VISA APPLICATION FORM 1. Nationality (if you formerly had USSR or Russian citizenship, please indicate when and why you lost it). 2. Surname (as in passport). 3. First name, other names, patronimic (as in passport). 4. Date of birth (dd/mm/yyyy). 5. Sex. 6. Passport. Type of passport: Passport No: Issued by: Date of issue: Valid until: 7. Purpose of visit. 8. Category and type of visa. 9. Number of entries. 10. Date of arrival and departure. 11. Host organisation you intend to visit. Company name: Reference No: Confirmation No: Address: 12. Route of journey (destination points). Photograph and signature. Service information (automatically generated). Application form recipient: RNVB 20002023945723 Basis (voucher, dir. No, inv. No): The estimated date of visit to the RC: Application No (web-site): The date of processing: Application No (VAC): The date of processing by the VAC: Request No in Russian Consulate (RC): Date (dd/mm/yyyy), personal signature I hereby agree to the processing and transfer of my personal data in electronic form for the purposes of making a decision on visa issuance. I declare that data provided in the application form are full and correct. I am aware that any false information may be a cause for the denial of visa or for the cancellation of the previously issued visa and may lead to other consequences provided for by the legislation of the Russian Federation. Subject to the receipt of visa, I pledge to leave the territory of the Russian Federation before the visa expiration date. I am aware that valid visa does not automatically allow to enter the territory of the Russian Federation. In case of denial of entry, I will not seek any compensation for potential losses. Page 1 of 5
13. Your permanent address, telephone number, fax number, E-mail. 14. Social networks. 14.1. Do you have a social network account? 15. Current/latest place of work. Type of job: Company name: Position: Company address: Company telephone number: Company e-mail: Term of employment: Your work telephone number, fax number and email address: 16. Your previous visits to Russia. 16.1. Have you visited Russia in the last 10 years? Dates of visit, Purpose of visit: 17. Information about your previous trips abroad. Have you travelled abroad in the last 10 years? Country, Dates of visit, Purpose of visit: 18. Temporary residence permit (TRP) in Russia Have you ever been issued a TRP? 19. Permanent residence permit (PRP) in Russia. Are you planning to apply for a PRP in 20. Payment for trip to Russia. Who is paying for your trip to 21. Information about your financial situation. Your overall monthly income from all sources: Do you have any other sources of income including relatives and friends? Do you have any bank accounts, securities, stocks, other private property, including those in Total amount of money you are planning to spend for this trip/ stay/ visit to How much of this amount are you planning to spend on accommodation and food? 22. Information about medical insurance. 22.1. Do you have National Insurance Number? National insurance number: Page 2 of 5
22.2. Policy of mandatory medical insurance (MMI) issued in Russia. Have you ever been issued a MMI? 23. Additional information about you. 23.1. You previously received a British passport? Details of your previous passports over the last 10 years, including where these passports are now. Passport number, Issuing authority, Date of issue, Date of expiry, Passport status: 23.2. Information about nationality of other country or countries, details of passports or travel documents previously issued by these countries. Do you hold or have you ever held any other nationality or nationalities? 23.3. Information about changing surname or name (names). Have you ever changed your surname, name (names)? Other names you have been using before marriage (nicknames, religious titles, etc.): 23.4. Information about country and birth place Country of birth: Place of birth: 23.5. Information about emigration from the USSR or from Russia. Were you born in the USSR or 23.6. Information about marital status. Marital status: 23.7. Information about employment in organizations (governmental or nongovernmental) of the following categories: armed forces, government or municipal administration authorities, judicial authorities, law-enforcement authorities, private security companies. Have you ever worked at any of such organizations? 23.8. Information about involvement in armed conflicts. Have you ever been involved in any armed conflicts, have you ever taken part in or been a victim of any military actions? 23.9. Arrest or convictions at any crimes. Have you ever been under arrest or do you have any criminal convictions? 23.10. Information about refusals of visas to Russia or any other country. Have you ever been refused a Russian visa or visa to any other country? Page 3 of 5
23.11. Information about refusals to cross Russian border. Have you been refused entry to Russia on arrival? 23.12. Information about deportation from Russia or any other country. Have you ever been deported or removed from Russia or any other country? 23.13. Have you ever been suspected of any war crimes or crimes against humanity? 23.14. Have you ever been a member of an organization recognized as terrorist organization? 23.15. Have you ever by any means publicly expressed views that justify or glorify terrorist or extremist activities? 23.16. Have you ever by any means publicly declared for dismantling the constitutional system or territorial integrity of the Russian Federation? 23.17. Have you ever been charged with criminal or administrative offence (including traffic violation) in Russia or in any other country? 23.18. Have you ever broken migration laws and regulations of Russia or of any other country? 23.19. Have you ever had transmissible infectious diseases or suffered psychiatric or mental disorders dangerous to society? 23.20. Have you ever used drugs or have been a drug addict? 23.21. Russian language skills. Do you speak Russian? Level of Russian language skills: 24. Information about children. 24.1. Do you have children? 25. Information about children accompanied by you (Provide full details). 25.1. Will you accompany any children? 26. Information about your parents. 26.1. Your father. Surname: Name (names): Date, country and place of birth: Nationality: Is your father alive? Page 4 of 5
26.2. Your mother. Surname: Name (names): Date, country and place of birth: Nationality: Is your mother alive? 27. Information about your relatives in Russia. 27.1. Do you currently have any relatives in 28. Information about places of your stay during you visit to Russia. 28.1. Do you plan to stay anywhere (hotel, individual) during your stay in 29. Information about completing the application form. Have you completed this application form personally? Page 5 of 5