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Uganda Visa Form

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THE REPUBLIC OF UGANDA

VISA APPLICATION

SERIAL NO. …………………………………………………… (For official use only; please do not write in this space)

1. Family Name: ……………………………………………………………………………………………………................................

2. Other names: …………………………………………………………………………………………………………………………..

3. Former Name(s): ……………………………………………………………………………………………………………………...

4. Address/Telephone

a. Permanent Address: ………………………………………………………………………………………………

………………………………………………………………………………………………

b. Present Address: ……………………………………………………………………………………………..

………………………………………………………………………………………………

c. Telephone No (s): Home: (………) ……………….………… Work: (………) ………………..…………

d. E-mail: ………………………………………………………………………………………………

5. Nationality ……………………………………………………………………………………………………………………………..

6. Date and Place of Birth ………………………………………………………………………………………………………………


Day/Month/Year Place

7. Marital Status: (check/tick one): Married Single Divorced

8. Other family members accompanying applicant: (complete appropriate line/s)

Name Date of Birth Place of Birth

Spouse……………………………………………………………………………………………………………………………………..

Child……………………………………………………………………………………………………………………………………….

Child……………………………………………………………………………………………………………………………………….

Child……………………………………………………………………………………………………………………………………….

9. Passport No:…………………………………… Issued at:……………………………………………...On……………………….

Type (check/tic one) Diplomatic Official Ordinary

10. Type of Visa required (check/tick one)

Transit Single Entry Multiple Entry (Six Months) Multiple Entry (12 Months)

Form J 6/01 Side one


11. Proposed Date of Arrival: ……………………………………………………………………………
Day/Month/Year

Duration of Stay: ………………………………………………………………………………………….

9. Reason for Journey: …………………………………………………………………………………………………………………..

10. Date(s) of any Previous Visit(s): ………………………………………………………………………………………………….

a. If in transit, ultimate destination: ……………………………………………………………………………………….

b. Has a VISA been obtained for Country of Destination? …………………………………………………………….

11. Any contact person in the Country of which VISA is applied:

a. Name(s): …………………………………………………………………………………………………………………...
First Last

b. Phone: ……………………………………………………………………………….

12. The full address in Uganda where you intend to stay: …………………………………………………………………………

………………………………………………………………………………………………………………………………………………

Applicant(s) Signature: ………………………………………………………………….. Date: ……………..…………….20……

Form J 6/01 Side two

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