REQUEST FOR ENTRY VISA TO MOZAMBIQUE
莫桑比克入境申请书
RECIBO N.o
TO BE FILLED IN LEGIBLE LETTERS
请用清晰字体填写
For official use
VISTO N.o
DATA DE EMISSÃO
......... / ......... /20.........
Temporary
临时入境 □
Single entry
单次入境 □
VALIDADE
......... / ......... /20.........
Multiple entries
多次入境 □
Surname
姓
Full name
全名
Maiden name
婚前姓名
Country and place of birth
出生地、国家
Date of birth
出生日期
Sex
性别