ࡱ> 6  !"#$%&'()*+,-./012345789:;<Root Entry FeSjSummaryInformation(DocumentSummaryInformation8 hWordDocument{_  !"#$%&'()*+,-./0123456789:;<=>?@ABC Oh+'0   $ 0 <HPX`s~Ns~N1@@S/6O@q!@Rj@.a[Y={<WPS Office_10.1.0.7578_F1E327BC-269C-435d-A152-05C5408002CA ՜.+,D՜.+,HPXdlt | ' (\dlKSOProductBuildVer2052-10.1.0.75780Table Data WpsCustomData P3KSKS{_  8<Dk "  $Sh!2V "W D ,  I.M.-32 Photo 3uNgqGr (2.5x3.5cm) DEMOCRATIC SOCIALIST REPUBLIC OF SRI LANKA Form  B , Regulation 68 ȇpQaSqQTV APPLICATION FOR A VISIT VISA @b g&^*hv(uekXQ *Passport No. *Date of Expiry bgqSx gHeg *Date of Issue *Place of Issue ~{Seg ~{S0W Details of previous passports hold, if any gebgq,cO` *1.Name in Full Name of Father T Y *2.Nationality *3 (a). Date of Birth VM| Queg If nationalized, date and place of 3 (b) Place of Birth nationalization and former nationality Qu0W Y gVM|SR lfSRe00WpSSVM| 5.If married, where spouse is resident 4.Civil Status(Single ,Married, Widower, Widow or and full Postal Address divorcee) ]ZZMvPvOO@WS0W@W ZZYrQUS0]ZZ0yZZ 6. Applicant s height 3uNؚ 7.Any Identification Marks or Peculiarities *8.Applicant s address 3uNyr_ 3uN0W@W 8 (a). Profession *8 (b).During staying in Sri Lanka (WȇpQaSv0W@W LN 9.Profession or Occupation 10.Name and Address of employee, LMO if any USMO TyS0W@W 11.If in business where business is Y~FU Qf0W@W 12.Whether previously in Sri Lanka? If so, last place of residence and date of leaving NMR/f&T0RǏȇpQaS N!kSv0WpSyXeg Particulars of Visa or Residence Permit last obtained N!k~{bE\YuSv` 12a.If visa, give date of issue and period of validity ]_~{ lf~{SegT gHeg 12b .If Residence Permit, give date of issue, period of validity, permit No. and purpose of issue /fE\YuSQf~{Seg0 gHeg0SSxS~{SSV 13.Whether permission to visit Sri Lanka or to extend stay in Sri Lanka has been refused previously, if so, by whom and when or whether application has been made now or previously to any Sri Lanka visa office abroad? If so, full particulars and position of such application Yb~{Ǐ fSV *14. Object of present visit? vv 15. Route and mode of travel to Sri Lanka tȇpQaS~ *16. Period for which visit visa is required \PYue *17(a). Name and address of a person in Sri Lanka who can furnish information regarding applicant and security for maintenance and repatriation of the applicant, if so required: (WȇpQaST|NvY TSOO@W 17(b).Name and address of a responsible person in applicant s own country who can furnish information regarding applicant (W,gVT|NvY TS0W@W 18. How much money will the applicant have with him or have available for himself on arrival in Sri Lanka? tȇpQaS@b&^sёpe 19. Any other reason to urge in support of application 3u~{vvQNSV I hereby declare that to the best of my knowledge and belief the foregoing statements are true, that I shall not engage myself in any employment, paid or unpaid, on arrival in Sri Lanka and that I shall leave Sri Lanka before the date of expiry of the period of my authorized stay in the Island, I also undertake to notify the Controller of Immigration and Emigration, Colombo, immediately any change of my address while in Sri Lanka occurs. (WdkbXf@bkXQ[^\[ v^OYgyX ,gN(WȇpQaSXQ NNNNUORR]\O0Y(WȇpQaSgOO@Wf9e bOwy&OaWyl@\0 Dateeg Signature~{ T  PAGE  PAGE 2 FHJLTV`bx|~    4 j l n    d r ſ~zuqlhc\W 5o(\ 5>*o(\ 5o(\5o( 5o(\o(\ 5o(\o(\5o(\ CJaJ555o(5CJo(aJ5CJo(aJ5CJo(aJ5CJaJCJo(aJ5CJo(aJ5 CJaJ5CJo(aJ5 CJaJ5CJo(aJ5 5mH sH  5mH sH  5mH sH 5o(5o(5o(55"r  * , 4 ~ . d f h l J V }{wsqmkgo(\o(5o(55o(o(\o(o(>*o(>*>*o(o(>*o(o(o(o(5o(5o(\ >*o(\ >*o(\o(\\ 5o(\ 5o(\ 5>*o(\ 5o(\ 5>*o(\ 5o(\ 5o(\ 5o(\o(\ 5o(\o(\ 5o(\ 5o(\ 5>*\ 5>*o(\' (*2^`  8:@PRn6tvxo( B*ph B*pho(o(o(o(o(>*o(o(>*o(o(>*o(o(o(>*o(o(o(o(o(>*o(>*o(o(o(o(o(>*o(o(o(o(o(>*o(o(o(o(o(o(o(o(>*o(o(>*o(o(o(5o(55o(26TZ^LN@BLBNPhp~o(o(o(o(>*o(o(>*o(>*o(o(>*o(o(o(o(5o(5o(o(\o(>*>*>*o(>*o(o(>*o(>*o(o(o(5o(55o(5o(o(\o(o(B*pho(>*o(>*o(>*>*o(2(*.*,Z\`b\^  8~TV&~ " D F !!!!!!$"&""""¾>*o(>*o(o(o(o(o(o(>*o(>*o(o(o(o(o(mH sH o(o(o(>*o(o(o(>*o(o(>*o(o(>*o(o(>*o(o(>*o(>*o(o(o(o(o(>*o(>*o(o(>*o(o(>*o(o(o(>*o(2"""2$4$$$%v%x%z%%%%%J&L&P&R&&&&0'2'4'6'''''((((@)D)))******.+0++++~o(o(o(o(o(>*o(>*o(o(o(o(5o(o(5o(o(\o(o(>*o(o(o(o(5o(5o(\o(>*o(o( B*pho(o(o(o(>*o(o(5o(5o(5o(\o(>*o(o(o(o( CJo(aJo(o(0+2,4,8,:,,,- - -----.........0022222222*3n3p3r3v3x3333333333333o(0JU0JmHsHnHtHU0JU0JU0JUPJo(nHtHUo(o(>*o(o(>*o(o(o(o(o(o(o(o(o(o(>*o(>*o(o(o(o(o(>*o(>*o(o(o(o(o(o(>*o(>*o(2HJVbzda$$$If&da$$$If&da$$$If&da$$$If&da$$z|  n zl^PE dWDd` da$$WDd` da$$WDd` da$$WDd` da$$WDd`w$$If:V 44l44l0\ 6`qn  , f *`dT^TWD`dT^TWD`dT^TWD`dT^TWD`ddddddddd dWD4`4:RxNBzd^WD<~`~ddd dWD `dddT^TWD`dT^TWD`ddVD T^TWDj`dT^TWD`dT^TWD` P*,\^ Vdd^WDP`Pdddd dWD ` dddd^WD<~`~ dWD `d^WD<~`~d^WD<~`~V" F !!&""4$$x%%L&&2''()dddddddddddddddddd)**+4, --..222p3t3v3333  ! ! ! !&`#$ddd dWD`dddddddd333333d  ! ! ! !&`#$,. 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