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Application 43801881

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ntnlzekarias
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19 views

Application 43801881

Uploaded by

ntnlzekarias
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
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ON-LINE VISA APPLICATION FORM 20002-43801881 \ 29.07.

2024 7:51:14
EMBASSY OF THE RUSSIAN FEDERATION IN
ETHIOPIA
1. Nationality (if you formerly had ETHIOPIA
USSR or Russian citizenship, please
indicate when and why you lost it).

2. Surname (as in passport). DLU

3. First name, other names, patronimic ASMAMAW BESFAT


(as in passport).

4. Date of birth (dd/mm/yyyy). 26/07/1994

5. Sex. MALE

6. Passport.
Passport No: EP8700261
Date of issue: 29/01/2024
Valid until: 27/01/2029

7. Purpose of visit. TOURISM

8. Category and type of visa. COMMON TOURIST

9. Number of entries. SINGLE

10. Date of arrival and departure. 02/09/2024 - 10/09/2024

11. Host organisation you intend to


visit.
Company name: STATUS TRAVEL
Reference No: 023907
Confirmation No: 36205
Address: KHABAROVSK, DIKOPOLTSEVA STREET 46 OF 21

12. Route of journey (destination MOSCOW


points).

Photograph and signature. Service information (automatically generated).

Application form recipient: EMBASSY OF THE RUSSIAN


FEDERATION IN ETHIOPIA
Basis (voucher, dir. No, inv. No): 023907
The estimated date of visit to the RC:
Place for Application No (web-site): 43801881
photograph The date of processing: 7/29/2024
*2000243801881*

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.

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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 ETHIOPIA, AMHARA REGION, LALIBELA, TEL: 0941283449
number, fax number, E-mail.

15. Current/latest place of work. NAHOM MEAZA AND THEIR FRIENDS CONSTRUCTION, CONTRACTOR, ETHIOPIA,
AMHARA REGION, LALIBELA, TEL: 0942345242

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 NO
valid in Russia?

18. Other names used in the past NONE


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

19. Your place of birth (if you were LALIBELA


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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