ENTRY PERMIT

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...

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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.

Date

Signature

For official use only. DATE

REMARKS (FOR OFFICIAL USE ONLY)