DOMINICANREPUBLIC

CONSULARDEPARTMENT

1.Surnames

VISA APPLICATIONFORM

2.Name

3.Birth and Citizenshipinformation

3.1Country / 3.2Province / 3.3Locality
3.4 Date(dd/mm/yy) / 3.5 FirstCitizenship / 3.6 SecondCitizenship

4.Sex, profession yoccupation

4.1Sexo / 4.2Mayorgradoacadémicoalcanzado / 4.3Ocupación

5.Currentaddress

5.1Country / 5.2Province / 5.3Locality
5.4Vía / 5.5Number / 5.6Floor / 5.7Stairway / 5.8Door / 5.9CP
5.10 Home TelephoneNumber / 5.11 Mobile Telephone Number / 5.12 Office TelephoneNumber / 5.13 Fax TelephoneNumber
5.14 PersonalE-Mail / 5.15 WorkE-Mail

6.PassportInformation

6.1 PassportNumber / 6.2 Country ofIssuance / 6.3Localitywherepassportwasissued
6.4 Country where the Passport belongto / 6.5 Issue Date(dd/mm/yy) / 6.6 Expiration Date(dd/mm/yy)

7.IdentityDocument

7.1 Country ofIssuance / 7.2 DocumentType / 7.3Number / 7.4 Expiration Date(dd/mm/yy)

8.Information about marital status andspouse

8.1 CivilState / 8.2 spouses complete name (even ifdivorced) / 8.3 Spouses date of birth(dd/mm/yy)

9.Time of visit to the Dominican Republic andpurpose

9.1 On which date do you plan to travel?(dd/mm/yy) / 9.2 How many daysstay? / 9.3 What is the Purpose of yourtrip?
Pleasure Study Business Work Dependency Official Diplomatic
Residence Courtesy Other()

10.Temporary address while staying in the Dominican Republic

10.1 Name (hotel or physicalperson) / 10.2 TelephoneNumber / 10.3 Mobile TelephoneNumber
10.4 In whichcity? / 10.5 In whichlocality? / 10.6 In whichsector?
10. 7 Type ofway / 10.8 Name ofway / 10. 8Number / 10.9 PostalCode

11.. Employer and/or center of study actual data (write more than one ifapplicable)

11.1Activity / 11.2 Name of theInstitution / 11.3 TelephoneNumber / 11.4Address

12.Other Than you, who will help pay the expenses of your trip? (in case itʼs only you do notanswer)

13. Have you visited Dominican Republicbefore?
YesNo (if Yes answer the question on the rightstarting with the most recentvisit. / 13.1 On which date?(dd/mm/yy) / 13.2 For how manydays?

14.Have you been issued a Dominican Republic visabefore?YesNo

(if the answer is Yes specify the following for eachvisit):

14.1 Date(dd/mm/yy) / 14.2 Country ofIssuance / 14.3City / 14.4 VisaType / 14.5 VisaNumber

Note:Onlyfillininformationforwhichyousubmitproofatthemomentofpresentingthisapplication.

15.Visas given by othercountries:

15.1 EmittingCountry / 15.2 Country ofEmission / 15.3 Date ofExpiration
(dd/mm/yy) / 15.4 VisaType / 15.5 VisaNumber

Note:Onlyfillininformationforwhichyousubmitproofatthemomentofpresentingthisapplication.

16.HasyourDominicanRepublicVisaeverbeenrevokedorcanceled?YesNo

17.Have you ever been turn down for a Dominican Republic Visa? YesNo

(in case of yes, answer the followingquestions):

17.1 Date(dd/mm/yy) / 17.2Country / 17.3City / 17.4 VisaType

18.Do you intend to work and/or study in the DominicanRepublic?YesNo

(incaseofyes,specifyactivity, nameandinformationabouttheemployerorStudyInstitutioninDominicanRepublic)

18.1a Type ofactivity / 18.2aName(person,companyoeducationinstitution) / 18.3a Telephone (mobile or landline)
18.4aProvince / 18.5aLocality / 18.6aWay / 18.7aNumber

19.Has someone ever submitted a Visa petition in yourname?YesNo

(in case of yes, specify who and the relation they have withyou):

20.Names of people who will be traveling withyou

20.1Names / 20.2Relationship

Internal Information (Do NotFill)

ApplicantsSinature

NumberDate

Location

NumberDateSattus

Indicate documents that accompany thisapplication:

MarriageCertificatePaymentProof

BirthCertificateUniversityProof

Parent or TutorAuthorizationWorkContractPassport

BankLetterBankAccountHotelReservation

Bank Letter ofGuarantorIdentificationDocumentFlightReservationLetter ofGuarantee Identification Document ofGuarantor CreditCardInvitationLetter Taxes PaymentDocument Real EstateTitle

WorkLetterPhotoUSAVisa

ScholarshipCertificateBank Book orLedgerEuropean UnionVisa

Certificate of GoodConductFamilyBookPrevious DominicanVisa

MedicalCertificatePayrollVisas from othercountries

VariousCertificatesVerbalNoteOtherDocuments