FEDERAL REPUBLIC OF NIGERIA No. APPLICATION FORM FOR VISA/ENTRY PERMIT This form must be completed in full. Your application may be rejected for wrong...
Downloaded from www.immigration.gov.pg PNG Immigration & Citizenship Service Authority APPLICATION FOR ENTRY PERMIT INSTRUCTION OFFICE USE ONLY
Signature (for minors, signature of parental authority/legal guardian): 28. Entry permit for the final country of destination, where applicable
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sanitary / plumbing permit date of application date issued ... grease trap bar sink ... deep well & pump set septic vault/imhoff tank street canal
DUMB WAITER PUMPS COMPRESSED AIR, VACUUM, PNEUMATIC TUBES, CONVEYORS AND/OR MONORAILS FUNICULAR Box 2 (To be accomplished by the Design Professional) (Signed and Sealed over Printed Name) Date Issued SUPERVISOR / IN-CHARGE OF MECHANICAL WORKS Validit
Form Imm 22
FEDERAL REPUBLIC OF NIGERIA
No.
Photograph
APPLICATION FORM FOR VISA/ENTRY PERMIT
This form must be completed in full. Your application may be rejected for wrong and misleading information. ( A separate form for personal History is no longer required.) 1.
Surname(MR/MRS/MISS)
2.
First name
3.
a. Sex
Middle name b. Marital Status
c. Full name and address of spouse
4a.
Present Nationality
4b. Previous Nationality
5a.
Date of Birth(day/month/year)
5b. Place of Birth
6.
Residential Address
Telephone No. 7a.
Office Address
7b.
Company's Name
7c.
Telephone No.
8.
Profession
9.
State what branches of the Armed Forces of your country you have served in or are serving in
from
10.
Colour of Hair
Colour of eyes
11.
Visible Identification marks
12.
Passport No.
13.
to
Date of issue
Date of expiry
Place of issue
Issuing Government
Purpose of journey(please give full details)
Height
14.
Number of entries required.
15.
Intended duration of stay
16.
Proposed date of travel(day/month/year)
16b.
Mode of travel to Nigeria
16c.
If on transit, what is your destination?
16d.
Have you got entry visa to your country of destination?
17.
Indicate how much money is available for your trip
18.
If your reason for journey to Nigeria is for employment, state:
19.
A. Single
a)
Name of Employers
b)
Post to be occupied
c)
Give a full description of job
B. Multiple
Yes
No
Persons joining spouses, parents or relatives, should give full particulars of the employment of parents or spouse in Nigeria including the address where they reside.
20.
How long has/have your spouse/parents been living in Nigeria.
21.
Your Intended address in Nigeria (NOT P.O. Box)
22.
Have you ever applied for a Nigerian visa before? Yes
23.
Where did you apply for the visa?
24.
Indicate whether visa was granted or rejected
25.
Give reason if visa was rejected
26.
Have you ever visited Nigeria?
27.
If yes, was it for:
i
Tourism
ii
Business
iii
Temporary Employment
iv.
Residency
v.
Transit
Yes
No
No
28.
State the Period of those visits and the Address at which you stayed From
to
Address
i. ii. iii. 29.
How long have you lived in the country where you are applying for visa/entry permit?
30.
Have you ever: a)
Been infected by any contagious diseased (e.g. Tuberculosis) or suffered serious mental illness?
b)
Yes
No
Been arrested or convicted for any offence or crime even though subject of pardon, arrested or other such legal action?
c)
Been involved in narcotic activities?
d)
Been deported?
Yes
Yes
Yes
No No
No
If so, from which country?
31.
e)
Sought to obtain a visa by misrepresentation or fraud?
d)
Tested positive to HIV AIDS? If yes, please state status
No
Give a list of the countries you have lived in for more than a year during the last five years: Country
32.
Yes
City
Date
Which countries have you visited during the last twelve(12) months: Country
City
Date
I understand that I will be required to comply with the Immigration/Alien and other laws governing entry of Immigrants into the country for which I now apply for visa/Entry Permit.
