Wka Applimtion Form of the People's Repubfic of C b
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g 1 Given Name :
1.5 $1 $ ?kg m 4 / Other or Former Name:
1.2 ,Ik 83 / Sex:
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I Chinese Name if Applicable:
[ 1.4 TC$ Ej #g I Current Nationality:
1.6 !$ $ B $6 / Former Nationality:
I .7 $14 El ,Q I Date of BirthfYY-MM-DD):
1.9 f$!g@ 8
Passport Type
1 14 __DOCTEXT__lt; B ~ J R * (q
$I&) 1 Your Current Occupat~on(s)
l_li $j A I Bus~nessman
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yq. 7 +k / Teacher or Student a & IfF 9
W I Government Offic~al
$@ $ h E 1 Crew Member of Airl~nes, Trams or Ships
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181 Jh* A W I Staff of Med~a
$1"- TX F, I Member of Parl~ament, Congressman or Senator
3 %&A k /Clergy
1" J St I&( $i!
fl8) /Other (Please specify)
{'nssport slyle color f~hoto,
wirh hill hce, h n t virw,
no hat
agafi~st a ~ I ~ I J J
l~kht backgrou~~d
1.8 $ JkSlb, ,&(a. g/$)
I Place (ProvinceIState, Country) of B~rth.
$/. & I Diplomatic
4L&. $ R / Service or Official
1 Regular
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1.
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1 Section 2. Your Visit to China
1 2.1 $ i A & tl' 3 9 S I& ( 4 S; $) I Major Purpose(s) of Your Visit(s) to China:
1.12 $ &+h,$($/$ XtN x) 1 Place (ProvinceIState, Country) of Issue:
g% / Tourism
['j $h.fh$C$ / As Crew Member of Airlines, Trains or Ships
cl:~: #x & / Visiting Relatives
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$j $ / Business Trip
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I As Journalist for Temporary News Coverage
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1 Transit
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31.2 $ ,
@ ,i&T $? 42 / As Resident Diplomat or Consul in China
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/Study
U 9 Ai7; W / Official Visit
@ & :ia $i
1 Commercial Performance a ($1, $ $L I Employment
E.1 ;%
fh(iX iR Q ) 1 Other (Please specify):
1. I0 fp 81 5 6% / Passport Number:
1.13 k$
0 ,Q / Expiration Datef YY-MM-DDt.
[.I -&A$ )!&$a
(3 +A 4%) / Single entry valid for 3 months;
2.2 it ?I] A %8 & /
3 &A $ *kjZ & (6 +A & ;k &) 1 Double entry valid for 6 months;
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