All fields marked * are REQUIRED.
  VISA TYPE
SELECT VISA TYPE ->  
  VISA APPLICATION
* Last Name
* First Name and Middle Name
   Other names ever used (maiden name)
* Gender

Male
Female

* Date of birth
* Country of birth
* City of birth
* Present citizenship
   If you changed your citizenship(s), please specify citizenship(s) you held previously
   Date(s) of acquiring new citizenship(s)
* Type of Passport
* Passport Number
* Passport expiration date
* Passport issue date
   Passport Authority
* Passport issue place
* Marital status

Married
Single
Divorced
Widow

* Spouse family name, first name, other names
* Spouse maiden name
* Spouse date of birth
* Spouse place of birth
* Spouse citizenship
* Work address: Street
* Work address: City
* Work address: State
* Work address: Zip
   Work phone number
* Purpose of stay in Belarus
* Date of entry
* Date of departure
* Have you ever been to the Republic of Belarus

yes
no

   Date of entry of last visit (if any)
   Purpose of last visit
   Means available for stay in the Republic of Belarus
* Medical insurance organization
* Insurance policy number
* Term of insurance certificate validation
* Name of inviting organization or person
  Address of inviting organization or person
* House (apartment)
* Street
* City (town)
* Region
* Phone
* E-mail
  Address of stay in Belarus
* House (apartment)
* Street
* City (town)
* Region
* Hotel
  Applicant Information (Billing address)
* Company Name:
* Employment Title/Position
* Home Address:
* City:
* State:
* Zip:
* Home Phone:
   Day Phone:
* E-Mail Address:
  Ship to address (if different from above)
   Name:
   Company Name:
   Shipping Address:
   City:
   State:
   Zip:
   Phone:
  Travel Information
* Earliest Known Date of Departure from USA
* Please enter cities you intend to travel to
  Shipping & Handling (per person)
* Please, choose your return shipping method (per person)
   Signature

Signature Release on Delivery
Signature Required on Delivery

  Payment Information
* Form of Payment:
   Credit card holder's name
   Credit Card Number:
   Credit Card Expiration Date:
  Comments
   Special Request / Comments