EMBASSY OF THE REPUBLIC OF GUYANA

Quinta Los Tutis, Segunda Avenida entre Novena y Decima Transversal, Altamira, Chacao, Caracas, Venezuela
Telephone: 58-212-267-7095; 58-212-261-7745
Fax: (58) 212 976-3765
[email protected]

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Posted December 3rd. 2003 - Back to Embassy page

Download Passport Application Form

GUYANA IMMIGRATION SERVICE VISA APPLICATION FORM

1. Surname (as in passport)
2. First and Middle Names (as in passport)
3. Other Surnames Used (Maiden, Religious, Professional, Aliases)
4. Date of Birth (d/m/y)
5. Place of Birth
6. Passport Number
7. Issuance Date (d/m/y)
8. Place of Issuance
9. Expiration Date (d/m/y)
10. Nationality
11. (a) Home Address (in full)
11. (b) How Long Resident?
11. (c) Home Telephone Number
12. (a) Name and Address of your Present Employer or School
12. (b) Present Occupation (if retired, past occupation)
12. (c) Business Phone and Fax Number
12. (d) Mobile/Cell Number
13. Sex M ( ) F ( )
14. Colour of Hair
15. Colour of Eyes
16. Height
17. Martial Status
18. Spouse's Full Name
19. Spouse's Date of Birth (d/m/y)
20. Visible Marks of Identification
21. Final Destination (If in transit)
22. Purpose of Trip
22. (a) If on Business (Submit Letter on Firm's Letter Head)
23. When do you intend to travel to Guyana?
24. How long do you plan to stay in Guyana?
24. (a) At what address will you stay in Guyana?
24. (b) Name and telephone number of person in Guyana with whom you are staying Name: ................................................... Telephone No. ...........................................
25. Have you ever been to Guyana? Yes ( ) No ( ) When............................................. For How Long? ...........................................................
26. Do you intend to work study or preach in Guyana?
27. Who will pay for your trip?
28. Work References
29. Names and relationships of persons travelling with you.
30. Has your Guyanese visa ever been cancelled ( ), Revoked ( ) or Refused ( )?
31. Have you ever been issued a Guyanese Visa? Yes ( ) No ( ) When?............................ Where?................................ What Type of Visa?....................................
32. HAVE YOU EVER: (a) been afflicted with contagious diseases (e.g., Tuberculosis) or has suffered serious mental illness? YES ( ) NO ( ) (b) been arrested or convicted for any offence or crime even though subject of a pardon, amnesty, or other such legal action? YES ( ) NO ( ) (c) been involved in narcotic activities? YES ( ) NO ( ) (d) been deported from Guyana? YES ( ) NO ( ) (e) sought to obtain a visa by misrepresentation or fraud? YES ( ) NO ( )

DECLARATION:

I certify that I have read and understood all the above questions and the answers I have given on this form are true and correct to the best of my knowledge and belief. I understand that possession of a visa does not entitle the bearer to enter Guyana at port of entry if he/she is found inadmissible.

Signature of Applicant.................................................. Date of Application.............

NOTE:

Failure to disclose the true purpose of applying for a visa or the submission of false information will result in refusal of entry or expulsion from Guyana. (Note: Applications must be made in Duplicate). A photograph must be attached to each form. The application form is provided free of charge.

Attach One Passport Photo Here:

SIGN NAME ON BACK OF PHOTO

 

 

 

 

 

FOR OFFICIAL USE ONLY

No.: …………………………………………….
Passport No.: …………………………………..
Name: ………………………………………….
VALID UNTIL: …………………………………
for SINGLE/MULTIPLE Visit (s)
Date of Issue: …………………………………
Visa Classification: …………………………...
Signature: ……………………………………..
Visa/Consular Officer

Esta página es parte de Noticias e información de Guyana .
(http://www.guyana. org)