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1 1625 K Street NW Suite 750 Washington DC Tel: Visa requirements shown below are for U.S. citizens. Nationals of all other countries please contact Pinnacle Travel Document Systems directly for specific requirements for your itinerary. Visa # # Cost Late Req d Forms Photos Per Visa Fee Zambia-Single 2 2 $ $80.00 Zambia-Double 2 2 $ $85.00 Zimbabwe-Single 2 2 $ $50.00 Zimbabwe-Double 2 2 $ $50.00 Mozambique-Single 1 2 $ $40.00 Mozambique-Multi 1 2 $ $40.00 Photographs for Zambia must be signed on the back. PLEASE NOTE THAT SOUTH AFRICA REQUIRES THAT YOU HAVE ONE SET OF FACING BLANK VISA PAGES FOR EACH ENTRY. In addition to the per person combined service and consular fees shown above please include $30.00 to cover the FedEx return of your passport(s) within the continental U.S. ($30.00 for all other U.S. and Canadian addresses.) We also strongly recommend that you use FedEx or another form of traceable shipping to forward your documents to our offices. You will need to enclose your actual passport along with the number of completed visa application forms and photographs indicated above for each country. Please also enclose two (2) clear photocopies of the vital information page of your passport. Photographs should be recently shot passport-type color photos with a clear background approximately 2 x 2 in dimension. (Note that machine or home digital photographs are not acceptable and photographs must be different than those in your current passport.) Your passport must generally be valid for a minimum of six (6) months beyond the completion of your travel unless otherwise indicated above. Contact PTDS directly for assistance with the renewal of or to add pages to your U.S. passport as this can easily be done at the same time that your visas are being processed. Applications for individual countries must be received in our offices no fewer than 30 days prior to your departure from your shipping address. (Contact PTDS directly regarding deadlines for requests that include more than one country.) Documents received after the deadline will be subject to the per person late fees shown for each country. Please contact PTDS before submitting documents you expect may be received substantially after the deadline as there may be special requirements and/or additional fees associated with processing your request. It may not be possible to cancel processing of your applications once they have been submitted. Please note that consular fees, shipping fees and application requirements are subject to change without notice. Check or credit card payment accepted. Credit card payment subject to 3.5% surcharge.

2 PLEASE BE CERTAIN TO RETURN THE FOLLOWING TO: Pinnacle Travel Document Systems 1625 K Street NW Suite 750 Washington DC Your actual passport (Please keep a photocopy for your records.) This completed form Two (2) photocopies of the vital information page of your current passport Total number of completed visa application forms per person indicated Total number of passport-type color photographs per person indicated Credit or debit card authorization below PLEASE PRINT CLEARLY Full Name (1): Full Name (2): Passport #: Exp: / Passport #: Exp: / Mo Yr Mo Yr Home Home Tel: Mailing Work Tel: Address: (FedEx cannot deliver to PO boxes) Date of Departure from Home: / / Month Day Year Address Custom Southern Africa For the Date of Tour Departure: / / Month Day Year Return of Special Instructions: Passport: Tel: Please indicate below if there are known periods prior to your tour during which you will need your passport for another international trip or when you will not be available to sign for the return of your passport. I will need my passport(s) for other international travel from / / to / / Month Day Year Month Day Year I will not be at my home and/or return shipping address from / / to / / Month Day Year Month Day Year CREDIT CARD AUTHORIZATION: AMEX / VISA / MC (please circle one) Cardholder Name: Signature: Billing Zip Code: Card #: CID# Expires: / Amount: US$ Mo Yr GEOEX CUSTOM S.AFRICA 2015(ZAMBIA-SING90DBL120/ZIMB-SING65DBL80/MOZAMB-SING65MULTI-95/)75 FX 30 1PGS VAL6MOS DL30 DYS % 2015 Pinnacle Travel Document Systems

3 IMPORTANT NOTICE REGARDING PASSPORT PAGES & VALIDITY: You must have at least at least one (1) completely blank unused page available in your passport for each country you are visiting that requires a visa available in your passport for visas and entry/exit stamps, not including the pages at the back of your passport reserved for amendments and endorsements. You should also have at least one (1) additional blank page to accommodate entry/exit stamps for those countries that do not require a visa or two sets of facing blank visa pages if entering South Africa. In addition, your passport must be valid for at least six (6) months beyond completion of your international travel. If you are a U.S. citizen, and need to renew or add pages to your passport Pinnacle Travel Document Systems can easily assist you with this at the same time your visas are being processed. The total additional fees for these services (including U.S. government expediting fees) are $ for passport pages and $ for passport renewals and second passports. We can also assist you with expediting first time passport applications. You will need to complete an application form and a letter of authorization for PTDS and must send your actual passport to us. Specific requirements and the necessary forms are available for download from our Internet site: Passport Pages Passport Renewals First Time Passports Second Passports You may also contact us via or phone at or and we will send you an instruction kit.

