1．英文姓名___________________________________________
Name in English(as it appears in passport)
中文姓名________________________ 国籍________________
Name in Chinese（if applicable） nationality
性别 男□ 女□ 职业________________
Sex M F Occupation
出生日期_______年______月_____日 出生地______________
Date of birth Y M D Place of birth
2．护照或者证件种类 外交□ 公务□ 普通□ 其他□
Type of passport or certificate Diplomatic Service Ordinary Others
护照或者证件号码_______________ 有效期至________年________月_______日
Passport or certificate number Valid until Y M D
3．现持签证或者居留许可号码_____________________ 签发机关 ________________________
Current visa or residence permit number Issued by
签证种类或者居留事由____________________________ 有效期至________年______月_____日
Type of visa or purpose of residence Valid until Y M D
4．在华邀请单位名称或者个人的姓名、地址和电话______________________________________
Company or person to visit in Shanghai,name(s),address and telephone numb
申请人在沪住址__________区（县）__________派出所___________路___________弄_________号
Address In ShangHai District(County) Police Station Road Lane No.
5．使用同一护照的偕行人Accompanying persons included in passport
姓名____________性别____________出生日期____________与申请人关系_____________________
Name Sex Date of birth Relationship to applicant
6．申请签证的种类 Type of visa to apply for
F商务□ C乘务□ J-2记者□ G过境□ 团体签证□
Business Crew Correspondent Transit Group Visa
L探亲□ L旅游□ L因其他私人事务□ 团签分离□
Visiting relatives Sight seeing For other private purposes Separation of Group Visa
7．申请签证的有效次数和有效期 Number of entries and validity of visa you are applying for
零次□ 一次□ 二次□ 多次□ 有效期至______年______月______日
Zero One Two Multiple Valid until Y M D
8．申请居留许可 Applying for residence permit
居留事由 学习□ 记者□ 记者家属□
purpose of residence Study Correspondent Family member of correspondent
任职□ 任职家属□ 就业□ 就业家属□ 其他□
Taking up post Family member Employment Family member Others
有效期至______年______月______日
Valid until Y M D
9．申请居留情况变更登记___________________________
Applying for change of residence permit
住址□ 就读院校□ 任职或者就业单位□ 其他□
Address Educational institute Place of work Others
10．申请其他证件 Applying for other certificate
外国人出入境证□ 外国人旅行证□ 其他□
Aliens’Exit-Entry Permit Aliens’Travel Permit Others
我谨声明我已如实和完整地填写了上述内容并对此负责 (如属代办,代办人签字)
I hereby declare that the information given above is true,correct and complete.I shall take full
Responsibility for the above information
申请人签字______________ 代办人签字____________
Applicant signature Agent signature
______年______月______日 联系电话______________
Y M D Phone Number
