Benin Tourist visa Application

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1 Benin Tourist visa Application Please enter your contact information Name: Tel: Mobile: The latest date you need your passport returned in time for your travel: Benin tourist visa checklist Filled out and signed Benin tourist visa application form. The form is enclosed. Original passport. Passport must have at least 6 months remaining validity and have at least 1 visa page. 1 Photographs. Standard passport photographs 2x2 inches on a white background. Payment. Credit Card Authorization form, Certified Check, or Money Order payable to VisaHQ.com. Return mailer. Prepaid self-addressed return label or payment for FedEx. If you wish to prepay return shipping, please add the shipping fee to the total and provide return address: FedEx 2nd day delivery - add $15 FedEx Standard Overnight - add $20 FedEx Priority Overnight - add $25 FedEx Saturday delivery - add $45 FedEx First Overnight - add $75 Prepaid self addressed mailer - $0 Local pick up in Washington - $0 Name: Company: Address: City: State: Zip:

2 Proof of status. Copy of Green Card (both sides) or other proof of legal status in the US (such as copy of I-20, US visa, H1B approval notice, etc. VisaHQ cannot assist US B1/B2 visa holders at this time.) Itinerary. Copy of round trip tickets or confirmed itinerary. Yellow Fever Vaccination. Copy of International Certificate of Vaccination for Yellow Fever.

3 Benin tourist visa fees for citizens of US Virgin Islands Type of visa Validity Processing time Embassy fee Service fee Total Single entry up to 1095 days 3 business days $ $79.00 $ Single entry up to 1095 days Next business day $ $ $ Multiple entry up to 1095 days 3 business days $ $79.00 $ Multiple entry up to 1095 days Next business day $ $ $ This order is subject to Terms of Service, posted on VisaHQ website. All fees and requirements may change without notice.

4 Credit Card Authorization Form By signing this form i accept VisaHQ.com Terms of Service and authorize to charge my credit card for the amount of $ Name on the Credit Card: Credit Card number: Exp. date: / Credit Card Billing Address: Signature: Comments: Thank you! We accept all major credit cards.

5 REPUBLIQUE DU BENIN AMBASSADE DU BENIN AUX ETATS-UNIS D AMERIQUE EMBASSY OF THE REPUBLIC OF BENIN 2124 Kalorama Road N.W. Washington, D.C DEMANDE DE VISA APPLICATION FOR VISA -:-:-:-:-:-:-:-:-:- RESERVE AU CONSULAT REFERENCE : TAXES PERCUES : MODE DE PAIEMENT : Nom (en capitales) Surname (in capitals) Née : (Nom de jeune fille Maden Name) Prénoms : First names (in small letters) Né le à Born on at D origine : Nationalité at birth Nationality actuelle : present Situation de famille : Enfants : Nombre Ages Married or single Number of children Ages Résidence (adresses exacte) Present address in full Téléphone Phone Profession: _ Occupation PHOTOGRAPH Passport N Délivrée le issued on Par : By Valable jusqu au Valid until Situation militaire : Military service status Nature et durée du visa sollicité : Transit à destination de : Transit en route to Avec arrêt de : jours With a stay of (Le cadre ci-contre doit être rempli par le: SEJOUR DE : jours demandeur qui rayera les mentions inutiles) STAY OF days Type and validity of visa requested : (The space opposite should be filled in) mois months ( ) unique ( ) multiple Motifs du voyage : Reason for journey Avez-vous déjà résidé en République du Bénin pendant plus de trois mois sans interruption? Have you already resided in the Republic of Benin for more than three months continuously? Précisez à quelle date: When (give exact date) : Attaches familiales en République du Bénin (adresses exactes ) rue et n Have you any relations in the Republic of Benin (give full addresses, including street and street number

6 2 Références dans le pays de résidence (adresse) : Reference in the country of residence (give full address) Indication précise du lieu d entrée en République du Bénin : State exact point of entry into the Republic of Benin Indication de vos addresses exactes en République du Bénin pendant que vous y séjournerez State your full address, during your stay in the Republic of Benin Comptez-vous installer en République du Bénin un Commerce ou une Industrie? Do you intend to establish a business or a factory in the Republic of Benin? Où comptez-vous vous rendre en sortant de la République du Bénin? Where do you intend to go upon your departure from the Republic of Benin? Je déclare avoir donné des réponses exactes et complètes à toutes les questions de la présente demande. I declare that I have answered all required questions in this application fully and truthfully. Signature du requérant Signature of Applicant Date

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