ࡱ> q` bjbjqPqP ;::G!99989V:5r~;????gBQDeEZZZZIZ e p$!shuqFKA|gBFKFKq??[q*O*O*OFKv??Z*OFKZ*O*O(RP6SS?r; 0Ǡ"x9N"#SVr05r;S)vN)v0SSSS0)vS4EqG*OH_IEEEqqNLEEE5rFKFKFKFK 99$ REPBLICA FEDERATIVA DO BRASIL MINISTRIO DAS RELAES EXTERIORES CONSULADO-GERAL EM WASHINGTONProtocol numberVisa number VISA APPLICATION FORM 01 - Full name (as per passport; do not abbreviate or omit any name) First Middle Last  FORMTEXT       FORMTEXT       FORMTEXT      Attach applicant s photo here02 - Place of birth (city/state/country)03 - Date of birth Day Month Year - size: 2 x 2  FORMTEXT        FORMTEXT    FORMTEXT    FORMTEXT     - Passport grade quality04 - Country of citizenship  FORMTEXT       05 - Sex male  FORMCHECKBOX  female  FORMCHECKBOX  06 - Marital status  FORMTEXT       - white or off-white background 07 - Passport # 08 - Issuing country 09 - Expiration date Day Month Year - front view, full face FORMTEXT       FORMTEXT       FORMTEXT    FORMTEXT    FORMTEXT     - must be recent picture10 - Parents full name (do not abbreviate or omit any name) 10.a - Parents country of birthFather s: FORMTEXT      Father s: FORMTEXT      Mother s: FORMTEXT      Mother s: FORMTEXT      11  Highest level of education (check only one box)  FORMCHECKBOX  no diploma  FORMCHECKBOX  high school diploma or the equivalent (e.g., GED)  FORMCHECKBOX  some college credit, but less than one year  FORMCHECKBOX  more than one year of college, but no degree  FORMCHECKBOX  associates degree (e.g., AA, AS)  FORMCHECKBOX  bachelors degree (e.g., BA, AB, BS)  FORMCHECKBOX  masters degree  FORMCHECKBOX  professional degree (e.g., MD, DDS DVM, LLB,JD)  FORMCHECKBOX  doctorate degree12 - Major/primary field of study or interest  FORMTEXT       13 - List certificates and/or any special skill  FORMTEXT       14 - Job position (as per business card) or title  FORMTEXT       15 - Employer (for students, name school/university)  FORMTEXT       16  E-mail:  FORMTEXT       17 - Business address (if retired, identify business that retired from)  FORMTEXT       18 - Business telephone # (with area code)  FORMTEXT      19 - Home address  FORMTEXT       20 - Home telephone # (with area code)  FORMTEXT       FOR OFFICIAL USE ONLYA - Consulta SERE OF ( TEL ( No. _______B - Autorizao da SERE DESP ( DESPTEL ( No. ______ C - Tipo do Visto ___________________D - ( Concesso Denegao Impedimento E - ( Uma entrada ( Mltiplas entradas F - Validade _____________anos/diasG - Data ______/______/______H Anotaes: M.O.: US$ I - Assinaturas Funcionrio Chefia  21 - Purpose of trip: check item that is the most applicable to the circumstances of your trip.  FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX   FORMCHECKBOX  Provide services in Brazil of a temporary nature, including activities such as office and technical support, installation and repair of equipment, including computer and telecommunications systems, construction activities, and direct supervision of personnel in Brazil U.S.-based personnel involved in business development activities, including negotiating contracts, marketing, opportunity assessments, specifying orders for contracts, customer relations related activities, performance assessments, project reviews, and establishing a framework for doing business in Brazil. Attach a signed letter presenting the applicant. Direct participation in oil and gas exploration and/or production activities Work under an employment contract with a company/organization in Brazil - i.e., hired under a Brazilian labor contract as a local employee (this applies to the foreign employees of multinationals working in their Brazilian subsidiaries) Transfer of residence to Brazil under permanent residency status Attend conference, seminar or workshop. (Explain under field 21.a whether an attendee, paid/unpaid speaker, trainer, and provide name of event sponsor). Attach to this application a Letter of Invitation or Letter of Presentation of the attendee Provide religious or missionary services and/or assistance Provide community and/or medical services Attend school or pursue studies Conduct research or pursue scientific-technologic activities under an international