Please, complete – print or write in printing letters – the form

填写本表格请打印填写或使用印刷字体手填

cross the boxes where applicable

方格中的内容请按提示填写           

Submit with this form:

·         current passport

·         two photographs

·         the consular fee receipt

1. SURNAME (as written in your passport)   姓（应与护照相符）

2. FULL NAME (as written in your passport)   全名（应与护照相符）

3. OTHER NAMES OR SURNAMES USED IN THE PAST 其他姓名或曾用名

4. DATE OF BIRTH 出生日期

                    day                                 month                        year

                     日                              月                          年

                       country                                                                             town

                                国家                                                                 地区

5. SEX  性别

6. NATIONALITY 民族

                              present                                                              former (if any)

                     现在                             过去

7. PERSONAL NUMBER 身份证号码

8. ADDRESS OF PERMANENT RESIDENCE (country, postal code, town, street, building №, apt №).

   现居住地地址（国家，邮政号码，城市，街道，建筑号）

FOR OFFICE USE ONLY

   A                   1                   2

  Д          1            2            3

  Е