CATEGORY OF PERMIT BEING APPLIED FOR

Visitor's visa

Exchange Visa

Biometric

(Attach Fingerprint Form, with Photograph)

Study Visa (>3months)

Business Visa

Treaty Visa

Work Visa: Critical Skills

Relative's Visa

Work Visa: General

Medical Treatment Visa

Work Visa: Intra-company transfer

Retired Person's Visa

FOR OFFICIAL USE ONLY

Office of application:

BLOK:

Track & Trace Ref No

Date received:

Date forwarded to Head Office:

Application quality checked by/on:

Date received at Head Office

Remarks:

Passport seen/returned by/on:

Decision and date:

Fee: Currency and amount

Fee received by/on:

Receipt no:

Conditions of permit/Reason for refusal

Title:

Mr

Ms

Other (specify)

Surname/Family name:

Given names:

Maiden name:

Stage name:

Previous/alternative name(s)/aliases, including details:

Date of birth:

Year......................Month............................ Day..................

Place of birth: ...............................................Town/City...........................................Country

Marital Status:

Never married

Separated

Legally recognised spousal relationship

Married

Widowed

Divorced

Customary union

If separated state:

Whether divorce proceedings have been instituted and when final decree is expected

......................................................................................................................................

......................................................................................................................................

If divorced, provide:

Date of divorce: ...............................................................................................................

Divorce order must be attached.

If part to a spousal relationship with a citizen or permanent resident, a certified copy of the marriage certificate or a spousal affidavit must be attached.

Present country of citizenship:

If acquired other than by birth, date and conditions under which acquired:

........................................................................................................................................

........................................................................................................................................

Do you hold any other citizenship?

Yes

No

If so, of which country, plus details ..........................................................................................

.................................................................................................................................................

.................................................................................................................................................

Passport number:

Country of issue:

Date of issue: ........... /............ /............

Expiry date: ........... /............ /............

If you have any other document required by your government, provide details:

Type of document: ....................................... Number: ................................. Expiry date:........... /............ /............

Residential address:

.......................................................................

.......................................................................

.......................................................................

Postal code ....................................................

Postal address:

....................................................................

.....................................................................

.....................................................................

Postal code .................................................

Country of usual residence if other than country of origin or above address:

Telephone No.: Work: (incl. area code) ......................................... Home: (incl. area code) ...............................................

Other addresses where you have lived during the last ten years other than your current address:

Address:

Period:

Country:

Do you hold the right of re-entry into your country of origin and/or country of residence if this differs?            Yes

No

If no, specify period and present status.........................................................................................

Have you ever applied for asylum or refugee status in SA or any other country?  

Yes

No

If yes, specify the country..............................................................................................................

Contact person:  

Relationship: Friend

Business Associate

Relative

Other

Name: ..........................................................................................................................................

Address: .......................................................................................................................................

.....................................................................................................................................................

Telephone No.: Work: (incl. area code) ................................................... Home: (incl. area code) ........................................................

Details regarding relatives and/or friends in the Republic, if any.

Name

Address

Relationship

Identity No

Proposed date and place of departure for the Republic:

......................../................/...................

Anticipated date and place of arrival in the Republic:

..................../.................../....................

Travelling by:

Air

Road

Rail

Sea

Carrier

What is your intended duration of stay in the Republic:

Days/weeks/months/ or

Years

Intended date of departure

.........../........../..............

Outline your proposed activities whilst in the Republic:

................................................................................................................................................

................................................................................................................................................

................................................................................................................................................

Available funds (foreign currency): Type: ................................. Amount: .......................

South African Rand equivalent: ....................................(attach bank statement as proof of funds held).

Valid return or onward ticket no: .................................. Expiry date: ............/............./.............

Other: .......................................................................................................................................

..................................................................................................................................................

...................................................................................................................................................

Full names

Date of birth

Relationship

Passport No.

Expiry date

Nationality

Occupation

If your spouse and/or other dependents are not accompanying you, do they intend to enter the country at a later stage?

Yes

On (date)

................../................/......................

No

Details/reason(s):

...............................................................................................

................................................................................................

................................................................................................

Have you ever been refused entry into or deported from the Republic: If so, please provide details: ..................................................................................................................................

..............................................................................................................................................

Have you or any of your dependents accompanying you ever been convicted of any crime in any country?

Yes

No

Is a criminal/civil case pending against you or any of your dependents accompanying you in any country?

Yes

No

Are you or any of your dependents suffering from tuberculosis, any other infectious or contagious disease or any mental or physical deficiency?

Yes

No

Are you an unrehabilitated insolvent?

Yes

No

Have you ever been judicially declared incompetent?

Yes

No

Are you a member of or adherent to an association or organisation advocating the practice of social violence, or racial hatred?

Yes

No

Furnish full particulars if the reply to any of these questions is in the affirmative:

.......................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

I acknowledge that I understand the contents and implications of this application and solemnly declare that the above particulars given by me as well as all particulars in the attached supporting documentation are true and correct.