longest intended stay in China among all entries

Days



2.6在中国境内行程（按时间顺序,可附另纸填写）Itinerary in China (in time sequence，may type on separate paper)

日期Date

详细地址Detailed address











































2.7谁将承担在中国期间的费用？Who will pay for your travel and expenses during your stay in China?





2.8中国境内邀请单位或个人信息Information of inviter in China

姓名或名称

Name





地址

Address





联系电话

Phone number





与申请人关系

Relationship with the applicant



2.9是否曾经获得过中国签证？如有，请说明最近一次获得中国签证的时间和地点。Have you ever been granted a Chinese visa? If applicable, please specify the date and place of the last time you were granted the visa.





2.10过去12个月中访问的其他国家或地区Other countries or territories you visited in the last 12 months







三、其他事项 Part 3: Other Information

3.1是否曾在中国超过签证或居留许可允许的期限停留？Have you ever overstayed your visa or residence permit in China?

□是Yes □否No



3.2是否曾经被拒绝签发中国签证,或被拒绝进入中国？Have you ever been refused a visa for China, or been refused entry into China?

□是Yes □否No



3.3是否在中国或其他国家有犯罪记录？Do you have any criminal record in China or any other country?

□是Yes □否No



3.4是否具有以下任一种情形Are you experiencing any of the following conditions?

①严重精神障碍Serious mental disorder

②传染性肺结核病Infectious pulmonary tuberculosis

③可能危害公共卫生的其他传染病Other infectious disease of public health hazards

□是Yes □否No



3.5近30日内是否前往过流行性疾病传染的国家或地区？Did you visit countries or territories affected by infectious diseases in the last 30 days?

□是Yes □否No



3.6如果对3.1到3.5的任何一个问题选择“是”，请在下面详细说明。

If you select Yes to any questions from 3.1 to 3.5, please give details below.



3.7如果有本表未涉及而需专门陈述的其他与签证申请相关的事项，请在此或另纸说明。

If you have more information about your visa application other than the above to declare,please give details below or type on a separate paper.



3.8如申请人护照中的偕行人与申请人一同旅行，请将偕行人照片粘贴在下面并填写偕行人信息。If someone else travels and shares the same passport with the applicant , please affix their photos and give their information below.





偕行人信息

Information

偕行人 1

Person 1

粘贴照片于此

Affix Photo

here

偕行人 2

Person 2

粘贴照片于此

Affix Photo

here

偕行人 3

Person 3

粘贴照片于此

Affix Photo

here



姓名

Full name









性别

Sex









生日

DOB(yyyy-mm-dd)











四、声明及签名 Part 4: Declaration & Signature

4.1我声明，我已阅读并理解此表所有内容要求，并愿就所填报信息和申请材料的真实性承担一切法律后果。

I hereby declare that I have read and understood all the questions in this application and shall bear all the legal consequences for the authenticity of the information and materials I provided.

4.2我理解，能否获得签证、获得何种签证、入境次数以及有效期、停留期等将由领事官员决定，任何不实、误导或填写不完整均可能导致签证申请被拒绝或被拒绝进入中国。

I understand that whether to issue a visa, type of visa, number of entries, validity and duration of each stay will be determined by consular official, and that any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into China.

4.3 我理解，根据中国法律，申请人即使持有中国签证仍有可能被拒绝入境。

I understand that, according to Chinese law, applicant may be refused entry into China even if a visa is granted.

申请人签名 日期

Applicant’s signature: Date (yyyy-mm-dd): 内容过长，仅展示头部和尾部部分文字预览，全文请查看图片预览。 information of the one who completes the form

5.1姓名 Name



5.2与申请人关系 Relationship with the applicant





5.3地址 Address



5.4电话 Phone number





5.5声明 Declaration

我声明本人是根据申请人要求而协助填表，证明申请人理解并确认表中所填写内容准确无误。

I declare that I have assisted in the completion of this form at the request of the applicant and that the applicant understands and agrees that the information provided is true and correct.

代填人签名/Signature： 日期/Date (yyyy-mm-dd):





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