
- 外国人签证、居留许可申请表
- 更新时间:2017-05-03
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外国人签证、居留许可申请表
Visa or Residence Permit Application Form
请用蓝黑色或者黑色墨水笔填写申请表内容
Please complete the form with a dark blue or black ink pen
 1、英文姓名     姓:________________名
1、英文姓名     姓:________________名
 Name in English:    Surname           Given name
   Name in English:    Surname           Given name
中文姓名:___________________________  性别:  男 □  女 □
   Name in Chinese                         Sex     M.      F.
  
   出生日期: _________年________月_______日    国籍:______________
   Date of birth          Y        M       D     Nationality
 
在哈住址:                                                        
   Address in Harbin                              
所属派出所                            来华职业或身份                
Police station in the vicinity          Occupation or status in China   
在哈单位名称:                                     电话:                 
   Name of employer/school                               Tel
  
2、护照种类:           外交 □          公务(官员)□         普通 □          其他 □    
   Passport type         Diplomatic        Service(Official)         Ordinary          Other
 
   护照号码:                       有效期至:________年________月________日
   Passport No.                       Valid until         Y         M        D
3、本次入境签证种类:      L □    F □    Z □    X □   J-1 □   J-2□   C □   G □    
Current visa category   D □    居留许可 □          团签 □       免签 □         其他 □
Residence permit    Group visa   Exempt        Other            
   签证号码:                  入境次数:______次      有效期至:_______年_____月______日
Visa No.                     Number of entries         Valid until         Y      M      D
4、使用同一护照的偕行人  
Dependents on applicant’s Passport
   
姓            名                   性别     出生年月          与申请人关系
Surname     Given name         Sex    Date of birth     Relationship w/applicant
    
____________                        ____    _______________                                         
   
____________                        ____    _______________                           
   
  
5、申请签证类填写 For visa application only
F 商务 □    L 探亲  □        L 旅游  □       L 因其他私人事务 □      团签 □
Business    Visiting family    Tourist         Other private reasons     Group visa 
J-2 记者 □     G过境  □      C乘务  □        寄养   □             团分 □
Journalist        Transit          Crew          Child with custodian    Separation from group visa  
申请入境次数:      零次 □      一次 □     二次 □       多次 □  
Number of entries     Zero         Single      Double       Multiple       
申请日期至:_____________年_________月_________日
Desired validity until        Y         M          D
6、申请居留许可类填写 For residence permit application only
| 任职 □ | 及 | 任职者家属 □ | 就业 □ |  | 就业者家属 □ | 
| Executive | &/ | Accompanying family member | Employee |  | Accompanying family member | 
| 记者 □ | 及 | 记者家属 □ | 学习 □ | 其他 □ | |
| Journalist | &/ | Accompanying family member | Study | Other | |
首次申请居留许可 □      申请居留许可 □      申请有效期至: _________年______月_______日
1st time application          Renewal             Desired validity date until   Y      M        D 
7、变更:         住址 □       身份 □           单位 □        院校 □        其他 □
Change of      Residence     Employment status   Employer       School         Other              
增 □      减 □         偕行人                        如其他请注明                       
Increase    Decrease    of dependents                 or other, please specify
迁出 □      迁往____________省(市)                                               单位
Move out    to            Province(city)                               Employer/Organisation
8、申请其他证件:Other documents application
外国人出入境证 □                   外国人旅行证 □                     其他 □ 
Foreign citizen exit-entry permit         Foreign citizen travel documents        Other         
旅行地点:                          有效期至 :         _________年________月_________日
Destination                           Desired validity date until      Y        M        D  
9、备注:Notes
我保证以上填写的内容真实、准确、完整,并保证在居(停)留期间遵守中华人民共和国的法律。
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.
申请人签字:                                 代办人签字:                           
Applicant’s signature                          Agent’ signature
联系电话 Tel:_________________________     联系电话Tel.:_________________________
申请日期:             年     月     日      
Application date         Y     M      D      单位印章Company/School chop:
