MINISTÉRIO DAS RELAÇÕES EXTERIORES
EMBAIXADA EM OTTAWA
Protocol number
Visa number
|
REPÚBLICA FEDERATIVA DO BRASIL MINISTÉRIO DAS RELAÇÕES EXTERIORES EMBAIXADA EM OTTAWA |
Protocol number
|
Visa number
|
01 - Full Name First Middle Last |
Attach photo here - size: 40 mm x 35mm (1 9/6 x 1 3/8 inches) - white or off-white background - front view, full face - must be recent picture |
02 - Place of birth (city/state/country) |
03 - Date of birth |
04 - Country of citizenship
|
05 - Sex Male Female |
06 - Marital status
|
07 - Passport # |
08 - Issuing country
|
09 - Expiration date |
10 - Parent’s full name (do not abbreviate or omit any name) and country of citizenship Father's:
|
11 – Highest level of education (check only one box)
no diploma |
12 - Major/primary field of study |
13 - List any special skill and/or certificates
|
|
14 - Job position (as per business card) or title
|
|
15 - Employer (for students, name school/university)
|
|
| 16 - E-mail:
|
| 17 - Business address |
18 - Business telephone # (with area code)
|
19 - Home address
|
20 - Home telephone # (with area code)
|
FOR OFFICE USE ONLY
|
Embaixada do Brasil em Ottawa/VisaForm.Doc Updated: May 2001
| 21 - Purpose of trip (check item that is the most applicable to the circumstances
of your trip) Provide services in Brazil of a temporary nature, including activities such as office and technical support, installation and repair of equipment, including computer and telecommunications systems, construction activities, and direct supervision of personnel in Brazil Personnel involved in business development activities, including negotiating contracts, marketing, opportunity assessments, specifying orders for contracts, customer relations related activities, performance assessments, project reviews, and establishing a framework for doing business in Brazil Direct participation in oil and gas exploration and/or production activities Work under an employment contract with a company/organization in Brazil - i.e., hired under a Brazilian labor contract as a local employee (this applies to the foreign employees of multinationals working in their Brazilian subsidiaries) Transfer of residence to Brazil under permanent residency status Attend conference, seminar or workshop (note under “Comments” below whether attendee, paid/unpaid speaker, trainer, and provide name of event sponsor) Provide religious or missionary services and/or assistance Provide community and/or medical services Attend school or pursue studies Conduct research or pursue scientific-technologic activities under an international cooperation program Pursue professorial studies/research/teaching and/or pursue scientific/technologic activities at an university, research or similar organization (attach letter specifying conditions: employment contract? research scholarship? ) Participation in athletic or performing arts events (note under “Comments” below whether paid/unpaid participation) Journalism activities and/or film making As a government official Tourism, visit friend(s) and/or relatives (under “Comments” below provide further insight on intended trip and, as applicable, list relationship to parties being visited)
Other:
|
|
22 - Expected port of entry and date of arrival in Brazil
|
23 - Expected duration of immediate trip
|
24 - Name and address of person, institution or company through whom you can be contacted in Brazil
|
|
25 - Address in Brazil where you will be staying |
26 - Telephone # in Brazil (with city code)
|
27 - Have you ever been to Brazil? Yes No |
28 - If yes for item 27, provide date, place and duration of last visit
|
| 29 - I declare that the above information is true and accurate. | ||
Name
|
Date Day /Month/Year |
Signature _______________________________ |