ON-LINE VISA APPLICATION FORM 20002-43288670 \ 03.04.
2024 17:05:07
EMBASSY OF THE RUSSIAN FEDERATION IN
ALGERIA
1. Nationality (if you formerly had ALGERIA
USSR or Russian citizenship, please
indicate when and why you lost it).
2. Surname (as in passport). HANZAL
3. First name, other names, patronimic ABDELKARIM
(as in passport).
4. Date of birth (dd/mm/yyyy). 15/11/1999
5. Sex. MALE
6. Passport.
Passport No: 307841277
Date of issue: 25/07/2022
Valid until: 24/07/2032
7. Purpose of visit. TOURISM
8. Category and type of visa. COMMON TOURIST
9. Number of entries. SINGLE
10. Date of arrival and departure. 29/04/2024 - 28/05/2024
11. Host organisation you intend to
visit.
Company name: AZIMUTH TOUR SERVICE
Reference No: 0221961088
Confirmation No: 0221961088
Address: 72A, VASYUNINO, VILLAGE, ROGOVSKOE, MOSCOW, RUSSIA
12. Route of journey (destination MOSCOW
points).
Photograph and signature. Service information (automatically generated).
Application form recipient: EMBASSY OF THE RUSSIAN
FEDERATION IN ALGERIA
Basis (voucher, dir. No, inv. No): 0221961088
The estimated date of visit to the RC:
Place for Application No (web-site): 43288670
photograph The date of processing: 03/04/2024
*2000243288670*
Application No (VAC):
The date of processing by the VAC:
Request No in Russian Consulate (RC):
I hereby agree to the processing and transfer of my personal data in
electronic form for the purposes of making a decision on visa issuance.
I declare that data provided in the application form are full and
Date (dd/mm/yyyy), personal signature correct. I am aware that any false information may be a cause for the
denial of visa or for the cancellation of the previously issued visa and
may lead to other consequences provided for by the legislation of the
Russian Federation. Subject to the receipt of visa, I pledge to leave
the territory of the Russian Federation before the visa expiration date.
I am aware that valid visa does not automatically allow to enter the
territory of the Russian Federation. In case of denial of entry, I will
not seek any compensation for potential losses.
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13. Children under 16 years and other
relatives written in your passport.
Do you travel with children under 16 NO
years or other relatives written in
your passport?
14. Your permanent address, telephone BLOC D11 N 841 NOUVELLE VILLE CHORFA CHLEF, TEL: 213696 38 64 33
number, fax number, E-mail.
15. Current/latest place of work. ENTREPRISE DE TRAVAUX DE BATIMENT, RUE DE GARE N 19 HAY HOURIA CHLEF,
RUE DE GARE N 19 HAY HOURIA CHLEF, TEL: 213776 53 71 75
16. Information about your previous
trips to Russia.
How many times have you been to Russia? -
17. Information about health insurance.
Do you have health insurance that is YES
valid in Russia?
Name of the insurance company, ASSURANCE SAA
insurance number:
18. Other names used in the past NONE
(maiden, pen-name, religious, etc.).
19. Your place of birth (if you were CHLEF
born in Russia, please specify when and
which country you emigrated to).
20. Additional information about your
relatives.
Do you currently have relatives in NO
Russia?
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