SAMPLE VISA APPLICATION FORM TO ENTER JAPAN Smith Sallie May Different name used N/A Name in full Date & place of birth 01/01/1979 Philadelphia, PA Sex Female married Marital status USA single √ United States of America Nationality or citizenship Former nationality, if any N/A Study Purpose of journey to Japan Length of stay intended 6 months Route of present journey: Probable date of entry 01/08/12 Port of entry Narita Name of ship or airline Continental Airlines Passport (...) United States (if dual, list the one used on your COE application) No. 1234567 CIRCLE “Ordinary” Issued at New Orleans on 05/15/2006 Issuing Authority United States Passport Agency Valid until 05/14/2016 NEWER PASSPORTS are usually just “Dept. of State” b/c no city is listed. Criminal record, if any None Home Address 123 Main Street, Apt. 1 Philadelphia, PA 19111 Profession or occupation Tel 215-555-5555 Student Name and address of firm or organization Temple University Law Program in Japan 4-1-27 Mita Hall, Minato-ku, Tokyo 108-0073, Japan Telephone: 81-3-5441-9841 Post or rank held at present Student Principal former positions Student Address of hotels (list your own accommodation if arranged, or see list for short-term housing, or list TUJ as last resort) Dates / durations of previous stays in Japan 07/23/2004 – 07/31/2004 CIRCLE “Reference” in Japan Name: Sumi Sakata Address Temple University Law Program in Japan, 4-1-27 Mita Hall, Minato-ku, Tokyo 108-0073, Japan Telephone 03-5441-9841 Relationship to applicant Professor and Program Director [SAMPLE –ENGLISH-] (Paste a photo here) VISA APPLICATION FORM TO ENTER JAPAN Name in full approx. 45mm ×45mm Please print. KNEDDY (Surname) 2in×2in Surname should be capitalized. John Firzgeraid (Given and middle name) none Different name used, if any Date and place of birth Sex 15 April (Day) Male (Year) Yorkshire (City) Marital status: married Nationality or citizenship United Kingdom (Province) × (Country) single Please paste a photo here. (Do America Former nationality, if any NOT staple.) United Kingdom Purpose of journey to Japan to visit relatives Length of stay in Japan intended 15 days Route of present journey : Probable date of entry Port of entry into Japan Narita AP Please clarify as concrete as The photo should be clear and possible. identifiable, taken within the last 6 months. May 25, 2007 Name of ship or airline JAL-006 (Refugee or stateless should note the title of Travel Document) Passport No. : Skipton 1970 (Month) A11223344 Diplomatic, Official, Ordinary Issued at Issuing authority Criminal record, if any Home address U.S.Dept. of State Valid until Boston on March 10,2007 March 10, 2012 If not applicable, please write “none” or “N/A”. none 321 East Maple Street, Los Angeles, California 90012, United States of America Tel.start from the area code.) Please write accurately. (Phone numbers should Profession or occupation Company Employee Please write accurately. Name and address of firm or organization to which applicant belongs America Trade Inc. 654 Park, Avenue, New York , N. Y. 10171, U. S. A. Tel. (212) 333-8888(Phone numbers should start from the area code.) Post or rank held at present Assistant Director Principal former positions Section Chief Please writeProfession/occupation accurately. ＊Partner’s (or Parents’ Profession/occupation) In case the applicant is a dependant. (Phone numbers start the area code.)with whom applicant intends to stay Address of hotelsshould or names andfrom addresses of persons Hotel Kayu Kaikan, 8-1, Sanbancho, Chiyoda-ku, Tokyo 102 (03)3230-1230 Please write accurately. Dates and duration of previous stays in Japan February 4 – April 3, 2007, 3 month Guarantor or reference in Japan : Name Mr. Roberr Taylor Address 2-2-1, Kasumigaseki, Chiyoda-ku, Tokyo 100 Relationship to applicant (Phone numbers should Tel. start from the area code.) (03)3230-1111 brother in law ＊(Remarks) Special circumstances, if any In case the applicant has humanitarian reasons should be considered. I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to be granted are decided by the Japanese immigration authorities upon my arrival. I understand that possession of a visa does not entitle the bearer to enter Japan upon arrival at port of entry if he or she is found inadmissible. Date of application 25 (Day) *These items are not essential to be filled April (Month) 2007 (Year) Signature of applicant KNEDDY In case of an infant, parents or a legal representative can sign here. Please indicate the relationship. (eg. Signed by mother)