Visa Application form for Nepal (Please fill in capital letters)

The Ambassador Embassy of Nepal Brussels, Belgium As I have to visit or would like to visit Nepal, I request for issuance of a tourist/official/diplomatic visa to Nepal. My details are as follows : 1. First Name: …………………………………Family Name : …………..…………………. 2. Nationality: …………………………….. 3. Occupation : …………………………………. 4. Place of birth: ………………………………. 5. Date of birth: …………………………….. 6. Permanent Address: …………………………………………………………………………. Post Code : ………………………………. City………………………………………….. 7. Temporary Address in Nepal:………………………………………………………………... 8. Passport number: …………………………………… 9. Date of issue: ……………………………………….. 10. Date of expiry: ……………………………………. 11. Purpose of visit in Nepal: …………………………………………………………………... 12. Length of probable stay in Nepal: ……………………………..day/s 13. Date of arrival in Nepal: ……………………………………………………………... 14. Number of previous visits to Nepal : ……………………………… 15. Last visit in Nepal: from…………………………... to ………………................................. 16. Telephone no: …………………………… Email: ………………………………………… Signature of the applicant ……………………………….. date ………………………………..

For official use only

1. Type of visa: …................................... 2. Visa sticker number: ………………………….. 3. Receipt number: …………………….. 4. Date of issue: …………………………………..

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