سفارت جمهوري اسلامي ايران – پکن


Embassy of The Islamic Republic of Iran - Beijing

: شماره

درخواستنامه رواديد         VISA APPLICATION

: تاريخ


This application form should be typed and forward to the embassy.

in order to type this form , please click on space concerned.

First and middle names (As in passport)


Surname (As in passport)

نام خانوادگي

Previous name(s)  (if any)

نام قبلي

Date of birth

تاريخ تولد

Place of birth

محل تولد



Former nationality

تابعيت قبلي


Male مرد       Female زن


Father´s Name

Father´s Nationality

Type & Passports number

نوع و شماره گذرنامه

Place & Date of passport  issue

محل و تاريخ صدور گذرنامه

Date of expiry

تاريخ خاتمه اعتبار گذرنامه



Work Address and telephone

نشاني و تلفن محل کار


Home address and telephone

نشاني و تلفن منزل

Marital status

Maried متاهل   Single مجرد

وضعيت تاهل

Name of spouse

نام همسر

Nationality of spouse

تابعيت همسر

Name and the relationships of persons travelling with your Passport

نام همراهان شما در گذرنامه

Have you ever applied for Iran Visa?

Yes آري           No  نه

آيا تاکنون درخواست رواديد ايران را نموده ايد؟

Have you ever been refused Iran visa?

Yes آري            No  نه

آيا تاکنون درخواست رواديد شما رد شده است ؟

Have you ever visited Iran?

Yes   آري                No    نه  

آيا قبلا به ايران سفر کرده ايد؟


If yes, please give dates and lengths of each stay?

اگر سفر کرده ايد در چه تاريخ هائي و هر بار چه مدت اقامت ؟


When do you intend to enter Iran (date)?

چه تاريخي قصد به ايران وارد شويد؟

How long do you intend to stay in Iran?

قصد چه مدت اقامت در ايران  را داريد؟


At what address will you stay in Iran

نشاني و تلفن محل اقامت در ايران



What is the purpose of your trip to Iran?




Name(s) of person(s) & organization(s) you are going to meet in Iran


The Countries you have stayed more than six month?


If you have any relative currently living in Iran, please write theirs complete particulars.



If you intend to visit Iran with an Iranian travel agency, indicate the name of travel agency.


Have you been treated for any serious physical or mental disorders or any communicable or chronic diseases?

آيا تا به حال  مبتلا به بيماري جسمي ، رواني ،خطرناک يا مسري بوده ايد ؟

Yes              No


Have you ever used narcotics or ever been an addict?

Yes              No


Have you committed any criminal offence in any country?

Yes              No



Name, address and tel. nr. of foreign national sponsor(s)/contact(s) in Iran?


Category of visa requested? 


Tourist or pilgrimage




Research and study

Work permit visa

Multiple entry






If an agency or person fills this application for you, should write details (Name, address and signature)

   Name and Surname                               Date                                 Applicants signature