Visa Application Form To Enter Japan Page 2
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1
2[SAMPLE –ENGLISH-]
(Paste a photo here)
VISA APPLICATION FORM TO ENTER JAPAN
approx. 45mm ×45mm
Please print.
Name in full
KNEDDY
2in×2in
(Surname)
Surname should be capitalized.
John Firzgeraid
(Given and middle name)
none
Different name used, if any
: Skipton
15
April
1970
Yorkshire
United Kingdom
Date and place of birth
(Day)
(Month)
(Year)
(City)
(Province)
(Country)
Sex
Male
Marital status: married
single
×
Please paste a photo here. (Do
Nationality or citizenship
America
NOT staple.)
Former nationality, if any
United Kingdom
Please clarify as concrete as
The photo should be clear and
Purpose of journey to Japan
to visit relatives
possible.
identifiable, taken within the
Length of stay in Japan intended
15 days
last 6 months.
Route of present journey : Probable date of entry
May 25, 2007
Port of entry into Japan
Narita AP
Name of ship or airline JAL-006
Passport
(Refugee or stateless should note the title of Travel Document)
No.
A11223344
Diplomatic, Official, Ordinary Issued at
Boston
on
March 10,2007
Issuing authority
U.S.Dept. of State
Valid until
March 10, 2012
If not applicable, please write “none” or “N/A”.
Criminal record, if any
none
Home address
321 East Maple Street, Los Angeles, California 90012, United States of America
Please write accurately. (Phone numbers should start from the area code.)
Tel.
Profession or occupation
Company Employee
Please write accurately.
Name and address of firm or organization to which applicant belongs America Trade Inc.
(Phone numbers should
654 Park, Avenue, New York , N. Y. 10171, U. S. A.
Tel. (212) 333-8888
start from the area code.)
Post or rank held at present Assistant Director
Principal former positions Section Chief
In case the applicant is a dependant.
Please write accurately.
＊Partner’s Profession/occupation (or Parents’ Profession/occupation)
(Phone numbers should start from the area code.)
Address of hotels or names and addresses of persons with whom applicant intends to stay
Hotel Kayu Kaikan, 8-1, Sanbancho, Chiyoda-ku, Tokyo 102 (03)3230-1230
Please write accurately.
Dates and duration of previous stays in Japan
February 4 – April 3, 2007, 3 month
(Phone numbers should
Guarantor or reference in Japan : Name
Mr. Roberr Taylor
start from the area code.)
(03)3230-1111
Address
2-2-1, Kasumigaseki, Chiyoda-ku, Tokyo 100
Tel.
Relationship to applicant
brother in law
＊(Remarks) Special circumstances, if any
In case the applicant has humanitarian reasons should be considered.
I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to
be granted are decided by the Japanese immigration authorities upon my arrival. I understand that possession of a visa does not
entitle the bearer to enter Japan upon arrival at port of entry if he or she is found inadmissible.
Date of application
25
April
2007
(Day)
(Month)
(Year)
In case of an infant, parents or a
Signature of applicant
KNEDDY
legal representative can sign here.
*These items are not essential to be filled
Please indicate the relationship.
(eg. Signed by mother)
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