BI-84) Form 11
DEPARTMENT OF HOME AFFAIRS
REPUBLIC OF SOUTH AFRICA
APPLICATION FOR VISA OR TRANSIT VISA
[Section 7(1)(g) read with section 10A and 10B; Regulation 8(1)]
Failure to complete this application form in full may result in the visa being delayed or refused. 信息不全可能导致延迟或拒签 Please use block letters and black ink only. 请用黑印刷体填写 |
PERSONAL PARTICULARS 个人信息
Surname:姓 | |||||||||||||||||||||||||||||||
First names (in full):名 | |||||||||||||||||||||||||||||||
Maiden name:婚前姓 | |||||||||||||||||||||||||||||||
Previous surname(s): | |||||||||||||||||||||||||||||||
Y | Y | Y | Y | M | M | D | D | ||||||||||||||||||||||||
Date of birth:生日 | 2 | 0 | 1 | 0 | 0 | 8 | 2 | 8 | City of birth:出生地 ……………………………………………… | ||||||||||||||||||||||
Country of birth:出生国家 ………..……………………………………………………………………………………………………………. | |||||||||||||||||||||||||||||||
Gender性别: | Male男 | Female女 | |||||||||||||||||||||||||||||
Nationality民族: …………………….…………………………………………...... | If acquired by naturalisation, state original nationality:如果已经获得，指明原始国籍 ……………….……………………. | ||||||||||||||||||||||||||||||
Where and when was present nationality obtained:何时何地获得现在国籍 ………………………………………………………………………….….. | |||||||||||||||||||||||||||||||
Passport/Travel Document Number护照号码: ………….………………….……….. Type of document: Diplomatic/Official/Ordinary Passport/Travel Document/other (specify) 护照类型：外交/公务/普通护照/旅行护照/其它……………………..……………………..……… | Issuing authority:签发机关 ……………………………. Date of expiry:有效期 …………………………….… | ||||||||||||||||||||||||||||||
Permanent residential address: 永久住址……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… | |||||||||||||||||||||||||||||||
Period resident at this address:暂住地址 …………………………………………….. | Telephone number电话号码: (…..……) (code) 区号 ……………………………………… (number)号码 | ||||||||||||||||||||||||||||||
Country of permanent residence: 国籍……… …………………………………………………… | Period resident in that country: …………………………………………………. | ||||||||||||||||||||||||||||||
Occupation or profession:职业 …… | |||||||||||||||||||||||||||||||
Name, address and telephone no. of employer, university, organisation, etc. to which you are attached, or that you attend or which you represent: ………你的老板的姓名、地址、电话、大学等等你需要说明的的.…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….………………………………………………………………………………………………………………………………… | |||||||||||||||||||||||||||||||
If self-employed, state name, address, telephone no. and nature of business:如果自己经营，请说明公司名字，电话和业务范围 ………………………………………………………………………………………….…………………………………………………………………….……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… | |||||||||||||||||||||||||||||||
Marital status:婚姻状况 | Never married未婚 | Married已婚 | Widowed寡居 | Separated分居 | Divorced离婚 | ||||||||||||||||||||||||||
First name(s) of spouse:配偶名 | |||||||||||||||||||||||||||||||
Maiden name:配偶姓 | |||||||||||||||||||||||||||||||
Y | Y | Y | Y | M | M | D | D | ||||||||||||||||||||||||
Date of birth:配偶出生日期 | Nationality国籍………………………………...………………… | ||||||||||||||||||||||||||||||
NB: SEPARATE FORMS MUST BE COMPLETED IN RESPECT OF PERSONS OVER THE AGE OF 16 AND CHILDREN UNDER THE AGE OF 16 TRAVELLING ON THEIR OWN PASSPORTS. | |||||||||||||||||||||||||||||||
Particulars of children endorsed on your passport accompanying you:你的护照上关于子女的情况： | |||||||||||||||||||||||||||||||
Surname 姓 | First name(s)名 | Date of birth出生日期 | Place of birth出生地 | ||||||||||||||||||||||||||||
(1) | |||||||||||||||||||||||||||||||
(2) | |||||||||||||||||||||||||||||||
(3) | |||||||||||||||||||||||||||||||
(4) | |||||||||||||||||||||||||||||||
VISIT TO SOUTH AFRICA南非行程
Expected date of arrival in the Republic: 预计到达日期 Y …………..……………….. M ………….…………………….. D …….……………….. Place of arrival到达地址:………………………………..……………………………………………..……………………………………………. 英文翻译中文翻译Purpose of visit:旅行目的 ……………………………………….……….…….……………………………………………………………………. Duration of stay (months, weeks or days)停留时间 .………………….………………………………………………………………………….. Number of entries required:
