ﺳﻔﺎرة ﻟــﯾﺑﯾــﺎ Entry Visa Application

2600 Virginia Ave., N.W, Suite # 705, Washington, D.C. 20037 • Tel: (202) 944-9601 • Fax: (202) 944-9606

ﺎــﻴﺒﻴــﻟ ﺓﺭﺎﻔﺳ

ﻦﻄﻨﺷﺍﻭ

Embassy of Libya

Washington, D.C.

Entry Visa Application

In case entry purpose is mission/work/study/visit ﻝﻮﺧﺪﻟﺍ ﻦﻣ ﺽﺮﻐﻟﺍ ﻥﺎﻛ ﺍﺫﺇ

give name and address of concerned body /ﺔﺳﺍﺭﺪﻠﻟ/ﻞﻤﻌﻠﻟ/ﺔﻤﻬﻤﻠﻟ

ﺎﻬﻓﺮﻄﺑ ﻥﻮﻜﺘﺳ ﻲﺘﻟﺍ ﺔﻬﺠﻟﺍ ﺩﺪﺤﺗ

Enclosed Documents: :ﺐﻠﻄﻟﺍ ﺪﻳﺆﺗ ﻲﺘﻟﺍ ﺕﺍﺪﻨﺘﺴﻤﻟﺍ ﻲﻫﺎﻣ

Have you ever been to Libya: :ﺎﻴﺒﻴﻟ ﻰﻟﺇ ﻝﻮﺧﺪﻟﺍ ﻚﻟ ﻖﺒﺳ ﻞﻫ

Last Departure Date: ﺎﻬﺗﺭﺩﺎﻏ ﻰﺘﻣ When : ﻰﺘﻣ

Purpose: : ﺓﺭﺎﻳﺰﻟﺍ ﺽﺮﻏ

Last Address in Libya: : ﻠﺑ ﻪﺑ ﺖﻤﻗﺃ ﻥﺍﻮﻨﻋ ﺮﺧﺃﻴﺎﻴﺒ

Indicate whether said entry was for work or ﺔﻤﻬﻤﻟﺍ ﻭﺃ ﻞﻤﻌﻟﺍ ﺽﺮﻐﻟ ﻝﻮﺧﺪﻟﺍ ﻥﺎﻛ ﺍﺫﺇ

on mission - indicate nature of work or mission:

: ﺔﻤﻬﻤﻟﺍ ﻭﺃ ﻞﻤﻌﻟﺍ ﻉﻮﻧ ﺩﺪﺣ

Indicate destination in case of ﺭﻭﺮﻣ ﺽﺮﻐﻟﺍ ﻥﺎﻛ ﺍﺫﺇ

transit: : ﺪﺼﻘﺗ ﻱﺬﻟﺍ ﺪﻠﺒﻟﺍ ﺩﺪﺣ ﻩ

Means of Travel: : ﻪﻴﻟﺇ ﺮﻔﺴﻟﺍ ﺔﻄﺳﺍﻭ

References in Libya: ﺎﻴﺒﻴﻠﺑ ءﺎﻗﺪﺻﻷﺍ ﻭ ﻑﺭﺎﻌﻤﻟﺍ ﻢﻫﺃ

Applicant's Signature: : ﺐﻠﻄﻟﺍ ﻊﻴﻗﻮﺗ

Receiver's Signature: : ﻢﻠﺘﺴﻤﻟﺍ ﻊﻴﻗﻮﺗ

Date : : ﺦﻳﺭﺎﺘﻟﺍ

FIRST: Application's Personal Particulars ﺃﻻﻭ/ ﻝﻮﺧﺪﻟﺍ ﺓﺮﻴﺷﺄﺗ ﺐﻠﻁ ﻦﻋ ﺔﻴﺼﺨﺷ ﺕﺎﻧﺎﻴﺑ

Name in Full: : ﻲﺛﻼﺜﻟﺍ ﻢﺳﻻﺍ

Family name: : ﺐﻘﻠﻟﺍ

Place & Date of birth: :ﺩﻼﻴﻤﻟﺍ ﺦﻳﺭﺎﺗ ﻭ ﻥﺎﻜﻣ

Former Nationality: : ﺔﻘﺑﺎﺴﻟﺍ ﺔﻴﺴﻨﺠﻟﺍ Present Nationality: : ﺔﻴﻟﺎﺤﻟﺍ ﺔﻴﺴﻨﺠﻟﺍ

Occupation: : ﺔﻨﻬﻤﻟﺍ

Qualifications: : ﻞﻫﺆﻤﻟﺍ Sex: : ﺮﻛﺫ/ ﻰﺜﻧﺃ

Phone: : ﻒﺗﺎﻬﻟﺍ ﻢﻗﺭ Religion: : ﺔﻧﺎﻳﺪﻟﺍ

Father's name in full: : ﻲﺛﻼﺛ ﺏﻷﺍ ﻢﺳﺍ

Mother's name in full: : ﻲﺛﻼﺛ ﻡﻷﺍ ﻢﺳﺍ

Social status: single/married/divorced/widow: :ﻲﻠﺋﺎﻌﻟﺍ ﻊﺿﻮﻟﺍ

Present Address: :ﻙﺩﻼﺑ ﻲﻓ ﻥﺍﻮﻨﻌﻟﺍ

Issued on: : ﻩﺭﺍﺪﺻﺇ ﺦﻳﺭﺎﺗ Passport: : ﺮﻔﺴﻟﺍ ﺯﺍﻮﺟ ﻢﻗﺭ

Valid to: : ﻪﺘﻴﺣﻼﺻ ءﺎﻬﺘﻧﺍ ﺦﻳﺭﺎﺗ

SECOND: General Information ﺎﻴﻧﺎﺛ/ﺔﻣﺎﻋ ﺕﺎﻣﻮﻠﻌﻣ

Purpose of visit: :ﻝﻮﺧﺪﻟﺍ ﻦﻣ ﺽﺮﻐﻟﺍ

Required period: : ﺍ ﺔﻣﺎﻗﻺﻟ ﺔﺑﻮﻠﻄﻤﻟﺍ ﺓﺪﻤﻟ

Address in Libya: : ﻠﺑ ﻪﺑ ﻢﻴﻘﺘﺳ ﻱﺬﻟﺍ ﻥﺍﻮﻨﻌﻟﺍﻴﺎﻴﺒ