韩国签证申请表(单次填写).doc

■ 出入境管理法 实行规则 [第17号样式]
签证发给申请表
APPLICATION FOR VISA

<申请表填写方法>
‣ 申请人须以事实为根据，并将在以下空格处完整记载。
‣ 申请人必须用中文或英文填写以下申请表。
‣ 在相关选项的“[ ]”内打钩。
‣ 如您选择“其他”，请写具体内容。
<How to fill out this form>
‣ You must fill out this form completely and correctly.
‣ You must write in block letters either in English or Korean.
‣ For multiple-choice questions, you must check [√] all that apply.
‣ If you select‘Other’, please provide us with more information in the given space.

1. 个人信息 / PERSONAL DETAILS
PHOTO
护照规格照片
(35㎜×45㎜)
6个月内拍摄的正面免冠
彩色相片，相片背景颜色
须为纯白色
A color photo taken within la
st 6 months(full face without
hat, front view against whit
e or off-white background)
1.1 护照上的英文姓名/Full name in English (as shown in your passport)
姓 Family Name
CAO
名 Given Names
LU
1.2 中文姓名 漢字姓名
曹璐
1.3 性别 Sex
男/Male[ ] 女/Female[ √ ]
1.4 出生日期 Date of Birth (yyyy/mm/dd)
1990/10/18
1.5 国籍 Nationality
中国
1.6 出生国 Country of Birth
中国
1.7 身份证号码 National Identity No.
350802199010181528
1.8 过去访韩时是否使用过其他姓名
Have you ever used any other names to enter or depart Korea?
否 No [√ ] 是 Yes [ ] → 选择‘是’选项时填写详细内容。 If‘Yes’please provide details
(姓 Family Name 名 GivenName )
1.9 是否双重国籍 Are you a citizen of more than one country ? 否 No [ √ ] 是 Yes [ ]
→选择‘是’选项时记载详细内容。 If‘Yes’please write the countries ( )

领馆审核栏 FOR OFFICIAL USE ONLY
기본사항
체류자격

체류기간
30D
유효기간

사증종류
S ▪ D ▪ M
접수사항
접수일자

접수번호

처리과

허가사항
허가일자

인정번호

고지사항

결 재
담당

가 [ ]
부 [ ]
심사의견>

< 邮票粘贴处>
<수입인지 부착란>
B/L:
출입국사항:
복수대상사유:
사건부:
불허경력:
기타:
2. 签证发给认定书签发信息（反签号） / DETAILS OF VISA ISSUANCE CONFIRMATION
※ 仅限于在大韩民国出入国管理事务所·办事处收到签证发给认定书的人
(Section 2 is only for those who possess confirmation of visa issuance issued by the Immigration Office of the Republic of Korea)
2.1 签证发给认定号码(反签号)
Confirmation No.

2.2 签发日期 Issue Date

2.3 护照号码 Passport No.

2.4 护照有效期Passport Expiry Date

‣ 签证发给认定书持有者直接移到第12部分(誓约)，填写以下空格后提交申请表(不用写第3~11部分)
Those who have confirmation of visa issuance must move to section 12 (Declaration) to complete this from (Those
with visa issuance confirmation must not fill out section 3~11).

3. 护照信息 / PASSPORT INFORMATION
3.1 护照种类　Passport Type
外交 Diplomatic [ ] 公务 Official [ ] 公务普通 Official [ ] 因私 Regular[√ ] 其他 Other [ ]
→ 如您选择‘其他’，请写具体内容 If‘Other’please provide details
( )
3.2 护照号码 Passport No.
G56758123
3.3签发国家 Country of Passport
中国
3.4 签发地点 Place of Issue
福建
3.5 签发日期 Date of Issue
2011/12/13
3.6 有效期间 Date Of Expiry
2021/12/12

3.7 是否持有其他护照 Do you have any other valid passport ? 否 No [√ ] 是 Yes [ ]
→ 如您选择‘是’，请写具体内容 If‘Yes’please provide details
a) 护照种类　Passport Type
外交 Diplomatic [ ] 公务 Official [ ] 公务普通 Official [ ] 因私 Regular[√ ] 其他 Other [ ]
b) 护照号码 Passport No.

