※　签证发给认定号码[反签号] (CONFIRMATION OF VISA ISSUANCE NO. ) :

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1.姓(拼音) Surname 

3.汉字姓名 

4.性别 Gender

[ ]M [ ]F

2.名(拼音) Given Names

5.出生日期 Date of Birth

6.国籍 Nationality 

7.出生地点 Country of Birth 

8.现住所 Home Address

9.固定电话号码 Phone NO.

10.手机号码 Cell Phone

11.电子邮箱 E-mail

12.身份证号 National Identity Number

护照

Passport

13.护照号码 Passport NO.

14.护照类型Classification

外交 公务 公务普通 √因私 其他

DP OF OF OR OTHERS

15.签发地点 Place of Issue 

16.签发日期 Date of Issue

17.有效期至 Date Of Expiry 

职业

Occupation

18.职业 Occupation

自由职业者请在“职业”一栏中填写从业类别，如：（自由职业：专职炒股）、（自由职业：个体经营服装）、（自由职业：自由作家）等

19.单位电话 Business Phone NO. 

20.单位名称 Name of Present Employer

单位地址 Address of Present Employer

婚姻状况

Marital status

21.[ ]未婚 Single [ ]已婚 Married [ ]丧偶 Widowed [ ]离婚 Divorced

22.配偶者姓名 Spouse's Name

23.配偶者出生日期 Spouse's Date of Birth 

24.配偶者国籍 Spouse's Nationality 

25.配偶者联系电话 Spouse's TEL 

26.赴韩目的 Purpose of Entry 

27.在韩停留时间 Potential Length of Stay

28.预定赴韩日期 Potential Date of Entry 

29.过去有无访韩经历 Previous Visit (If Any) 有 √无

30.韩国内停留地 Address in Korea 

31.韩国内联系电话 Phone NO. in Korea 

32.此次赴韩费用支付者 Who Will Pay For The Expense For Your Stay?

33.最近5年内旅行过的国家 Countries You Have Traveled During The Past 5 Years

34. 同伴家族

Accompanying

Family

如直系亲属不同行，此栏所有空格请填“无”。

关系 Relationship

国籍Nationality

姓名 Name

出生日期 Date of Birth

性别 Gender

35. 韩国内担保人

Guarantor or

Reference in Korea

关系 Relationship

国籍Nationality

姓名 Name

出生日期 Date of Birth

性别 Gender

I declare that the statements made in this application are true and correct to the best of my knowledge and belief that I will observe the provisions of the Immigration Law of the Republic of Korea and that I will not engage in any activities irrelevant to the purpose of entry stated herein. Besides I am fully aware that any false or misleading statement may result in the refusal of a visa and that possession of a visa does not entitle the bearer to enter the Republic of Korea upon arrival at the port of entry if he/she is found inadmissible.

申请日 DATE OF APPLICATION    申请人署名 SIGNATURE OF APPLICANT （申请人亲笔中文签名）