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1. Surname (as in passport) | .................................................. |
2. First and Middle Names (as in passport) | .................................................. |
3. Other Names (Maiden, Professional, Alias, etc) | .................................................. |
4. Date and place of Birth | .................................................. |
5. Nationality | .................................................. |
6.(a) Passport No | .................................................. |
(b) Date and Place issued | .................................................. |
(c) Date Passport Expires | .................................................. |
7. Home Address (in full) | .................................................. |
8.(a) Telephone No | .................................................. |
(b) How Long Resident | .................................................. |
9.(a) Name and address of Employer | .................................................. |
(b) Telephone No | .................................................. |
10. Present Occupation (if retired, past occupation) | .................................................. |
11.(a) Sex | .................................................. |
(b) Colour of hair | .................................................. |
(c) Height | .................................................. |
(d) Colour of Eyes | .................................................. |
(e) Complexion | .................................................. |
(f) Marks of Identification | .................................................. |
12. Marital Status: (Place X )(a) Married | .................................................. |
(b) Single | .................................................. |
(c) Widowed | .................................................. |
(d) Divorced | .................................................. |
(e) Separated | .................................................. |
13. Have you ever applied for a Guyana visa before? If yes: (a) Where? |
.................................................. |
(b) When? | .................................................. |
(c) Type | .................................................. |
(d) Was visa issued | .................................................. |
14. Who will furnish financial support? | .................................................. |
15. (a) With whom will you stay in Guyana? | .................................................. |
(b) Address of your host in Guyana | .................................................. |
16. What is the purpose of your visit? | .................................................. |
17. Have you ever visited Guyana before? | .................................................. |
18. Do you intend to work in Guyana? | .................................................. |
19. If on business, name and address of firm etc. | .................................................. |
20. Have you ever:(a) been afflicted with contagious diseases (e.g., Tuberculosis) or has suffered serious mental illness? |
.................................................. |
(b) been arrested, convicted for any offence or crime even though subject of a pardon, amnesty, or any other such legal action? | .................................................. |
(c) been involved in narcotic activities? | .................................................. |
(d) been deported from Guyana within the last five (5) years? | .................................................. |
(e) Caught trying to obtain a visa by misrepresentation or fraud? | .................................................. |
21. When are due to arrive in Guyana? | .................................................. |
22. How long do you intent to stay? | .................................................. |