EFTA01186519.pdf

EFTA01186519 12. Type of Passport : ftal Ordinary Passport ❑ Diplomatic Passport D Service Passport or equivalent 0 Travel document for refugier or apatried Voluble du : . . /. . /. . . . Other .••••. .. . ... ... ... ••• • •.. ... ... ..... • ...... .... Au: . ./../... . 13. Passport Numb 14. Issued by : Serial Number : pp Anissz17 Of Foie/ Motif :(En cas de Refus ou d'Annulation) //Ps 15. Date of issue 16. Valid until : e6 3 16.-/P‘A/5 17. Profession : .Dei2Z 18. Purpose of Travel : 61 Tourism 0 Affairs 0 Family visit 0 Culture/ Sport 0 Official visit 0 Medical Purpose ❑ Studies 0 Other ( Precise): 19. Type of visa 20. Number of entries : 21. Duration of stay : 0 Long validity 1=1 Single entry Number of days- 3.0 VShort validity 0 Two entries 0 Transit [V Multiple entries 22. Arrival date : 23. Border of entry or transit 24. Mean of transport : route /1//- fa4/aear rctt9fj Rafra ee 1/3 - 25.Previous visas : Date Number Place of issue Duration 11- /5 MAR -6,5-10?? YorL 30 clays /146i/ yod_ I. 2 2.fit p9. Alif-Rai Xia ;t2d€,77J- 3. country 4/1,4 26. In case of transit, have you un entry permit to entry to Final 0 No 0 Yes Country of destination: Valid until: . . I . . I. . Delivered by