Surname :

Given Name:

Nationality:

Gender:

Type of Visa:

Visa No.:

Valid Until:

Original Visa type:

Original Visa No.:

Valid Until:

Desired Visa Type:

Number of Entries:

Desired Validity until:

Resident Permit No.:

Valid until:

Mobile Number:

Fix line Number:

E-mail:

Current Address:

  

I hereby declare that the information given above is true, correct, current and complete. I shall abide by the Law of the People’s Republic of China during my stay in its territory, and understand I shall otherwise subject myself to legal liabilities.