4 EMBASSY OF THE REPUBLIC OF ZAMBIA 2419 Massachusetts Avenue, Telephone: (202) NW Washington, DC Facsimile: (202) PLEASE STAPLE ONE (1) COLOR PHOTO SIGNED ON THE REVERSE HERE ON BOTH COPIES OF YOUR APPLICATION VISA APPLICATION FORM 1. Surname: 2. First Name: Middle Name: DOE Jonathan Bonham 3. Date of Birth: Place of Birth: 4. Nationality: Sex: 13 MAR 1961 Los Angeles CA USA USA Male 5. Profession: Business Telephone No. 6. Nationality of Parents at time of Birth: Engineer ( 987 ) USA 7. Passport No Place of Issue: US Dept of State Date of Issue: 1 0MAY 2005 Date of Expiration: 09 MAY If accompanied by your spouse or children, give the following particulars: (Note: Every applicant fills out an individual form) Full Name (s) Date & Place of Birth Relationship COMPLETE AS APPLICABLE 10. Present Address: Telephone No. 11. Permanent Address: 1234 Main Street Anywhere CA ( ) SAME AS ABOVE Telephone No. ( ) (a) Type of Visa Requested: Tourist ( ) Business ( ) Church Business ( ) Visitor ( ) Diplomatic ( ) Official ( ) Student ( ) Transit ( ) Volunteer ( ) Courtesy ( ) (b) Entry requested: Single ( ) Double ( ) Multiple (x ) (c) Date of entry into Zambia: (d) Length of Stay in Zambia: PER YOUR ITINERARY 13. Final Destination of Journey in Zambia: Address in Zambia: 14. Expected Departure Date from Zambia: Next Destination from Zambia: 15. Duration and Particulars of any previous residence or visits in Zambia: COMPLETE IF APPLICABLE 16. If traveling on business, please list names and addresses of persons to be visited in Zambia: LEAVE BLANK 17. If visiting relatives or friends, please list names and addresses of persons to be visited in Zambia: LEAVE BLANK UNLESS APPLICABLE PLEASE DO NOT FORGET TO SIGN & DATE BOTH YOUR APPLICATIONS 18. Signature of Applicant: Date: For official use only: Date Tag # Visa fee Rush Fee Payment Visa # Receipt# Notations Rev. 04/2006 GEOEX

5 PLEASE STAPLE 1 PHOTO HERE TO BOTH OF YOUR VISA APPLICATIONS DOE Male Jonathan Bonham 13 MAR 1961 Los Angeles CA USA USA NONE US Dept of State 10 MAY MAY 2015 DOE Joanna Page 16 JAN 1961 Los Angeles CA USA COMPLETE ONLY IF APPLICABLE Engineer TOURISM - PREPAID TOUR 1234 Main Street Anywhere CA DOE Jonathan Bonham 13 MAR 1961 Los Angeles CA USA NONE GEOEX

6 COMPLETE ONLY IF APPLICABLE PTDS 1625 K STREET NW SUITE 750 WASHINGTON DC CONTACT PTDS IF APPLICABLE PLEASE DO NOT FORGET TO SIGN AND DATE BOTH OF YOUR VISA APPLICATIONS PTDS 1625 K STREET NW SUITE 750 WASHINGTON DC GEOEX

7 ABC INTERNATIONAL INC 1234 MAIN STREET, ANYWHERE CA LEAVE BLANK UNLESS YOU HAVE BEEN A PAST RESIDENT OF MOZAMBIQUE LEAVE BLANK UNLESS PAST RESIDENT DOE MARRIED FEMALES 13 MAR 1961 M JONATHAN BONHAM MARRIED LOS ANGELES, CA USA USA USA ENGINEER MANAGER

8 PER YOUR ITIN LEAVE BLANK LEAVE BLANK PER YOUR ITIN PER YOUR ITIN N/A AS APPLICABLE PLEASE DO NOT FORGET TO SIGN AND DATE YOUR APPLICATION TOURISM-PREPAID TOUR PER YOUR ITIN

