[별지 제17호서식] <개정 2010.11.16> (앞 쪽)
사증발급신청서 APPLICATION FOR VISA ※ 사증발급인정번호(CONFIRMATION OF VISA ISSUANCE No : )
사 진 PHOTO 3.5㎝×4.5㎝	1.성 Surname	3.漢字姓名	4.성별 Gender [ ]M [ ]F
2.명 Given Names	5.생년월일 Date of Birth
6.국적 Nationality	7.출생국가 Country of Birth
8.현주소 Home Address
9.전화번호 Phone No.	10.휴대전화 Mobile Phone No.
11.이메일 E-mail	12.신분증번호 National Identity No.
여권	13.여권번호 Passport No.	14.여권종류 Classification	外交, 公務, 公務普通, 因私, 其他 DP(外交), OF(官用), OR(一般), OTHERS(其他)
15.발급지 Place of Issue	16.발급일자 Date of Issue	17.기간만료일 Date Of Expiry
직업	18.직업 Occupation	19.직장전화번호 Business Phone No.
20.직장명 및 주소 Name and Address of Present Employer
결혼여부 Marital status	21.[ ]기혼 married [ ]배우자사망 widowed [ ]미혼 Single [ ]이혼 divorced
22.배우자 성명 Spouse's Name	23.배우자 생년월일 Spouse's Date of Birth
24.배우자 국적 Spouse's Nationality	25.배우자 연락처 Spouse's Phone No.
26.입국 목적 Purpose of Entry	27.체류예정기간 Potential Length of Stay
28.입국예정일 Potential Date of Entry	29.방한사실 Previous Visit (If Any)
30.국내체류지 Address in Korea	31.국내전화번호 Phone No. in Korea
32.국내 체류비용 지불자 Who Will Pay For The Expense For Your Stay?
33.과거 5년간 여행국가 Countries You Have Travelled During The Past 5 Years
※ Please note that C-series visa holders are not able to change their residential status after entry into Republic of Korea pursuant to the first clause of article 9 of Immigration Regulation
34.동반가족 Accompanying Family	관계 Relationship	국적 Nationality	성명 Name	생년월일 Date of bitrh	성별 Gender
35.국내 보증인 Guarantor or Reference in Korea	관계Relationship	국적 Nationality	성명 Name	생년월일 Date of bitrh	성별 Gender
I declare that the statements made in this application are true and correct to the best of my knowledge and belief, that I will observe the provisions of the Immigration Law of the Republic of Korea and that I will not engage in any activities irrelevant to the purpose of entry stated herein. Besides, I am fully aware that any false or misleading statement may result in the refusal of a visa, and that possession of a visa does not entitle the bearer to enter the Republic of Korea upon arrival at the port of entry if he/she is found inadmissible.
신청일자 DATE OF APPLICATION 신청인 서명 SIGNATURE OF APPLICANT
공용란 FOR OFFICIAL USE ONLY
기본사항	체류자격		체류기간		사증종류	단수ㆍ복수(2회, 3회 이상)
접수사항	접수일자		접수번호		처리과
허가사항	허가일자		허가번호		고지사항
결 재	담당자		가 ㆍ 부	〈심사의견〉
수입인지 부착란 210mm×297mm(인쇄용지(2급) 60g/㎡)

(뒤 쪽)

Notice

○ Fill out the form in English language and sign it with your signature.

○ Attach a photo taken within the last 6 months.

○ Submission of additional documents may be requested, after the application is completed.

○ The visa issuance may be denied after the screening of the application.

○ Applicants shall notify the competent Korean embassy if there is a material change after the application is lodged or a visa has been issued.

○ If you obtain a new passport after a visa has been issued, you should transfer the visa onto a new passport before departure.

○ If you have a history of breaking the immigration law in foreign countries, you should submit the details of it with the application.

○ Visa fee is not refundable even if visa is denied.

How to fill it out

Write down the number of the Confirmation of Visa Issuance, if applicable.

1~2. Write down the name as printed in your passport. Surname is last name and given name is first name.

3. If you have the Chinese character name, write down in Chinese character.

※ Only for people from countries that use chinese character.

4. To mark your gender, check a bracket below.

5. Write down the date of birth in the order of date, month, and year.

6. Write down your nationality.

7. Write down the name of the country you were born in.

8.~11. Write down your address, phone number, mobile phone number and email in your home country.

13.~17. Write down the type of your passport (see your passport) and draw a circle around the appropriate one.

※ DP(Diplomatic Passport), OF(Official Passport), OR(Ordinary Passport)

18.∼20. Write down your occupation and the phone numberㆍnameㆍaddress of your company.

21.~25. Write down personal data of your spouse, if you are married.

29. Write down how many times you have visited Korea.

30.~31. Write down the address and phone number of a place you are going to stay after arriving in Korea. If they are undecided, write down "undecided."

32. Write down who will bear the cost of your stay in Korea. (name, relation)

34. If you are a spouse or a child under the age of 20 of a person who holds the visa status of Culture and Art(D-1), Student(D-2), General Training(D-4) through Particular Occupation(E-7), fill these blanks.

35. Write down the name of person who sponsors your visa.

※ A sponsor may be a non-korean.