Complete the form by replacing the highlighted fields with appropriate and correct information. Send us the completed form via email for a loose-leaf visa application or mail us a hard copy for a conventional visa application.

Visa Approval/Reference Number
(if any):
xxxxx ... xxxxx ... xxxxx /

EMBASSY OF VIETNAM

vietnam visaAPPLICATION

(FOR non-vietnamese
passport holders) / 01 Photo
(2 inches x 2 inches)
Glued here
Or 01 photo scanned with this form for a loose -leaf visa request (if you just have image file, attach it via email)
1. Name (in block letters): XXXXXX . . . XXXXXX . . . XXXXXX
Family name First name Middle name
2. Date of birth (month in letters): dd / mm / yyyy / 10. Name, address of your contact (sponsor, host, hotel…) in Vietnam (if any):
xxxxx xxxxx xxxxx
Proposed date of entry (month in letters):
dd / mm / yyyy
Date / Month / Year
Proposed date of exit (month in letters):
dd / mm / yyyy
Date / Month / Year
3. Male: xxxxx / Female: xxxxx
4. Place of birth: xxxxx xxxxx xxxxx
5. Nationality at birth: xxxxx xxxxx xxxxx
Nationality at present: xxxxx xxxxx xxxxx
6. Passport number (or Green card): xxx xxx xxx
Date of issue: xx / xx / xxxx
Date of expiry: xx / xx / xxxx
7. Profession: xxxxx xxxxx xxxxx
Place of employment: xxxxx xxxxx xxxxx
Telephone (Office): xxx- xxx- xxxx
11. Requesting a visa good for:
·  Times of entries:
- Single (one time) visit ¨ xxxxx
- Multiple visits ¨ xxxxx
·  Length of stay:
- One month ¨ xxxxx xxxxx
- 03 months ¨ xxxxx xxxxx
- Less than 6 Months (with an approval only) ¨
- Up to one year (with an approval only) ¨
8. Present mailing address (P.O Box Not Accepted for USPS express mail): xxxxx xxxxx xxxxx xxxxx
Email :
Telephone : xxx-xxx-xxxx
9. Purpose of visit to Vietnam: xxxxx xxxxx xxxxx

I solemnly declare that the statements made in this application are true and correct.

Date: dd / mm / yyyy

Signature of Applicant :

Check list: Before submitting, make sure you have included:

o Valid Passport (for a visa sticker request); or o Passport copy (front photo page, for a loose-leaf visa request)

o Completed and signed Application with One Photo glued or stapled;

o Visa Fee: Money Order (or Cashier’s Check).

Note: This form must be accompanied by a digital copy of your passport and portrait photo (loose-leaf visa) or the valid passport (conventional visa).