c) 签发国家 Country of Passport

d) 有效期间 Date Of Expiry

4. 联系方式 / CONTACT INFORMATION
4.1 本国地址 Address in Your Home Country 上海市浦东新区海阳路1080号香樟苑14座402室
4.1 现居住地 Current Residential Address *仅限于现居住地与本国地址不同者 / Write if it is different from the above address

4.3 手机号码 Cell Phone No.
13262677660
4.4 固定电话 Telephone No.
021-50831209
4.5 电子邮箱 E-mail
amydew1@
4.6 紧急情况联系人信息 Emergency Contact Information
a) 姓名 Full Name 张琼仙
b) 居住国家 Country of residence 中国
c) 电话号码 Telephone No. 13860285328
d) 关系 Relationship to you 母女

5. 婚姻状况 / MARITAL STATUS DETAILS
5.1 婚姻状况 Current Marital Status
已婚 Married [ ] 离婚 Divorced [ ] 未婚 Single [√ ] 丧偶　Widowed [ ]
5.2 配偶个人信息 *标记为已婚时填写 If‘Married’please provide details of your spouse
a) 姓 Family Name (in English)

b) 名 Given Names (in English)

c) 出生日期 Date of Birth (yyyy/mm/dd)

d) 国籍 Nationality

e) 住址 Residential Address

f) 联系电话 Contact No.

6. 学历 / EDUCATION
6.1 最终学历 What is the highest degree or level of education you have completed ?
硕士/博士 Master’s/Doctoral Degree [√ ] 学士 Bachelor’s Degree [ ]
高中 High School Diploma [ ] 其他 Other [ ]
→ 如您选择“其他”，请写具体内容 If‘Other’please provide details ( )
6.2 学校名称 Name of School
旧金山大学
6.3 学校地址 Location of School(city/province/country)
美国加州旧金山

7. 职业 / EMPLOYMENT
7.1 职业 What are your current personal circumstances ?
企业家 Entrepreneur [ ] 个体经营 Self-Employed [ ] 职员 Employed [√ ]
公务员 Civil Servant [ ] 学生 Student [ ] 退休者 Retired [ ]
无职 Unemployed [ ] 其他 Other [ ]
→ 如您选择“其他”，请写具体内容 If‘Other’please provide details ( )
7.2. 职业详细信息 Employment Details
a) 单位/机构/学校（名称） Name of Company/Institute/School
招商证券股份有限公司
b) 职位/专业 Your Position/Course
财富顾问
c) 单位/机构/学校（地址） Address of Company/Institute/School
上海市浦东新区上南路3121号
d) 电话号码 Telephone No.
13262677660

8. 邀请人信息 / DETAILS OF SPONSOR
8.1 邀请人/邀请单位 Do you have anyone sponsoring you for the visa ?
否 No [ √ ] 是 Yes [ ] → 如您选择“有”，请写具体内容 If‘Yes’please provide details
a) 邀请人/邀请单位（名称 ）Name of your visa sponsor (Korean, foreign resident in Korea, company, or institute)

b) 出生日期/营业执照号码 Date of Birth/Business Registration No.

b) 关系 Relationship to you

d) 地址 Address

e) 电话号码 Phone No.

9. 访问信息 / DETAILS OF VISIT
9.1 赴韩目的 Purpose of Visit to Korea
观光/经由 Tourism/Transit [√ ]
参加会议/Meeting, Conference [ ]
医疗观光 Medical Tourism [ ]
短期商务 Business Trip [ ]
留学/研修 Study/Training [ ]
就业 Work [ ]
贸易/投资/派驻Trade/Investment/Intra
-Corporate Transferee [ ]
探亲Visiting
Family/Relat ives/Friends [ ]
结婚移民 Marriage Migrant [ ]
外交/公务 Diplomatic/Official [ ]
其他 Other [ ]

→ 如您选择“其他”，请写具体内容 If‘Other’please provide details ( )
9.2 预定停留时间Intended Period of Stay
7天
9.3 访韩预定日 Intended Date of Entry
2015.4.1
9.4 韩国联系地址(包括酒店) Address in Korea(including hotels)

