EFTA00304503.pdf

24.11)%ni Eby panei y liters/gnaw 6enapyte/Have you ever been to the Republic of Beaus DalNies El ne/n0 sani szie, asananue apse masa i tory anounra eeny/rf yes, please specify dates, places and purpose of your prewous via o r= WA no. WA A3e/where N1* /era abny/purpose 0 Oat WA 23. flartspayrite earns 9 Pxrridriary Eienapyrki na npausry &sayers rasa I aryabmgRot Niagara naxogsansisi/Previcte gays al the Arepiblic at Wanes Mt/In a current year and the aggregate term of temporary gay 1) fl an WA nayunti N/A 4) 3/from WA neArti WA arynota wails gacceara eisacvoraiset/ the aggregate term of temporary Soy 2) atfrom WA natural WA 5) miunt WA Away WA . - If 3) syfygn WA natunty N/A 6) 3/frorn WA. - _ ._ nigunti N/A - Oats 26. lb %MO 8.101 appojtriena 9 6enagyou4 Mae abo Mg &ma erymearefirave your Reigustan visa request been ever refused a your via was cancelled • TaVyes Bite/no Pal rat limaimaaneriamyrif yes, specify the date WA 27. lli fleabag EN namgc passeAwra 3.incrionfreig Na mperroptai P301f3MCI &many:a naa arerstaaw 33 naPnuanne 6enaPY0am *sae/ Have giu ear been charged with viclating the %artisan Law while n %lams aran/ses Eine/no Kul ras, anomie ranyd yes, specify when WA i pae/and where NIA Crapoijone/ atoms Na %Taw* Ne woe na a5aainrossaP acgosw li atoaatan ease Ulnas y rano/ annadcy regallaga Bata acb5iCrel nreaCYTtiaallt 3 IeTail rpaasupessia Sage* 3 KO4CyllbOLIM paSormiram/Positte answer wia not necessarty affect negatwely the consilerabm d ense request, but in this case your presence is requested for an interview with a consular officer 28. ta WA % onapraeass 3 igoinnatsmas spasiteittave you ever been deported horn any ccurtry Crashes ®Nero mi Tat, wavoinuse icarsid yes. sped). when WA i 3 smal main /end from witch count). WA 29. TOOMalignkbiCrOMIC, aid npaywrsemeauy aura teisy 9 Flayrsnity &mania/ !34). mampyr pyxygonerary Men of transpat avalade for your entrance to the Republic of eeiarus i Looking to Invest in business Flying Private Airplane (Tail PN212JE) 31. Cpeeci au timelier, nacres snakomasois 9 Floyd:Kis Senapya/ 32. Niecna a6 tgraaopta neatnutssoran crpaxasamma/Meclical insurance Means available for sray in the Republic of Beiarus information cmasseas apramaauna (.aaea sups:, r3nectonyinsurance company (name, El maiihibia moan cash 0 EaHaiousi coo/bank cheques address, phone)AltianZ. 9950 Mavland Drive OrP3AbiThodi Naomi/met cards • seaport/LA 6.nedreturn ticket O hauuseqo gat cheques ri ng„ ... incliccantnoiation Richmond. VA 23233, 866 884 3556 0 sanatoria 3/valid from June 4, 2015 nai um June 42015 33. Canesitme crassomuna/Marecal status 0 antrowitypi 9 uimo6elnwried Elie *a:mama 9 wao6e/ancie ripanerpeigaraYdbaced Chmarieu 6raesaYeillorrter) 34. npcnaiuma nee Nomer,pouse's family name 35. n P 031341148 wfWa (xMC) VFW nagaagnos/Spoustts lag maw by birth N/A WA 36. Mei I twain Went wpm (xema)/Spouse's first and other names 37. rpanaasmscrea(u) wpm (mad)/Spouses cidzertesp(s) NIA N/A 387Aara Planarian Mike OlobsoY 39. Medea IMPAPP3aari moo (sobsc)/Spcuses place of birth Spade's date of birth sparnaicarey WA roPaNcitt WA - I - - I - - I - I - I - acfmaass (peed/region N/A day mirth year 40. MAI Bat cYnPseadaanals Mei i Rem clecerel 9 Eau nausea*. 3anaPiaut Ta6Muy/If you are accompariad by didren ad they are itided in as passport 61in the table below npogiunia/Family name beafibst Name Aan i moos napagramia/Date and Pace of tam WA WA WA WA WA WA WA N/A WA 41. Annapaubm/Declaration A 3afelfM10, WTO incpapmaybra, seas 3aseunama 9 raraS miscue, akjlnseitga dasnaman I nperidsiset. A awe, hero naaeda manure isertpaidalabcs saecrac ace& acuseinentre ad npacicraYnenns nea6xodnoix bacymentat wows cnynanuo nadcraisaii and aw-soeis ea 9P1R30 9 PaalY5/liiry 5emallYco- CI TaxaHa nannawranbi, urro, rani r3Tas ntbapmatibm 60.3e npbanana Nearnatutag, Boa mono 6bIlth anymmana Si no% retain. Si agaasaroot na npb6bno4I 9 Pacny6nlry Eenapycb sa 9craso9neleatm napasy al90Plillb PNICrPallau0 j naiohyub Re rapbrropboo as 3343i.43nme 13pMiny babisassi abs. A nanapadwaimi a6 Hea6xodriacur mew, redgac naesiksi meabaistiCKr0 apax0tcy, Stasi unaantae sagaKa.4ataBY Pacn)Enlal Eenapycb / I declare that information in this application is true and correct_ I am aware that any false statenelba or refusal to submit the necessary documents may lead to wthholdirg a permit to enter Belarus. I am also warned that if this information is found to be incorrect, the visa may be cancelled at any tme. Or, arrival to the Republic of Belarus I will register according to the established procedure and leave the territory of the Republic of Belarus before my vda expires. I am aware that during my travel I need to have a medial insurance that corresponds to the requirements of belarusian legislation. 42. acadicrs no:ink/Watt/a i 43. Agra nturiczerwiDate of airwave _ — 215 014 2101116 __ day month year EFTA00304503