9 EMBASSY OF THE REPUBLIC OF ZAMBIA 2419 Massachusetts Avenue, Telephone: (202) NW Washington, DC Facsimile: (202) VISA APPLICATION FORM 1. Surname: 2. First Name: Middle Name: 3. Date of Birth: Place of Birth: 4. Nationality: Sex: 5. Profession: Business Telephone No. ( ) 7. Passport No. Date of Issue: 8. Place of Issue: Date of Expiration: 6. Nationality of Parents at time of Birth: 9. If accompanied by your spouse or children, give the following particulars: (Note: Every applicant fills out an individual form) Full Name (s) Date & Place of Birth Relationship 10. Present Address: Telephone No. 11. Permanent Address: ( ) Telephone No. ( ) (a) Type of Visa Requested: Tourist ( ) Business ( ) Church Business ( ) Visitor ( ) Diplomatic ( ) Official ( ) Student ( ) Transit ( ) Volunteer ( ) Courtesy ( ) (b) Entry requested: Single ( ) Double ( ) Multiple (x ) (c) Date of entry into Zambia: (d) Length of Stay in Zambia: 13. Final Destination of Journey in Zambia: Address in Zambia: 14. Expected Departure Date from Zambia: Next Destination from Zambia: 15. Duration and Particulars of any previous residence or visits in Zambia: 16. If traveling on business, please list names and addresses of persons to be visited in Zambia: 17. If visiting relatives or friends, please list names and addresses of persons to be visited in Zambia: 18. Signature of Applicant: Date: For official use only: Date Tag # Visa fee Rush Fee Payment Visa # Receipt# Notations Rev. 04/2006

10 GEOEX TOURISM - PREPAID TOUR

11 PTDS 1625 K STREET NW SUITE 750 WASHINGTON DC PTDS 1625 K STREET NW SUITE 750 WASHINGTON DC 20006

12 PEDIDO DE ENTRADA EM MOCAMBIQUE REQUEST FOR ENTRY VISA TO MOZAMBIQUE RECIBO PREENCHER COM LETRA LEGIVEL RESERVADO AOS SERVICOS: TO BE FILLED IN LEGIBLE LETTERS FOR OFFICIAL USE: VISTO UMA ENTRADA Single entry DUPLAS ENTRADAS Double entry MULTIPLAS ENTRADAS Multiple entries DATA DE EMISSAO.../.../.. VALIDADE./.../ APELIDO Surname NOME COMPLETO Full name NOME DE SOLTEIRA Maiden name PAIS E LOCAL DE NASCIMENTO Country and place of birth DATA DE NASCIMENTO Date of birth SEXO Sex ESTADO CIVIL Marital status NACIONALIDADE Nationality PASSAPORTE Passport PROFISSAO/OCUPACAO Profession/Occupation DATA DE EMISSAO Date of issue / /. Validade Validity / /. CARGO QUE OCUPA Position you hold NACIONALIDADE DO P.te P.te nationality INSTITUICAO, ORGANIZACAO OU EMPRESA ONDE TRABALHA Institution, organization or firm you work ENDERECO DA RESIDENCIA PERMANENTE Address of the permanent residence ESTEVE ALGUMA VEZ EM MOCAMBIQUE? SIM NAO Have you ever before been in Mozambique? Yes No JA FOI RESIDENTE EM MOCAMBIQUE? SIM NAO Have you ever been a resident in Mozambique? Yes No PORQUE SAIU DE MOCAMBIQUE? DATA DE SAIDA Why did you leave Mozambique? Date of exit }./../. INDIQUE AS INSTUICOES E EMPRESAS A QUE ESTEVE LIGADO Mention the institutions and firms to which you were attached O PREENCHIMENTO INCORRECTO OU INCOMPLETO IMPLICA RESPOSTA TARDIA, DEVOLUCAO OU INDEFERIMENTO INCOMPLETE OR INCORRECT FILLING IN OF THIS FORM MAY RESULT IN DELAY DEVOLUTION OR REJECTION

13 DETALHE OS MOTIVOS DA ENTRADA EM MOCAMBIQUE In detail give reasons for your entry in Mozambique TEMPO DE ESTADA EM MOCAMBIQUE Length of stay in Mozambique FRONTEIRA DE ENTRADA Entry border DATA DE ENTRADA Date of entry././ FRONTEIRA DE SAIDA Exit border DATA DE SAIDA Date of exit././ ENDERECO DA HOSPEDAGEM EM MOCAMBIQUE Address of residence in Mozambique PROVINCIA Province DISTRITO District CIDADE City AVENIDA/RUA Avenue/street CASA House FAMILIARES/AMIGOS RESIDENTES EM MOCAMBIQUE Relatives, friends living in Mozambique NOME COMPLETO Full name NACIONALIDADE Nationality PARENTESCO Relationship ENDERECO Address RESERVADO AOS SELOS Reserved for stamps DATA... Date }././.. ASSUNATURA DO REQUENTE OU DA ENTIDADE SOLICITANTE Signature of applicant or of the applying entity ASSINATURA RECONHECIDA POR SEMELHANCA A EXISTENTE NO..... EMITIDO A.../ / EM RESERVADO AOS SERVICOS For official use DATA DE RECEPCAO.../ /.... ASSINATURA DO FUNCIONARIO DATA DE ENTREGA.../ /.

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