Application for Tourist Visa

Name (Last, First)Nationality

AddressPassport No.

CityExpiration Date

Zip CodeTelephone

Height Weight

Eye Color Hair ColorDistinguishing Marks

Profession

Employer's Name

Employer's Address

City

StateZip CodeTelephone

______________________________
Name of Hotel or Residence while in HaitiApplicant's Signature

Address

City ______________________________
Registration No. (for official use only)