Consulate of the Republic of Madagascar
160 / 775 – 777 Silom Road, ITF Palace 30th, Bangkok 10500 - Thailand
Tel +66 (0)26345838 Fax +66 (0)26345829 Mobile +66 (0) 889616178
www.consulmada-th.org
APPLICATION FOR A Non-Immigrant VISA
Visas are delivered for a maximum multiple stays of 90 days and Photo
Have to be used within 3 months from the issuing date. 2 x 1.5 inch
5 x 4 cm
Surname (Family Name) ______
Name (Given Names) ______
Spouse Name ______
Place of Birth ______Date of Birth ______FOR OFFICIAL USE ONLY
Personal Status ______
Current Nationality ______Visa no______
Former Nationality ______Date 2016______
Permanent Address ______Type ______
______Number of days ______
City ______Zip Code ______Paid _4,500 baht______
Off Tel ______Fax ______Ref ______
Home Tel ______Mobile ______
Email ______Non Transformable En Long Séjour
Job/Occupation ______
Employer (self employed or Company's Name) ______
Employer's Address ______
Passport No. ______Issued at ______By ______
Date ______Valid until ______Nationality ______
Visa Tourism Business Others ______
Airline ______Flight number ______
Date of Entry in Madagascar ______Port of entry ______
Date of Exit ______Port of exit ______
Traveling alone Yes No
If travelling with family members, indicate names and surnames ______
______
Trip Purpose:
For Business trip, Convention, please indicate names, addresses of traders or industrials, organizer, offices, places, dates and duration ______
______
If you already lived in Madagascar for more than 3 years continuously, please indicate where and when:
______
Relative or References in Madagascar ______
______
Address and Accommodation during your stay in Madagascar ______
______
Person to contact in case of necessity and guarantee here in Thailand ______
______
I hereby pledge to accept no paid or au pair employment during my stay, to make no attempt to remain in the country indefinitely and leave the MADAGASCAR TERRITORY upon expiry of the visa which may be granted to me. My signature commits my responsibility and in case of misrepresentation, makes me liable to prosecution as provided by law in case of false declarations as well as to refusal of visa in the future.
At Bangkok on the date of ______And Signature ______
2016 non immigrant visa