cooperation program Pursue professorial studies/research/teaching and/or pursue scientific/technologic activities at a university, research or similar organization (attach letter specifying conditions: employment contract? research scholarship?) Participation in athletic or performing arts events (explain under field 21.a whether it is paid/unpaid participation) Journalism activities and/or film making As a government official Tourism (include further details under field 21.a) 21.a Please provide additional details about your trip in Brazil, such as places and activities: ________________________ 22 - Expected port of entry and date of arrival in Brazil  FORMTEXT       23 - Expected duration of immediate trip  FORMTEXT      24 - Name and address of person, institution or company through whom you can be contacted in Brazil  FORMTEXT       25 - Address in Brazil where you will be staying (e.g., hotel, vessel, friend, other)  FOEUbc` a k l   $ & ( 2 4 6 8 L N P Z \ ^ d j Žx h~05CJh1hwojYh~0Ujh~0Ujh.UmHnHujmh~0U h~06CJh$\h~05 h~0CJ h~0CJ hX+hX+5hX+5OJQJh&5OJQJh~0OJQJh~0jh~0U-"Ecspnlf !kkd0$$Ifl\8w")  4 la <d$If$If<$If  !$If ߝ^ _ `  6 ^ wiwa$If $ !$Ifa$ $$Ifa$skd$$Ifl0") ~ 04 la  !$If  bWQWG> $Ifgds $If$If  !$Ifkd$$Ifl4z\D ")   ~ 04 laf4      * , . 6 8 : > j n r Ѹٲ٧ѸٜѸїٌѸїxh$\h~05hshs5hsjh~0U h~06jh~0Ujh~0U h~0CJ jh.UmHnHujh~0Ujh~0Uh~0hEh.!5CJaJhEh~05CJaJ hE5 hs5*  : l xoiooo` $Ifgds$If $$Ifa$kd$$Ifl F")~ 0    4 lal n p TICCCCC$If  !$Ifkdu$$Iflr")8~ 04 la  * , . 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FORMCHECKBOX  Yes  FORMCHECKBOX  No28 - If yes for item 27, provide date, place and duration of last visit  FORMTEXT       29 - I declare that the above information is true and accurate. Name (type or print) Date Signature   FORMTEXT       Day  FORMTEXT      Month  FORMTEXT      Year  FORMTEXT       INSTRUCTIONS - For complete instructions, including visa fees and vaccinations, consult  HYPERLINK "http://www.brasilemb.org" www.brasilemb.org Passport must be signed by bearer, be valid for at least 6 months; and have at least one blank page available to affix visa. Applicant must complete all fields, from 01 to 29. Signature on application form must match signature on applicants passport. Tourist visa application must include a copy of a two-way ticket or an itinerary to/from Brazil, with applicants name, and dates of arrival/departure in/from Brazil. The first entry in Brazil must occur within 90 days after the visa is issued! Attach an applicants recent photo to the form, taken against a white or off-white background - no snapshots are accepted! Applicants going to/coming out of Brazil by land must present a current bank statement of one of his/her accounts. Applicants for non-tourist visa must attach a signed letter stating businesses to be conducted. For visa fees visit our website. An application for a minor must include minors Birth Certificate and non-traveling parent/s notarized letter of consent. 4΁d}}u$If$If($Ifskd1$$Ifl<0t")04 laƂւBFHJ^`blnprz|ĄƄȄЄ҄Ԅք ڷڱڠڱڕڱڊڱԄ h(CJj6h~0Ujw6h~0Uj6h~0U h~0CJ h~0CJj5h~0U h~0CJh@h ph~05 h CJh~0jh.UmHnHujh~0Ujw3h~0U3(@t  !$If$If !skd3$$Ifl0")04 la@BDFHr91$If`kd5$$IflP"))04 la$If^kd4$$Ifl"))04 larzք $ !$Ifa$ $$Ifa$ RL>) & F ^`gdcu $(^a$gdA: !kd?7$$IflrV4")>j04 la&(*,4D^<=KS^ps 05?x|Ç݇øǯ|hVhahA:hWihpGhHh7hd&h%h[Lh( h8V8h(h<{%hO0JjA8h@UhOjhOUhV#hV#5CJ hO5CJ h]'5CJhOhO5CJ hOCJh8V8h(CJ.~Vߝ$a$ & F ^`gdcu݇-.3OPQZ^nӈԈ؈ 45]_`bc~ډމ %<ÿۻ۷㻳Uh)Gh:a h'=h-h(h%hWih<7hWLhYh]'hcghDf{ h8V8h(h#hV hhh hhhVCTo request a return of passport with visa by mail, provide a prepaid, self-addressed Priority or Express mail from the USPS. The only acceptable form of payment for visa fees is a money order issued by the United States Postal Service. An US-tourist must pay a reciprocity fee of US$130.00. When applying by mail or via proxy, add US$10.00. Drop-off and pick up of visa applications are from 2:00PM to 4:00PM. 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Barbosa  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRTUVWXYZ[\]^_`abcdefghijklmnoqrstuvwxyz{|}~Root Entry FV"xData S81TablepYvWordDocument;SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q