Visa is valid for 3-months from the date of Issue Copy No.

CONSULATE-GENERAL OF THE REPUBLIC OF THE UNION OF MYANMAR

3435 WILSHIRE BOULEVARD, SUITE 1590, L A., CA 90010, TEL (213) 387-0041, (213) 387-0043, Fax (213) 387-0042
APPLICATION FOR ENTRY VISA / BUSINESS VISA

1. Name in Full (Fill in Block Letters) PHOTO

________________________/__________________________/_________________________ Recently taken

color photo
(First Name) (Middle Name) (Last Name)
2. Father’s Full Name ____________________/__________________/________________________ with full face, front view,
(First Name) (Middle Name) (Last Name) no hat and against
3. Date of Birth (dd/mm/yy):____________/___________________/__________________________ a plain light background
4. Place of Birth (City/State/Country)______________/_________________/__________________
(Official Name: Country is Myanmar, City is Yangon)
5. Nationality: 0 U.S./ 0 (Others):______________________________4. Sex 0(F) / 0(M)
6. Present Occupation: ______________________________________________________________
(If retired write “retired”, if student write “student”, if self employ: mention specifically)
7. Marital Status: 0Married 0Separated 0Divorced 0Widowed 0Single (Never Married)
8. Spouse’s Full Name:_______________________________________________________________________________________
Passport
9. (a) Number___________________(b) Date of Issue (dd/mm/yy) ______/______/_____________
(c) Date of Expiration (dd/mm/yy) ______/______/_________
(d) Place of Issue: (e) Issuing Authority:
0United States,_______________________ 0United States, Department of State/
0Other:_____________________________ 0National Passport Center/ 0 (if others):_____________________________
10. Present Address in U.S._____________________________________________________________________________________
(Include apartment number, street, city, state or province & postal zone)
11. Contact Ph. No.(Res:)(____)_____________(Work)(____)_____________(Cell)(____)_____________e-mail________________
12. Address in Myanmar:______________________________________________________________________________________
13. Have you ever been to Myanmar: 0Yes 0No (If Yes) Date of Last Visit: (dd/mm/yy) ________/__________/________________
14. Have you ever been refused to enter Myanmar: 0Yes 0No (If Yes) When: (dd/mm/yy) ________/_________/_______________
Why:___________________________________________________________________________________________________
15. Expected date of Arrival: (dd/mm/yy) ________/______/_________& Departure: (dd/mm/yy) ________/________/_________
16. Name and address of Guarantor during stay in Myanmar___________________________________________________________
________________________________________________________________________________________________________
17. Attention for Applicant:
(a) Apart from the professions mentioned this visa application from applicants are not to engage in any sort of work, with or
without charges.
(b) Applicant shall abide by the Laws of the Republic of the Union of Myanmar and shall not interfere in the Internal Affairs of
the Republic of the Union of Myanmar.
(c) Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of
the Republic of the Union of Myanmar.
I hereby declare that I fully understand the above mentioned conditions, that the particulars given above are true and
correct and that I will not engage in any activities irrelevant to the purpose of entry stated herein.

_______________________________
Signature of Applicant
Date (dd/mm/yy) _____/_____/__________
____________________________________________( FOR OFFICE USE ONLY)__________________________________________
Visa No. _________________________Date:____________________________
Visa Authority: MOFA Lt. No. 46 11 11 (110) Dated: 6 April 1994

(If other): MOFA Lt. No.___________________________, Date:______/________/___________

Signature of Officer in-Charge

Consulate-General of the Republic of the Union of Myanmar, Los Angeles, U.S.A

Up Dated: may 2015

Contact: Tel (213) 387-0041, (213)387-0043, Fax (213) 387-0042, e-mail: [email protected]

Visa is valid for 3-months from the date of Issue Copy No. 2

CONSULATE-GENERAL OF THE REPUBLIC OF THE UNION OF MYANMAR

3435 WILSHIRE BOULEVARD, SUITE 1590, L A., CA 90010, TEL (213) 387-0041, (213) 387-0043, Fax (213) 387-0042
APPLICATION FOR ENTRY VISA / BUSINESS VISA

