FEDERAL REPUBLIC OF NIGERIA1M M/22
RESIDENCY / STR VISA APPLICATION FORM
IMPORTANT NOTICEVISA NO......
Your application may be rejected if the form is incorrectly filled. If wrong information is given, or if relevant sections are left incomplete.
1.Family Name (Mr/Mrs/Miss)...... Other .mes......
(in block letters)
2.Former Names (if married woman, insert maiden name) and Aliases ......
3.Sex......
4.Present Nationality...... Have you had other nationality before? If so state ..
5.Place of birth (city, country)......
6.Date of birth (state date, month, year)......
7.Residence Address (office, street, city, telephone)......
8.Official Address (office, street, city, telephone)......
' 9.Profession...... For how long have you been exercising this profession?
10.State what branches of the Armed Forces of your country you have served in or are serving......
(a) Army, Navy, Airforce (b) Regiment
(c)Duration of service...... from...... to......
(d)Last rank before retirement or discharge......
12.Any visible mark of Identification?......
13.
14.Type of visa required/visitors or Residence......
15.Date of last visit (if any) to Nigeria and address at which you stayed ......
16.Propose date of travel ......
17.If you are taking up an employment please fill in this section:
Name of Employer and full businessaddress (P.O. Box not accepted) / Employment / Duration
18.Please give in the space below a full description of the job you will be handling ......
19. If you are joining spouse, parents or relatives, please give their names and particulars of their employment in Nigeria
including the full address of their residence......
20.If you are not visiting spouse, parents, or relatives, please indicate place of residence......
21.Your reference in Nigeria (Names, addresses and positions) ......
22.Have you obtained his/her/their written permission to cite him/her/them as references') Show evidence ......
23.Sate where and approximately when you last applied for a Nigerian Visa / Entry Permit ......
24.Indicate whethervisa was grantedrejectedno reply
25.How long have you lived in the country where you are applying for a Visa / Entry Permit
26. Give a list of the countries you have lived in for more than a year during the last five years
27.Which countries have you visited during the last twelve months?
Countries / CitiesDatesI understand that I will be required to comply with the Immigration / Alien and other laws governing entry of immigrants into the country for which I now apply for a Visa / Entry Permit.
Date...... / Signature......APPLICANT / CHILDREN ENDORSED IN APPLICANTS PASSPORT
Photo / Photo / Photo
Date / Remarks (For Official Use Only)
FGP 01.1832