以色列签证申请表

State of Israel以色列国

申请表填写说明:

Photo照片 Application for entry visa to Israel签证申请表

Instructions for completing application form： 1. Please attach a recent ID photograph.。

2. If application is not for the purpose of visit, specify reasons and supply documentation.

3. Please fill in following details in Hebrew or English.

1. 请附一张近期护照照片.

2. 如申请不是为了访问以色列，请详述申请

原因，并递交相关材料.

3. 请用希伯来文或英文填写表格.

Given name 名 Family name 姓

Previous family name 曾用名

Previous nationality 曾有国籍

□ Passport 护照 □ Laissez passer 临时护照 valid until Issued on Issued at 有效期至 签发时间 签发地点 Family status 家庭状况 Number 号码 In English英文 □ married已婚 □ single未婚 □ widowed丧偶 □ divorced离异 Purpose of entry into Israel 进入以色列的目的 Present nationality 现国籍 Occupation 职业 Date of birth 出生日期 Place of birth 出生地点 Mother’s name 母亲姓名 Father’s name 父亲姓名 If you hold a Laissez-Passer issued by the State of your permanent residence, state whether you have a return visa and indicate its validity.若持永久居留国签发的临时护照，请说明是否具有回程签证及有效期。

telephone no. 电话

Countries of transit 中转国 Approximate duration of stay 拟停留期限 Anticipated date and place of entry to Israel 入境日期及地点 permanent address abroad 中国/他国永久地址 Street and house no. Province/City Country 街道及房号 省/市 国家 Address in Israel 在以色列地址 Category of previous residence permit in Israel (visitor, student, tourist, temporary resident, resident, immigrant, work)曾在以色列居留许可类型（访问者、学生签证、旅游签证、临时居民、居民、移民、工作签证）

Dates of previous stays in Israel 曾在以色列停留日期

particulars of dependants included in the application

Date of birth 出生日期

Children under the age of 18

Date of birth 出生日期

Relation/references in Israel Address地址

Declaration

I declare that the particulars contained in this application are correct and have been made in awareness of the fact that they are to serve as basis for the consideration of my application. I also declare that I have not committed any criminal offence or any act directed against the Jewish people or the security of the state of Israel and that I am not affected with any illness which might endanger public health. There is no judicial warrant against me and I am not wanted by the police of any country. 我声明，本申请表中所填内容属实，并将作为审核我申请的依据。我还声明， 我无犯罪记录也没有针对犹太人或以色列国安全的任何行为。我无任何危害公众健康的疾病。我没有受到司法缉捕，也未被任何国家警方通缉。 I hereby declare that I have not been issued with a restraining order. Furthermore, I have not been denied entry into Israel. I am aware that if a preventive order of this kind has been issued against me, I will be denied entry into Israel, and will be sent back to my country of origin. 我声明，我没有受到出行限制，也未曾被以色列拒签入境。我知道，如对我有此类限制令，我将会被以色列拒签入境，并被遣送回原籍国。 I am also aware that the receipt of a visa does not in any way invalidate the right of the Israel Ministry of the Interior to deny my entry into the territory of the State of Israel, if it becomes clear that the visa was issued on the basis of false information. 我知道，如查明发给我的签证是基于虚假信息，以色列内务部仍将有权拒绝我进入以色列国领土。

Applicant’s signature

申请人签名

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Date 日期

Place 地点

声明 以色列联系人/亲属 Relationship关系 Name 姓名 .1 Place of birth 出生地点 Given name 姓名 .1 18岁以下儿童 place of birth 出生地点 Spouse father’s name 父亲姓名 配偶 maiden name 婚前姓名 given name 名 family name 姓 申请人随行家属详细情况

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