Proposed residential address (physical) in the Republic, including the full name(s) of your host or hotel:在南非你的亲戚或宾馆的名字和地址 ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… Names of organisations or persons you will be contacting during your stay in the Republic:你在南非停留期间可以联系的机构或人员名字 | ||||||||||
Name名字 | Address地址 | Relationship与你关系 | ||||||||
Identity document number or permanent residence permit number of South African host: 南非主人的省份证件号码…………………………….……………………………………………………………………………………………….………………. Indicate by means of an X whichever is applicable请在选项后打X | ||||||||
Have you at any time applied for a permit to settle permanently in South Africa?以前你申请过南非签证吗？ | yes | no | X | |||||
Have you ever been restricted or refused entry into South Africa?你是否曾被限制或拒签南非？ | yes | no | ||||||
Have you ever been deported from or ordered to leave South Africa?你是否曾被驱逐出南非？ | yes | no | ||||||
Have you ever been convicted of any crime in any country?你是否曾被任何国家宣布有罪？ | yes | no | ||||||
Is a criminal action pending against you in any country? 你是否有未判决的指控？ | yes | no | ||||||
Are you an unrehabilitated insolvent? | yes | no | ||||||
Are you suffering from tuberculosis or any other infectious or contagious disease or any mental or physical deficiency? 是否或其他传染病或精神或身体缺陷？ | yes | no | ||||||
Have you ever been judicially declared incompetent?是否曾被公开宣布不合格？ | yes | no | ||||||
Are you a member of, or adherent to an association or organisation advocating the practice of social violence or racial hatred or are you or have you been a member of an organisation or association utilizing crime or terrorism to pursue its ends?是否是任何组织协会的成员或组织者，是否有暴力倾向或种族歧视，是否犯罪组织成员？ Give particulars if reply to one or more of the questions above is in the affirmative:如果属于上面一条或者多条请给出详细说明。……………………………………………………………………………………………….……………………………………………………………………………………………….………………………………………………………………………………………………………………………………………………. | yes | no | ||||||
To be completed by applicants applying for visitor’s permits exceeding three months:申请停留超过3个月请完成下面表格 | ||||||||
In the case of a spouse or dependant minor child of the holder of a permit issued in terms of section 11, 13, 14, 15, 17, 19 or 22, submission of a marriage certificate or an unabridged birth certificate. | ||||||||
Proof of academic sabbatical, if applicable. | ||||||||
Proof of non-remunerative voluntary or charitable activities to be undertaken, if applicable. | ||||||||
Proof of research to be undertaken, if applicable. | ||||||||
Proof of funds available for subsistence during period of visit. | ||||||||
To be completed by applicants applying for diplomatic, official or courtesy visas:外交或公务签证请完成： | ||
In the case of an official visit, submission of a note verbale. | ||
In the case of a diplomatic placing in the Republic, proof of such placing. | ||
To be completed only by passengers in transit to another country:中转旅客请完成： | ||
Destination after leaving the Republic: ……………………………………………………..…………………………………………… Mode of travel to destination: …………………………………………………………..………………………………………………… Intended date and port of departure from the Republic to that destination: ………………………………………………………… Do you hold a visa or permit for temporary or permanent residence in the country of your destination? (Proof must be submitted)………………………………………………………………………………………………………………………………….. | ||
To be completed by persons wishing to work in the Republic:希望在南非工作 Yes ………………………..… No ……………………….… If the answer is yes, please provide details:如果回答“是”，请提供详细： ……………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………….. | ||
I SOLEMNLY DECLARE THAT THE ABOVE PARTICULARS PROVIDED BY ME ARE TRUE IN SUBSTANCE AND IN FACT AND THAT I FULLY UNDERSTAND THE MEANING THEREOF. I FURTHER DECLARE THAT I DO NOT CONTEMPLATE CHANGING THE PURPOSE OF MY VISIT WHILST IN THE REPUBLIC.我庄严宣告上述我提供的信息是真实的，我确信它的意义。比外我还声明我不改变我的出行目的。 ………………………………………. …………………………………….. Signature of applicant 申请者签名 Date日期 | ||
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