Form V.2013 V.2013

中 华 人 民 共 和 国 签 证 申 请 表
Visa Application Form of the People’s Republic of China People’
(For the Mainland of China only) 申请人必须如实、完整、清楚地填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在□内打√选择。如有关项目 申请人必须如实、完整、清楚地填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在□ 完整、清楚地填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在 选择。如有关项目 不适用，请写“无”。The applicant should fill in this form truthfully ，completely and clearly. Please type the answer in capital English 不适用，请写“ truthful thfully clearly. English letters in the space provided or tick (√) the relevant box to select. If some of the items do not apply, please type N/A or None.

一、个人信息 Part 1: Personal Information
姓 Last name 1.1 英文姓名 Full English name as in passport 中间名 Middle name 名 First name 1. 中文姓名 1.2 Name in Chinese 1.4 性别 Sex 1.4 □ 男 M □ 女 F 1.3 别名或曾用名 1.3 Other name(s) ame( 1.5 出生日期 1.5 DOB(yyyy-mm-dd ) OB( yyyy-mm-dd) 1.7 曾有国籍 Former nationality(ies) ationality(ies)
粘贴一张近期正面免冠、浅色背 景的彩色护照照片。

/Photo 照片/Photo
Affix one recent color passport photo (full face, front view, bareheaded and against a plain bareheadedand light colored background).

1.6 现有国籍 1.6 Current nationality(ies) ationality(ies) ( / ) 1.8 出生地点(市、省/州、国) 1.8 Place of birth(city, province /state,country) irth(c ity, province/state,country) /state ,country / 1.9 身份证/公民证号码 1.9 Local ID/ Citizenship number ID/ 1.10 护 照 / 旅 行 证 件 种 类 Passport /Travel document 1.10 Passport/Travel type 1.11 护照号码 1.11 Passport number 1.13 签发地点 1.13 Place of issue □ 商人 Business person Businessperson □ 公司职员 Company employee □ 演艺人员 Entertainer

□ 外交 Diplomatic □ 普通 Ordinary

□ 公务、官员 Service or Official ( ) □ 其他证件(请说明) Other (Please specify): specify):

1.12 签发日期 1.12 Date of issue(yyyy-mm-dd) ssue(yyyy-mm-dd yyyy-mm-dd) 1.14 失效日期 1.14

Date of expiry(yyyy-mm-dd) xpiry yyyy-mm-dd)
/ □ 前/现任议员 Former/incumbent member of parliament 职位 Position________________________ Position________________________ / □ 前/现任政府官员 Former/incumbent government official 职位 Position________________________ □军人 Military personnel 职位 Position________________________ □ 非政府组织人员 NGO staff □ 宗教人士 Religious personnel □ 新闻从业人员 Staff of media

/ □ 工人/农民 Industrial/Agricultural worker 1.15 当前职业 1.15 （可选多项） Current occupation(s) □ 学生 Student □ 乘务人员 Crew member □ 自雇 Self-employed □ 无业 Unemployed □ 退休 Retired

( ) □ 其他(请说明) Other (Please specify): 1.16 受教育程度 Education

□ 研究生 Postgraduate ( ) □ 其他(请说明) Other (Please specify): 名称 Name 地址 Address

□ 大学 College

/ 1.17 工作单位/学校 Employer/School

联系电话 Phone number 邮政编码 Zip Code

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1.18 家庭住址 Home address / 1.20 电话/手机 Home/mobile phone number 1.22 婚姻状况 Marital status 1.22 □ 已婚 Married 姓名 Name 1.23 主要家庭成员 (配偶、子女、父母 , ) 等,可另纸) Major family members spouse, members（spouse, children,parents,et c.,may type on separate paper paper） 姓名 Name 与申请人的关系 Relationship with the applicant □ 单身 Single 国籍 Nationality

1.19 邮政编码 Zip Code 1.21 电子邮箱 1.21 E-mail address □ 其他 Other(Please specify): 职业 Occupation 关系 Relationship

1.24 紧急联络人信息 Emergency Contact

手机 Mobile phone number

1.25 申请人申请签证时所在的国家或地区 Country or territory where the applicant is located when applying for this visa

二、旅行信息 Part 2: Travel Information
□ 官方访问 Official Visit □ 旅游 Tourism □ 交流、考察、访问 Non-business visit □ 商业贸易 Business & Trade □ 人才引进 As introduced talent □ 执行乘务 As crew member crew □ 过境 Transit 2.1 申请 入境事由 Major purpose of your visit □ 短期探望中国公民或者具有中国永久居留资格的 外 国 人 Short-term visit to Chinese citizen or foreigner with Chinese permanent residence status □ 短期探望因工作、学习等事由在中国停留居留的 外 国 人 Short-term visit to foreigner residing in China due to work, study or other reasons □ 短期学习 Short-term study for less than 180 days □ 短期采访报道 As journalist for temporary news coverage ( )Other □ 其他(请说明)Other (Please specify) specify)： □ 与中国公民或者具有中国永久居留资格的外国人 家庭团聚居 留超 过 180 日 Family reunion for over 180 days with Chinese citizen or foreigner with Chinese permanent residence status □ 长期探望因工作、 学习等事由在中国居留的外国人 As accompanying family member of foreigner residing in China due to work, study or other reasons □ 长期学习 Long-term study for over 180 days □外国常驻中国新闻机构记者 As resident journalist □ 常驻外交、领事、国际组织人员 As resident diplomat consul or staff of international iplomat，c international organization □ 永久居留 As permanent resident res □ 工作 Work □ 寄养 As child in foster care

( ) □ 一次(自签发之日起 3 个月有效) One entry valid for 3 months from the date of issue 2.2 计划 入境次数 Intended number of entries ( ) □ 二次(自签发之日起 3-6 个月有效) Two entries valid for 3 to 6 months from the date of issue 3-6 entries ) Multiple entries □ 半年多次（自签发之日起 6 个月有效) Multiple entries valid for 6 months from the date of issue ) Multiple entries □ 一年多次（自签发之日起 1 年有效) Multiple entries valid for 1 year from the date of issue Other □ 其他（请说明）Other (Please specify): specify): 2.3 是否申请加急服务 Are you applying for express service?
Note: 注：加急服务须经领事官员批准，将加收费用。Note: Express service needs approval of consular officials, and extra fees may apply.

