Embassy of the Russian Federation in NepalVISA APPLICATION IMPORTANT! Please type or print using ballpoint pen I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will lead to my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the legislation of the Russian Federation. I undertake to leave the territory of the Russian Federation upon the expiry of the visa, if granted/ I am aware that the fact that a visa has been granted to me does not mean that I will be entitled to enter the territory of the Russian Federation, if any reasons are appear. In a case of refusal of entry I do not have a right to compensation of damage. ^ 1. Present citizenship (if you formerly had USSR or Russiancitizenship, please indicate when and why you lost it) ^ Last name (as in passport, in capital letters) ^ 3. First and middle names (as in passport) ^ 4. Other names ever used (maiden name, pen-name, holy orders, etc.) ^ 5. Place of birth (if born in Russia, please indicate when and to what country you emigrated) ^ 6. Date of birth (DD/MM/YY) 7. Sex M F ^ 8. Purpose of visit official tourism medical business private cultural sports other, please specify ^ 9. Russian institution or organization to be visited (name and address,phone, fax number, E-mail, name of contact person) **10. Itinerary (places to be visited) ^ 11. Date of entry (DD/MM/YY) 12. Date of departure (DD/MM/YY) ^ 13. Number of entries 1 2 multiple 14. Passport No Issued by ^ Date of issue ^ Valid until ^ 15.Type of passport diplomatic оfficial tourist seaman’s passport alien’s travel document other (please specify) **16. Name and reference number of the tourist group **17.Do you have а medical insurance policy valid in Russia (please specify)? ^ 18. Who will pay for your trip to and stay in Russia? ^ 19. Marital status мarried single (never married) divorced separated widowed ^ 20. Spouse’s full name (even if divorced or separated, please indicate maiden name if applicable) 21.Spouse’s date of birth (dd/mm/yy) ^ 22. Spouse’s place of birth **23. Your father’s full name **24. Your mother’s full name ^ 25. Have you ever been issued a Russian visa? Yes When? Where? No **26. Has your passport ever been lost or stolen? Yes No **27. List all countries you have visited in the last ten years and indicate the year of visit **28. List all countries which have ever issued you a passport **29. List your last two places of work, excluding the current one 1. Name ^ Phone number Address ^ Your chief’s surname ^ Your position ^ Dates of joining - dismissal 2. Name ^ Phone number Address ^ Your chief’s surname ^ Your position ^ Dates of joining - dismissal **30. List all educational institutions you ever attended, except high schools Name ^ Address and phone number ^ Course of study ^ Dates of admission and graduation Name ^ Address and phone number ^ Course of study ^ Dates of admission and graduation **31. List all professional, civil and charity organizations which you are (were) a member of or contribute (contributed) or cooperate (cooperated) with **32. Do you have any specialized skills, training or experience related to fire-arms and explosives or to nuclear, biological or chemical activities? If «Yes», please explain **33. Have you ever performed a military service? If «Yes», indicate the country, branch of service, rank, military occupation and dates of service **34. Have you ever been involved in an armed conflict, either as a member of the military service or a victim? If «Yes», please explain ^ 35. Is any of your relatives mentioned below staying in Russia now? Is he (she) a permanent resident or citizen of Russia? If «Yes», indicatethat person’s full name, address and status in Russia (citizen of Russia, permanent or temporary resident, visiting, studying, working, etc Husband/Wife Father/Mother Brother/Sister Bridegroom/Bride Son/Daughter ^ 36. IMPORTANT! EACH APPLICANT MUST READ AND GIVE ANSWERS TO THE FOLOWING QUESTIONSA visa may not be issued to persons belonging to specific categories, defined by the Law as undesirable, except in cases when a waiver has been obtained in advance. ^ Have you ever been arrested or convicted for any offence? Yes When? Where? No ^ Have you ever been sick with a communicable disease of risk for the public or suffered a dangerous physical or mental disorder? ^ Have you ever abused drugs or been a drug-addict? Yes No ^ Have you ever been refused a Russian visa? Yes When? Where? No ^ Has your Russian visa ever been canceled? Yes When? Where? No ^ Have you ever tried to obtain or assisted others to obtain a Russian visa or enter Russia by providing misleading or false information? Yes No ^ Have you ever overstayed your Russian visa or stayed unlawfully in Russia? Yes No ^ Have you ever been deported from Russia? Yes When? Where? No ^ While an affirmative answer does not automatically mean ineligibility for a visa, if you answered «Yes»you will have to appear in person before a Consular officer. 37. Your permanent address, phone, fax number and E-mail address ^ 38. Place of work or study (name, address, phone and fax number, E-mail address), present position Place forphotograph ^ 40. Has anyone assisted you in completing this application form? If «Yes», have the assisting person complete item 41 Yes No ^ 41. Application completed by Name ^ Relationship to applicant Address ^ 39. Name, address and phone number of person or hotel in Russia that you plan to stay with Applicant’s signature, Date Signature of person completing the form, Date ** - Not to be filled by holders of diplomatic and official passports