Cambodia Tourist visa Application

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1 Cambodia Tourist visa Application Please enter your contact information Name: Tel: Mobile: The latest date you need your passport returned in time for your travel: Cambodia tourist visa checklist Filled out and signed Cambodia 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 - From $16 FedEx Standard Overnight - From $22 FedEx Priority Overnight - From $26 FedEx First Overnight - From $55 FedEx Saturday delivery - From $60 Prepaid self addressed mailer - $0 Local pick up in Washington - $0 Name: Company: Address: City: State: Zip: * Actual prices may vary based on location per FedEx.com.

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.)

3 Cambodia tourist visa fees for citizens of Hong Kong living in Alabama Type of visa Validity Processing time Embassy fee Service fee Total Single entry up to 90 days 8 business days $40.00 $99.00 $ Single entry up to 90 days Next business day $70.00 $ $ 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 KINGDOM OF CAMBODIA Nation Religion King ~ ~ VISA APPLICATION FORM Photograph 2 x 2 ROYAL EMBASSY OF CAMBODIA IN : Washington D.C. Please submit 1 copy with 1 photo and your passport Surname: Present occupation: First name: Sex: Male Female Date of birth: Day....Month Year... Place of birth: Birth nationality: Present nationality: Passport of traveling document is valid for (country) Date of entry to Cambodia: Day..Month Year. Date of departure (length of stay) Place of residence: Fax: /Phone: Work Place: Purpose of visit Tourist Business Diplomatic Official Others (Please Specify) Point of entry: Means of Transportation: Address during the visit: Passport No: Place of issue: Date of issue: Date of Expiration: Children under 12 years traveling with you Surname Point of exit: Means of Transportation: Organization, Persons to be visited : First trip to Cambodia Traveling on group tour First name Sex Patronymic M F Yes No Yes No Date of birth Permanent Address Relatives in the Kingdom of Cambodia For official use éf pþl;... Tidæakarelx elxsmkal; RbePT éf Ex qñam htßelxam nþittylbnþúkkic karkugs ul I hereby declare that the information on this form is true and correct Place, (Date)... (Signature of the applicant)

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