2. Date of birth:..................................….…………
Data urodzenia - Ngµy sinh dd mm yy
3. Sex, Płeć, Male-M-Nam Female-K-N÷
Giới tính:
4. Place of birth:.......................................................
Miejsce urodzenia - N¬i sinh
5. Nationality at birth:..............................................
Obywatelstwo rodowe - Quèc tÞch gèc
Nationality at present:...........................................
Aktualne obywatelstwo - Quèc tÞch hiÖn t¹i
6. Passport number:..................................................
Nr. Paszportu - Sè hé chiÕu
Date of issue:...................Date of expiry:...........…
Data wydania - Ngµy cÊp; upłrywu terminuwwaz - hÕt h¹n
7. Profession:.............................................................
Zawód - NghÒ nghiÖp
Place of employment:...........................................
Miejsce pracy - N¬i lµm viÖc
8. Present address: (P.O Box Not Accepted)
Miejsce zamiekania - §Þa chØ c tró hiÖn nay
………….………………………………….….
…..…………………………………………….
Telephone .......................…...........................
Nr telefonu - Sè ®iÖn tho¹i
9. Accompanying children included in your same passport (full name, date of birth, gender) :
Dzieci towarzyszące - TrÎ em ®i cïng trong hé chiÕu
…………………………………...…………………………...
..................................................................................
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10. Purpose of visit to Vietnam :
Cel wjazdu - Môc ®Ých nhËp c¶nh ViÖt Nam
......................................................................................................................................…………………
11. Name, address of your contact in Vietnam : (organization or individual)
Nazwa i adres organów, osób zapraszających
Tªn vµ ®Þa chØ tæ chøc, th©n nh©n ë ViÖt Nam
................................................…………………… ................................................................………... ................................................................................………………………………………….………..
12. Proposed date of entry and exit Vietnam :
Czas pobytu w Wietnamie
Thêi gian dù kiÕn nhËp xuÊt - c¶nh ViÖt Nam
from.........../........../.........to....…./….…/……...
dd mm yy dd mm yy
Od - Tõ ngµy Do - §Õn ngµy
13. Number of entries - Sè lÇn nhËp c¶nh :
Single Mét lÇn Multiple NhiÒu lÇn
Wiza : Jednokrotna Wielokrotna
14. Port of arrival and departure :
Przejście graniczne przyjazdu i wyjazdu
Các cửa khẩu xuất và nhập cảnh
……………………………………………………..
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