Instruction for filling out Visa Application Form V.2011A

Section 1
1.1    Your name:   Surname is last name
Given name is first and middle name
1.2    Select your gender. 
1.3    Current Chinese name, if applicable. 
1.4    Prior Chinese name (pinyin), maiden, religious, professional,
aliases names, if applicable. 
1.5    Your name in your own language
(Chinese characters if born in China*). 
        *For previously adopted children, attach a copy of the
Chinese Passport picture/info page.
1.6    Your current nationality. 
1.7    Your former nationality, if applicable. 
1.8    Your other nationality/nationalities, if applicable. 
1.9    Date of your birth (yyyy-mm-dd). 
1.10   Name of your birth place (City, Province/State and Country). 
1.11   Your local identity card number (Drivers License or State ID)
leave blank for children. 
1.12   Your marital status. 
1.13   Your current occupation.  If your occupation is not listed,
check "Other" and specify. 
1.14   Type of your passport (most often "Ordinary"). 
1.15    Passport number. 
1.16    Passport issue date (yyyy-mm-dd). 
1.17    Passport issue place (put exactly what is written under the
word "Authority" in your U.S. passport). 
(normally US Dept of State, US Passport Agency, or a city name)
1.18    Passport expiration date (yyyy-mm-dd). 
1.19    Service turnaround (Regular, Express, Rush). 

Section 2
2.1     Select the purpose of your visit to China. 
If adopting check "Tourism" or
“Tourism” and “Other” and put Adoption. 
2.2    Select number of entries for this visa. 
Check Multi-Entry 12 months if your passport has over
15 months left on it (contact me if there are less than
9 months left on the passport). 
2.3    Date of your first entry for this trip (yyyy-mm-dd). 
If adopting, and do not know the travel date, just estimate. 
2.4    Longest intended stay of your visit in China. 
If adopting, put 30 days. 
2.5    Your residence/hotel names, addresses, phone numbers
during the visit in China. If adopting, put child's orphanage city on
line 1 and on line 2 put China Hotel – Guangzhou  ph: 20-866-66888
 (if you do not know where your agency will have you stay). No
need to list Beijing or Hong Kong, but you can still visit them.
2.6    List who will pay for your cost of traveling and living during
your stay in China. 
2.7    Answer whether you have medical insurance covering your
visit in China.  If "Yes", fill out the name of the medical
insurance company and your account number.
Not a problem if you put "No". 
2.8    Name, address and phone number of your inviter or contact
unit in China. If adopting put:
CCCWA – China Center of Children Welfare and Adoption 
             Beijing, China 
             ph: 010-655-45199. 
2.9    Name, address and phone number of your relative, friend or
contact person in China. If adopting, you can leave this blank.

Section 3
3.1    Your current home mailing address (no P.O. Box’s, exact address only). 
3.2    Your home phone number. 
3.3    Your mobile phone number, if applicable. 
3.4    Your email address, if applicable. 
3.5    Name, mailing address and phone number of your current
employer or school (no P.O. Box’s, exact address only). 
3.6    Information for the family members living in your home. 
(if you live alone, you must list another family members info).
3.7    Your contact person in case of emergency while in China. 
3.8    Your contact person’s phone number.

Section 4
4.1    List date (yyyy-mm), city and purpose of prior visit(s) to China.
4.2    List date (yyyy-mm), name of other countries or territories,
you have visited in the last 12 months. 
4.3   Select "Yes" or "No" if you have ever overstayed your visa or
residence permit in China. 
4.4   Select "Yes" or "No" if you have ever been refused a visa or
refused entry into China. 
4.5   Select "Yes" or "No" if you have any criminal record in China
or any other country. 
4.6   Select "Yes" or "No" if you are affiliated with any of the
following diseases. 
4.7   Select "Yes" or "No" if you visited countries or territories
infected by infectious diseases in the last 30 days. 
4.8   If you select "Yes" to any questions from 4.3-4.7, give details. 

Section 5
5.1    If you are seeking to work or study in China, or if someone
else traveling with you who shares the same passport with
you, or if you are making this visa application in a country or
territory other than the country of your nationality, fill out
the "Supplementary Visa Application Form" (Form V.2011B)
and submit with this application form. 
5.2   If you have more information about your visa application to
declare, give details. 

Section 6
6.1    Read and understand all the questions on this application
form, and be fully responsible for the answers and the photo,
which are true and correct. 
6.2   Read and understand provisions of the application. Sign and
date (if application is for a minor child, skip section 6 and fill
out section 7. 

Section 7 If this application form is completed by another person
on the applicant’s behalf (mostly for children), complete
section 7:
7.1    Name of the person who completed this application form. 
7.2   Relationship to the applicant of the person who completed
this application form. 
7.3   Address of the person who completed this application form. 
7.4   Phone number of the person who completed this application
form. 
7.5   Type of ID document of the person who completed this
application form (Drivers License or State issued ID). 
7.6   ID number (Drivers License or State issued ID) of the person
who completed this application form. 
7.7   Signature and date (yyyy-mm-dd) of the person who
completed this application.

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