Part 1: Personal Information

1.1 Full English name as in passport
 

1.2 Name in Chinese
 

1.3 Other name(s) (leave it blank if you do not have)
 

1.4 Sex  
 

1.5 DOB (Date of birth)
 

1.6 Current nationality(ies)
 

1.7 Former nationality(ies) 
 

1.8 Place of birth (city,province/state,country) 
 

1.9 Local ID/Citizenship number
 

1.10 Passport/Travel document type
 

1.11 Passport number 
 

1.12 Date of issue 
 

1.13 Place of issue 
 

1.14 Date of expiry 
 

1.15 Current occupation(s) 
 

1.16 Education 
 

1.17 Employer/School 
 

1.18 Home address

1.19 Zip Code (leave it blank if you do not have)
 

1.20 Home/mobile phone number 
 

1.21 E-mail address 
 

1.22 Marital status
 

1.23 Major family members (Wife/Husband, child, parents)
 

1.24 Emergency Contact 
 

1.25 Country or territory where the applicant is located when applying for this visa
 

Part 2 Travel Information 

2.1 Major purpose of your visit
 

2.2 Intended number of entries 
 

2.3  Are you applying for express service? 
 

2.4 Expected date of your first entry into China on this trip 

2.5 Longest intended stay in China among all entries 
 

2.6 Itinerary in China 
 

2.7 Who will pay for your travel and expenses during your stay in China? 
 

2.8 Information of inviter in China
 

2.9 Have you ever been granted a Chinese visa? 
 

2.10 Others countries or territories you visited in the last 12 months
 

Part 3 Other information

3.1 Have you ever overstayed your visa or residence permit in China?
 

3.2 Have you ever been refused a visa for China or been refused entry into China?
 

3.3 Do you have any criminal record in China or any other countries?
 

3.4 Are you experiencing any of the following conditions?
 

• Serious mental disorder
   
• Infectious pulmonary tuberculosis
   
• Other infectious diseases of public health hazards
   

3.5 Did you visit countries or territories affected by infectious disease in the last 30 days?
 

3.6 If you select Yes to any questions from 3.1 to 3.5, please give details below.

3.7 If you have more information about your visa application other than the above to declare, please give details below or type on a separate paper.

3.8 If someone else travels and shares the same passport with the applicant, please affix their photos and give their information below.
 

Part 4 Declaration & Signature 
 

Part 5 Another person on the applicant’s behalf 

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