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ÄËß ËÈÖÀ, ÇÀÏÐÀØÈÂÀÞÙÅÃÎ ÂÈÇÓ.
1. ÔÀÌÈËÈß _____________________________________________________________________________________
2. ÏÐÎ×ÈÅ ÔÀÌÈËÈÈ (äåâè÷üÿ, ïñåâäîíèì, ïðåæíèå ôàìèëèè) ___________________________________________
3. ÈÌß è ÎÒ×ÅÑÒÂÎ _______________________________________________________________________________
4. ÄÀÒÀ è ÌÅÑÒÎ ÐÎÆÄÅÍÈß ______________________________________________________________________
5. ÃÐÀÆÄÀÍÑÒÂÎ íûíåøíåå ____________________________ ïåðâîíà÷àëüíîå
____________________________
6. ÑÅÌÅÉÍÎÅ ÏÎËÎÆÅÍÈÅ________________________________________________________________________
7. ÔÀÌÈËÈß, ÏÐÅÆÍÈÅ ÔÀÌÈËÈÈ, ÈÌß, ÎÒ×ÅÑÒÂÎ, ÄÀÒÀ, ÌÅÑÒÎ ÐÎÆÄÅÍÈß è
ÃÐÀÆÄÀÍÑÒÂÎ ÑÓÏÐÓÃÀ
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8. Ô.È.Î., ÄÀÒÀ, ÌÅÑÒÎ ÐÎÆÄÅÍÈß è ÃÐÀÆÄÀÍÑÒÂÎ
ÐÎÄÈÒÅËÅÉ:
Ìàòü____________________________________________________________________________________________
Îòåö ____________________________________________________________________________________________
9. ÑÅÐÈß è ÍÎÌÅÐ ÇÀÃÐÀÍÏÀÑÏÎÐÒÀ _______________________________________________________________
ÄÀÒÀ ÂÛÄÀ×È ____________ ÎÐÃÀÍ, ÂÛÄÀÂØÈÉ ÄÎÊÓÌÅÍÒ______________ÄÅÉÑÒÂÈÒÅËÅÍ
ÄÎ____________
10. ÄÎÌÀØÍÈÉ ÀÄÐÅÑ È ÒÅËÅÔÎÍ__________________________________________________________________
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11. ÏÐÎÔÅÑÑÈß __________________________________________________________________________________
12. ÌÅÑÒÎ ÐÀÁÎÒÛ è ÄÎËÆÍÎÑÒÜ __________________________________________________________________
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13. ÑËÓÆÅÁÍÛÉ ÀÄÐÅÑ È ÒÅËÅÔÎÍ__________________________________________________________________
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14. ÏÐÅÄÏÎËÀÃÀÅÌÀß ÑÒÐÀÍÀ ÏÎÅÇÄÊÈ, ÑÐÎÊ ÏÐÅÁÛÂÀÍÈß è ÄÀÒÀ ÂÚÅÇÄÀ
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15. ÅÑËÈ ÂÛ ÁÛËÈ ÐÀÍÅÅ Â ÑÒÐÀÍÀÕ ØÅÍÃÅÍÑÊÎÉ ÃÐÓÏÏÛ, ÓÊÀÆÈÒÅ ÂÐÅÌß
È ÌÅÑÒÎ
ÏÎÑËÅÄÍÅÃÎ ÏÐÅÁÛÂÀÍÈß ñ ____________ 199____ã. ïî___________
199____ ã. ñòðàíà______________________
ÊÎÃÄÀ È ÃÄÅ ÁÛËÀ ÎÔÎÐÌËÅÍÀ ÏÎÑËÅÄÍßß ØÅÍÃÅÍÑÊÀß ÂÈÇÀ ________________________________________
16. ÂÀØÈ ÊÎÍÒÀÊÒÍÛÅ ÒÅËÅÔÎÍÛ: ÑËÓÆÅÁÍÛÉ ____________________ ÄÎÌÀØÍÈÉ______________________
ÓÊÀÆÈÒÅ, ÊÎÌÓ ÂÛ ÄÎÂÅÐßÅÒÅ ÏÎËÓ×ÈÒÜ Ó ÍÀÑ ÏÀÑÏÎÐÒ ÏÎÑËÅ ÎÔÎÐÌËÅÍÈß
(åñëè äîêóìåíòû ñäàåò òóð.
ôèðìà, óêàæèòå íàçâàíèå ôèðìû, êîíòàêòíûé òåëåôîí è âàøè
ïðåäëîæåíèÿ ïî äîñòàâêå èëè
âûäà÷å ïàñïîðòà)
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Ñ óñëîâèÿìè îôîðìëåíèÿ îçíàêîìëåí, íà âîïðîñû àíêåòû îòâåòèë ïðàâèëüíî.
"___" ____________________200 ã. ______________________________(ïîäïèñü)
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