1. Name in Full (Fill in Block Letters) PHOTO

________________________/__________________________/_________________________ Recently taken

color photo
(First Name) (Middle Name) (Last Name)
2. Father’s Full Name ____________________/__________________/________________________ with full face, front view,
(First Name) (Middle Name) (Last Name) no hat and against
3. Date of Birth (dd/mm/yy):____________/___________________/__________________________ a plain light background
4. Place of Birth (City/State/Country)______________/_________________/__________________
(Official Name: Country is Myanmar, City is Yangon)
5. Nationality: 0 U.S./ 0 (Others):______________________________4. Sex 0(F) / 0(M)
6. Present Occupation: ______________________________________________________________
(If retired write “retired”, if student write “student”, if self employ: mention specifically)
7. Marital Status: 0Married 0Separated 0Divorced 0Widowed 0Single (Never Married)
8. Spouse’s Full Name:_______________________________________________________________________________________
Passport
9. (a) Number___________________(b) Date of Issue (dd/mm/yy) ______/______/_____________
(c) Date of Expiration (dd/mm/yy) ______/______/_________
(d) Place of Issue: (e) Issuing Authority:
0United States,_______________________ 0United States, Department of State/
0Other:_____________________________ 0National Passport Center/ 0 (if others):_____________________________
10. Present Address in U.S._____________________________________________________________________________________
(Include apartment number, street, city, state or province & postal zone)
11. Contact Ph. No.(Res:)(____)_____________(Work)(____)_____________(Cell)(____)_____________e-mail________________
12. Address in Myanmar:______________________________________________________________________________________
13. Have you ever been to Myanmar: 0Yes 0No (If Yes) Date of Last Visit: (dd/mm/yy) ________/__________/________________
14. Have you ever been refused to enter Myanmar: 0Yes 0No (If Yes) When: (dd/mm/yy) ________/_________/_______________
Why:___________________________________________________________________________________________________
15. Expected date of Arrival: (dd/mm/yy) ________/______/_________& Departure: (dd/mm/yy) ________/________/_________
16. Name and address of Guarantor during stay in Myanmar___________________________________________________________
________________________________________________________________________________________________________
17. Attention for Applicant:
(a) Apart from the professions mentioned this visa application from applicants are not to engage in any sort of work, with or
without charges.
(b) Applicant shall abide by the Laws of the Republic of the Union of Myanmar and shall not interfere in the Internal Affairs of
the Republic of the Union of Myanmar.
(c) Legal action will be taken against those who violate or contravene any provision of the existing laws, rules and regulations of
the Republic of the Union of Myanmar.
I hereby declare that I fully understand the above mentioned conditions, that the particulars given above are true and
correct and that I will not engage in any activities irrelevant to the purpose of entry stated herein.

_______________________________
Signature of Applicant
Date (dd/mm/yy) _____/_____/__________
____________________________________________( FOR OFFICE USE ONLY)__________________________________________

Visa No. _________________________Date:____________________________

Visa Authority: MOFA Lt. No. 46 11 11 (110) Dated: 6 April 1994

(If other): MOFA Lt. No.___________________________, Date:______/________/___________

Signature of Officer in-Charge

Up Dated: may 2015
 Consulate-General of the Republic of the Union of Myanmar, Los Angeles,
U.S.A Contact: Tel (213) 387-0041, (213)387-0043, Fax (213) 387-0042, e-mail: [email protected]
CONSULATE-GENERAL OF THE REPUBLIC OF THE UNION OF MYANMAR
3435 WILSHIRE BOULEVARD, SUITE 1590, LOS ANGELES, CALIFORNIA
90010 TEL (213) 387-0041, (213) 387-0043, Fax (213) 387-0042

Work History for Visa Applicant

1. Name in Full (Fill in block letters):__________________________________________________________
Surname (As in Passport):_________________________________________________________________
First Name & Middle Name:_______________________________________________________________
2. Date of birth (dd/mm/yy)___________/ ___________/_____________________
3. Place of birth: 0 U.S.,________________________ 0 (Other):___________________________________
4. Permanent Home Address:_________________________________________________________________
_______________________________________________________________________________________
5. Tel. (Res.)(_______)_________________________ (Work Place) (_______)_________________________
(Cell) (________)______________________________e-mail:____________________________________
6. Work Description (Current)
(a) Job Title:____________________________________________________________________________
From (dd/mm/yy)_______/__________/___________To(dd/mm/yy)_______ /__________/__________
(b) Office______________________________________________________________________________
Department__________________________________________________________________________
Describe your Duties:__________________________________________________________________
____________________________________________________________________________________
7. Work Description (Previous)
(a) Job Title:____________________________________________________________________________
From (dd/mm/yy)_______/__________/___________To(dd/mm/yy)_______ /__________/__________
(b) Office______________________________________________________________________________
Department__________________________________________________________________________
Describe your Duties:__________________________________________________________________
____________________________________________________________________________________

I hereby declare that the particular given above are true and correct and that I will not engage in any
activities irrelevant to the purpose of my entry.

______________________
Signature of Applicant
Date:(dd/mm/yy) _____ /______/_________
Up Dated: may 2015