Ambassade du Burkina Faso à Copenhague
Svanemøllevej 20
2100 Copenhague Ø - DANEMARK
Tél; : (45) 39 18 40 22 - Fax : (45) 39 27 18 86
E-mail : mail@ambaburkina.dk
| Ambassade du Burkina Faso à Copenhague Svanemøllevej 20 2100 Copenhague Ø - DANEMARK Tél; : (45) 39 18 40 22 - Fax : (45) 39 27 18 86 E-mail : mail@ambaburkina.dk | |
Name ....................................... Christian names.......................................
Date and place of birth............................................................................
Nationality........................................Profession .....................................
Home address.......................................................................................
............................... .....................Tel.nr........................................
Office address.....................................................................................
.....................................................Tel.nr........................................
Type of passport......................... Passport number..........................................
Issued at.................. on..................Expiry date........................................
Issued by..........................................................................................
Type of Visa required :--Short visit--Long visit--Diplomatic--Cooperation--Others
Reason for voyage...............................Method of transport................................
Date of arrival.............. Length of stay.............Number of entries.........................
Address in Burkina Faso............................................................................
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I hereby accept that I will take no form of paid employment, nor work as an au pair during my visit to Burkina Faso, nor to attempt to seek permanent residence. Furthermore I declare that I will leave the territory of Burkina at the expiration of my visa, provided that such is granted to me.
I sign this application in the acceptance that in the event of any false declaration that I will be subject of the due processes of the law, and that in the case of any false declaration or omission, that any future application for a visa will be refused. |
Signed at.........................on.............. Signature......................................
RESERVE AU SERVICE CONSULAIRE
No.Visa accordé.............................Nombre d'entrées............Date...................