9.5 韩国境内联系方式 Contact No. in Korea

9.6 最近5年内是否访问过韩国 Have you travelled to Korea in the last 5 years ?
否 No [ ] 是 Yes [ ] → 如您选择“是”，请写具体内容 If‘Yes’please provide details of any trips to Korea
( ) 次 times, 最近访韩目的 Purpose of Recent Visit ( )
9.7 最近5年内是否访问过其他国家（韩国除外）Have you travelled outside your country of residence, excluding to Korea, in the last
5 years ?
否 No [ ] 是 Yes [√ ] → 如您选择“是”，请写具体内容 If‘Yes’please provide details of these trips
国家 Name of Country
访问目的 Purpose of Visit
访问期间 Period of Stay
(yyyy/mm/dd)~ (yyyy/mm/dd)
美国
攻读硕士
2013.7.25-2014.9.22
泰国
旅游
2015.12.31-2016.1.4

9.8. 同行家属 Are you travelling to Korea with any family member ?
无 No [√ ] 有 Yes [ ] → 如您选择“有”，请写具体内容 If ‘Yes’ please provide details of the family members you are travelling with
姓名 Full name in English
出生日期 Date of Birth
(yyyy/mm/dd)
国籍
Nationality
关系 Relationship to you

* 参考: 家属范围 – 配偶, 子女, 父母, 兄弟姐妹
Note: Definition of a Family Member - your spouse, father, mother, children, brothers and sisters

10. 访问经费 / FUNDING DETAILS
10.1 访问经费(美元为基准) Estimated travel costs(in US dollars) 2000美元
10.2 访韩费用支付者 Who will pay for your travel-related expenses ? (any person including yourself and/or institute)
a) 姓名/单位名称 Name of Person/Company(Institute)
本人
b) 关系 Relationship to you

c) 支援内容 Type of Support

d) 联系电话 Contact No.

11. 填写申请表时是否接受过帮助 / ASSISTANCE WITH THIS FORM
11.1 您在填写申请表时是否接受过别人的帮助？Did you receive assistance in completing this form?
否[ √] No 是 Yes [ ] → 如您选择“是”，请写具体内容 If‘Yes’please provide details of the person who assisted you
姓名 Full Name
出生日期 Date of Birth
(yyyy/mm/dd)
联系电话 Telephone No.
关系
Relationship to you

12. 誓约 / DECLARATION
* 签证发给认定书持有者也须填写
Those who possess confirmation of visa issuance must only complete section 1,2, and 12 of this form
根据本人所知所信，我声明以上所有陈述均真实、准确、完整。我将遵守大韩民国的出入境管理法律法规。

I declare that the statements made in this application are true and correct to the best of my knowledge and belief,
and that I will comply with the Immigration Act of the Republic of Korea.
申请日期 (年. 月. 日) DATE OF APPLICATION (yyyy/mm/dd)
▪ ▪ ▪
申请人（签名） SIGNATURE OF APPLICANT

申请人未满17岁，父母或法定监护人签名
Signature of Parent or Legal Guardian´s for a person under 17 years of age

附件
ATTACHMENT
1. 「出入境管理法实行规则」 第76条第1项[表格 5]签证发给申请等附件

注意事项 Notice
1. 有关上述事项，本表如不够填写可另加附页或是追加提供相关材料。
If extra space is needed to complete any item, record on a separate sheet of paper or submit relevant documents which could
support your application.
2. 如您的大韩民国签证得到批准后因遗失、损毁等原因再次签发，必须通知签证处理机构变更的护照信息，以便准确反
映个人信息。
If you received Korean visa approval, and have new passport issued thereafter in lieu of lost/damaged passport, you must
notify the concerned visa office of changes in your passport information.
3. 申请人若在入境大韩民国时被发现是不许可入境者，即使持有韩国签证也无权入境。
Possession of a visa does not entitle the bearer to enter the Republic of Korea upon arrival at the port of entry if he/she is
found inadmissible.
4. 根据「出入境管理法施行规则」第9条第1项，C类签证持有者入境韩国后不得变更滞留资格。
Please note that category C visa holders are not able to change their status of stay after their entry into the Republic of Korea in
accordance with Article 9(1) of the Enforcement Regulations of the Immigration Act.

处理程序

填写申请表
Application
→
接受
Reception
→
审查
Review
→
批准
Approval
→
签发签证
Issuance
申请人
Applicant

处理机关
(驻外公馆)
Diplomatic Mission

处理机关
(驻外公馆)
Diplomatic Mission

处理机关
(驻外公馆)
Diplomatic Mission

处理机关
(驻外公馆)
Diplomatic Mission