ԴԻՎԱՆԱԳԻՏԱԿԱՆ-ՀՅՈՒPԱՏOSAKAH
ՀԱՅԱUТАНI ՀANPАПЕТОUTYON МУТQИ VISA
CТАНАЛOU НАМАР
APPLICATION FOR ENTRY VISA
TO THE REPUBLIC OF ARMENIA
Սahmanin dimelou depqoum partadir che
Not required when applying at the border
1 Azy / Surname (Family Name)
8 Անձnagramy houmar / Passport Number
2 Anun / First Name (Given Name)
9 Trrarvman atar (оr/amis/tarin) / Date of Issue (dd/mm/yyyy)
3 Ayl anunner / Other Names
10 Vajer minchev (оr/amis/tarin) / Valid Until (dd/mm/yyyy)
4 Tsnnndean atar (оr/amis/tarin) / Date of Birth (dd/mm/yyyy)
11 Andznagrayin vnaskagum / Type of Passport
5 Tsnnndean vayr / Place of Birth
6 Sex / Sex
7 Msnagitoutyoun / Occupation
12 Qzbaroutyoun (qaghaqatsoutyoun) / Nationality (Citizenship)
13 Mshtakay bargavorman maskherevm / Address of Permanent Residence
14 Heraskhosayin houmar / Telephone Number
El. nast / E-mail
15 Hayastanum kekhoutyan endatsqoum bargavorman maskherevm / Address during your stay in Armenia
16 Hraparagitchi azganouny, anouny, heraskhosayin houmarё ev maskherevm yev kazmakerpoutyouny (yete karekeli e) / Surname, first name, telephone number and the address of the inviting person or organization (if applicable)
Hastatakoum em, vor verin nashtved talyalknere hacharakin e ev lrjin. Gitem, vor usarits tangyal talyalknery karou e hankarcnel viza-i megarzoumin, kartsrel kam mangel ardén tstaragrrved viza-e, kam argelel mutqe Hayastan.
I confirm that the information provided above is true and complete. I am aware that false statements may lead to the rejection of the visa application, cancellation or revocation of a visa already issued, or denial of entry into the Republic of Armenia.
Vayré ev ataré / Place and date: ___________________________
Storagir / Signature: ___________________________