Q U E S T I O N N A I R E

photo

stamp

Full name(surname, first name and middle name):KARLSBERG, Michael Charles

Familýasy, ady, atasynyň ady:______

Place and date of birth:New York, United States of America, 25/11/1953

Doglan yeri we yyly______

Current nationality:British

Rayatlygy:______

Passport number: 500618026

Place of study: Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

Bilimi we okan yeri:______

Current occupation: Student, University of Bath, Claverton Down, Bath, Somerset, BA2 7AY, United Kingdom

Işleýän ýeri we wezipesi :______

Place of stay in Turkmenistan: In transit

Türkmenistanyňçäklerinde

anyk ýaşajak ýerleri:______

Permanent address: 1 Poudlands Cottages,Bushsberry, Kent, TN17 2EP, United Kingdom

Turkmenistandan dasardaoy salgysy:______

Marital status: Married

Maşgalaýagdaýy:______

Name of the head of the

applicant company/organization:___Donald Watkins______

(surname, first name) signature

Yüz tutýan tarapyň müdiri:

Stamp:

Möhür ýeri:

GUIDE TO FILLING IN THE QUESTIONNAIRE

1)Complete the questionnaire

  • Full name(exactly as in the passport in the requested order)
  • City/ Town, Country and Date of birth
  • Nationality
  • Passport number (all in capital letters)
  • Place of study (please keep the format as the name of the educational institution and full address. If you no longer study, you can confirm the place of the highest education achieved (college or university). “NA” is acceptable as well)
  • Current occupation (please keep the format as your position, name of the company and full address. It can be confirmed as student with the educational insitution’s address, retired, housewife, unemployed. If you are self-employed, confirm yourposition and home address in case you work from home)
  • Place of stay in Turmenistan: “In Transit” or “Transit only”, ”Camping”, “Ashgabat, Mary (in transit)”, “Grand Turkmen Hotel, Gorogly St. No 7 Ashgabat 74400”, etc.
  • Permanent address (keep the format)
  • Marital Status

2)Print it off

3)Glue a photograpg in designated place

4)That’s all. You must not sign the questionnaire as this is to be done by Real Russia representative

5)Post it to:

Real Russia Ltd
Unit 5, The Ivories
6 Northampton Street
N1 2HY, London

6)Thedeadlineforsubmittingtheoriginalquestionnaireaswellassendingotherrequiredinformation(includingafilledintableaspertheinstructionsontheCharityRallieswebpageandascannedcopyofyourpassportinformationpage)is1May2015.Pleasebearinmindthatwewillhaveonlyoneopportunitytoapplysoifyoumissthisdeadlinewewillnot beabletoobtainthe transitvisapermitforyou