□ 是 Yes

□ 否 No

2.4 本次行程预计首次抵达中国的日期 Expected date of your first entry into China on this trip (yyyy-mm-dd) yyyy-mm-dd)
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2.5 预计行程中单次在华停留的最长天数 2.5 Longest intended stay in China among all entries 日期 Date 详细地址 Detailed address

Days

2.6 在中国境内行 2.6 , 程（按时间顺序, 可附另纸填写） Itinerary in China (in time time sequence may sequence，may type on separate paper) paper)

2.7 谁 将 承 担 在 中 国 期 间 的 费 用 ？ Who will pay for your travel and 2.7 expenses during your stay in China? 姓名或名称 Name 2.8 中国境内邀请 单位或个人信息 Information of inviter in China 地址 Address 联系电话 Phone number 与申请人关系 Relationship with the applicant 2.9 是否曾经获得过中国签证？如有，请说明最近一次获得中国签证的时 Have 间和地点。Have you ever been granted a Chinese visa? If applicable, please please specify the date and place of the last time you were granted the visa. 2.10 过去 12 个月中访问的其他国家或地区 Other countries or territories you visited in the last 12 months

三、其他事项 Part 3: Other Information
3.1 是否 曾 在 中 国 超 过 签 证 或 居 留 许 可 允 许 的 期 限 停 留 ？ Have you ever overstayed your visa or residence permit in China? Have 3.2 是否曾经被拒绝签发中国签证,或被拒绝进入中国？Have you ever been refused a visa for China, or been refused entry into China? 3.3 是 否 在 中 国 或 其 他 国 家 有 犯 罪 记 录 ？ Do you have any criminal record in China or any other country? 3.4 是否具有以下任一种情形 Are you experiencing any of the following conditions? conditions? ①严重精神障碍 Serious mental disorder isorder ②传染性肺结核病 Infectious pulmonary tuberculosis ③可能危害公共卫生的其他传染病 Other infectious disease of public health hazards Did 3.5 近 30 日内是否前往过流行性疾病传染的国家或地区？Did you visit countries or territories affected by infectious diseases in the last 30 days? 3.6 如果对 3.1 到 3.5 的任何一个问题选择“是”，请在下面详细说明。 If you select Yes to any questions from 3.1 to 3.5, please give details below. details below. □是 Yes □是 Yes □是 Yes □否 No □否 No □否 No

□是 Yes

□否 No

□是 Yes

□否 No

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3.7 如果有本表未涉及而需专门陈述的其他与签证申请相关的事项，请在此或另纸说明。 If you have more information about your visa application other than the above to declare,please give details below or type on a separate paper. paper.

3.8 如申请人护照中的偕行人与申请人一同旅行， 请将偕行人照片粘贴在下面并填写偕行人信息。 someone else travels and shares If shares the same passport with the applicant , please affix their photos and give their information below. 偕行人 1 Person 1 偕行人信息 偕行人 2 Person 2 偕行人 3 Person 3

Information

粘贴照片于此 Affix Photo here

粘贴照片于此 Affix Photo here

粘贴照片于此 Affix Photo here

姓名 Full name 性别 Sex 生日 DOB(yyyy-mm-dd) OB(yyyy-mm-dd)

四、声明及签名 Part 4: Declaration & Signature
4.1 我声明，我已阅读并理解此表所有内容要求，并愿就所填报信息和申请材料的真实性承担一切法律后果。 I hereby declare that I have read and understood all the questions in this application and shall bear all the legal consequences for the bear authenticity of the information and materials I provided . provided. 4.2 我理解，能否获得签证、获得何种签证、入境次数以及有效期、停留期等将由领事官员决定，任何不实、误导或填写不完整均 可能导致签证申请被拒绝或被拒绝进入中国。 I understand that whether to issue a visa, type of visa, number of entries, validity and duration of each stay will be determined by consular official, and that any false, misleading or incomplete statement may result in the refusal of a visa for or denial of entry into China. 4.3 我理解，根据中国法律，申请人即使持有中国签证仍有可能被拒绝入境。 I understand that, according to Chinese law, applicant may be refused entry into China even if a visa is granted. 申请人签名 Applicant’s signature: Applicant’ 日期 Date (yyyy-mm-dd ): yyyy-mm-dd):

注：未满 18 周岁的未成年人须由父母或监护人代签。Note: The parent or guardian shall sign on behalf of a minor under 18 years of age. age.

五 、 他 人 代 填 申 请 表 时 填 写 以 下 内 容 Part 5 ： If the application form is completed by another person on the applicant's behalf, please fill out the information of the one who completes the form
5.1 姓名 Name 5.3 地址 Address 5.2 与 申 请 人 关 系 Relationship with the applicant 5.4 电话 Phone number

5.5 声明 Declaration 我声明本人是根据申请人要求而协助填表，证明申请人理解并确认表中所填写内容准确无误。 I declare that I have assisted in the completion of this form at the request of the applicant and that the applicant understands and agrees that the information provided is true and correct. /Signature 代填人签名/Signature /Signature： /Date yyyy-mm-dd): 日期/Date (yyyy-mm-dd):

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