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Application 43288670

The document is an online visa application form submitted by Abdelkarim Hanzal from Algeria applying for a single-entry tourist visa to Russia from April 29th to May 28th 2024. He will visit Azimuth Tour Service in Moscow and has health insurance valid in Russia. He provides personal details like passport information, address, employment, and confirms the information is correct.

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61 views

Application 43288670

The document is an online visa application form submitted by Abdelkarim Hanzal from Algeria applying for a single-entry tourist visa to Russia from April 29th to May 28th 2024. He will visit Azimuth Tour Service in Moscow and has health insurance valid in Russia. He provides personal details like passport information, address, employment, and confirms the information is correct.

Uploaded by

cybertowndz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 2

ON-LINE VISA APPLICATION FORM 20002-43288670 \ 03.04.

2024 17:05:07
EMBASSY OF THE RUSSIAN FEDERATION IN
ALGERIA
1. Nationality (if you formerly had ALGERIA
USSR or Russian citizenship, please
indicate when and why you lost it).

2. Surname (as in passport). HANZAL

3. First name, other names, patronimic ABDELKARIM


(as in passport).

4. Date of birth (dd/mm/yyyy). 15/11/1999

5. Sex. MALE

6. Passport.
Passport No: 307841277
Date of issue: 25/07/2022
Valid until: 24/07/2032

7. Purpose of visit. TOURISM

8. Category and type of visa. COMMON TOURIST

9. Number of entries. SINGLE

10. Date of arrival and departure. 29/04/2024 - 28/05/2024

11. Host organisation you intend to


visit.
Company name: AZIMUTH TOUR SERVICE
Reference No: 0221961088
Confirmation No: 0221961088
Address: 72A, VASYUNINO, VILLAGE, ROGOVSKOE, MOSCOW, RUSSIA

12. Route of journey (destination MOSCOW


points).

Photograph and signature. Service information (automatically generated).

Application form recipient: EMBASSY OF THE RUSSIAN


FEDERATION IN ALGERIA
Basis (voucher, dir. No, inv. No): 0221961088
The estimated date of visit to the RC:
Place for Application No (web-site): 43288670
photograph The date of processing: 03/04/2024
*2000243288670*

Application No (VAC):
The date of processing by the VAC:

Request No in Russian Consulate (RC):


I hereby agree to the processing and transfer of my personal data in
electronic form for the purposes of making a decision on visa issuance.
I declare that data provided in the application form are full and
Date (dd/mm/yyyy), personal signature correct. I am aware that any false information may be a cause for the
denial of visa or for the cancellation of the previously issued visa and
may lead to other consequences provided for by the legislation of the
Russian Federation. Subject to the receipt of visa, I pledge to leave
the territory of the Russian Federation before the visa expiration date.
I am aware that valid visa does not automatically allow to enter the
territory of the Russian Federation. In case of denial of entry, I will
not seek any compensation for potential losses.

Page 1 of 2
13. Children under 16 years and other
relatives written in your passport.
Do you travel with children under 16 NO
years or other relatives written in
your passport?

14. Your permanent address, telephone BLOC D11 N 841 NOUVELLE VILLE CHORFA CHLEF, TEL: 213696 38 64 33
number, fax number, E-mail.

15. Current/latest place of work. ENTREPRISE DE TRAVAUX DE BATIMENT, RUE DE GARE N 19 HAY HOURIA CHLEF,
RUE DE GARE N 19 HAY HOURIA CHLEF, TEL: 213776 53 71 75

16. Information about your previous


trips to Russia.
How many times have you been to Russia? -

17. Information about health insurance.


Do you have health insurance that is YES
valid in Russia?
Name of the insurance company, ASSURANCE SAA
insurance number:

18. Other names used in the past NONE


(maiden, pen-name, religious, etc.).

19. Your place of birth (if you were CHLEF


born in Russia, please specify when and
which country you emigrated to).

20. Additional information about your


relatives.
Do you currently have relatives in NO
Russia?

Page 2 of 2

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