■ 出入境理法 实行规 [第17号样式]
签证发申请表（样表）
APPLICATION FOR VISA
<申请表填写方法>
‣ 申请须事实根空格处完整记载
‣ 申请必须中文英文填写申请表
‣ 相关选项[ ]钩
‣ 您选择请写具体容
‣ You must fill out this form completely and correctly
‣ You must write in block letters either in English or Korean
‣ For multiplechoice questions you must check [√] all that apply
‣ If you selectOther’ please provide us with more information in the given space
1 信息 PERSONAL DETAILS
PHOTO
护规格片
(35㎜×45㎜)
6月拍摄正面免冠
彩色相片相片背景颜色
须纯白色
A color photo taken within la
st 6 months(full face without
hat front view against whit
e or offwhite background)
11 护英文姓名Full name in English (as shown in your passport)
姓 Family Name
WANG
名 Given Names
XIAOMING
12 中文姓名 漢字姓名
王明
13 性 Sex
男Male[ √ ] 女Female[ ]
14 出生日期 Date of Birth (yyyymmdd)
19900214
15 国籍 Nationality
中国
16 出生国 Country of Birth
中国
17 身份证号码 National Identity No
123456789123456789
18 访韩时否姓名
Have you ever used any other names to enter or depart Korea
否 No [√ ] Yes [ ] → 选择’选项时填写详细容 IfYes’please provide details
(姓 Family Name 名 GivenName )
19 否双重国籍 Are you a citizen of more than one country 否 No [ √ ] Yes [ ]
→选择’选项时记载详细容 IfYes’please write the countries ( )
领馆审核栏 FOR OFFICIAL USE ONLY（处填写）
기본사항 체류자격 체류기간 유효기간 사증종류 S ▪ D ▪ M
접수사항 접수일자 접수번호 처리과
허가사항 허가일자 인정번호 고지사항
결 재
담당
가 [ ]
부 [ ]
심사의견>
< 邮票粘贴处>
<수입인지 부착란>
BL
출입국사항
복수대상사유
사건부
불허경력
기타
2 签证发认定书签发信息（反签号） DETAILS OF VISA ISSUANCE CONFIRMATION
※ 仅限韩民国出入国理事务·办事处收签证发认定书（处填写）
(Section 2 is only for those who possess confirmation of visa issuance issued by the Immigration Office of the Republic of Korea)21 签证发认定号码(反签号)
Confirmation No
22 签发日期 Issue Date
23 护号码 Passport No 24 护效期Passport Expiry Date
‣ 签证发认定书持者直接移第12部分(誓约)填写空格提交申请表(写第3~11部分)
Those who have confirmation of visa issuance must move to section 12 (Declaration) to complete this from (Those
with visa issuance confirmation must not fill out section 3~11)
3 护信息 PASSPORT INFORMATION
31 护种类 Passport Type
外交 Diplomatic [ ] 公务 Official [ ] 公务普通 Official [ ] 私 Regular[√ ] Other [ ]
→ 您选择’请写具体容 IfOther’please provide details
( )
32 护号码 Passport No
G12345678
33签发国家 Country of Passport
中国
34 签发点 Place of Issue
海
35 签发日期 Date of Issue
20170902
36 效期间 Date Of Expiry
20270901
37 否持护 Do you have any other valid passport 否 No [ √ ] Yes [ ]
→ 您选择’请写具体容 IfYes’please provide details
a) 护种类 Passport Type
外交 Diplomatic [ ] 公务 Official [ ] 公务普通 Official [ ] 私 Regular[√ ] Other [ ]
b) 护号码 Passport No c) 签发国家 Country of Passport d) 效期间 Date Of Expiry
4 联系方式 CONTACT INFORMATION
41 国址 Address in Your Home Country 海市静安区XX路XX号XX室（填写身份证址）
41 现居住 Current Residential Address *仅限现居住国址者
Write if it is different from the above address海市静安区XX路XX号XX室（填写实际居住址）
43 手机号码 Cell Phone No
13900000000
44 固定电话 Telephone No
02122222222
45 电子邮箱 Email
123456789@qqcom
46 紧急情况联系信息 Emergency Contact Information
a) 姓名 Full Name 王帅 b) 居住国家 Country of residence 中国
c) 电话号码 Telephone No 02111111111 d) 关系 Relationship to you 父子
5 婚姻状况 MARITAL STATUS DETAILS
51 婚姻状况 Current Marital Status
已婚 Married [ √ ] 离婚 Divorced [ ] 未婚 Single [ ] 丧偶 Widowed [ ]
52 配偶信息 *标记已婚时填写 IfMarried’please provide details of your spouse
a) 姓 Family Name (in English)
张（中文填写）
b) 名 Given Names (in English)
萌萌（中文填写）
c) 出生日期 Date of Birth (yyyymmdd)
19901225
d) 国籍 Nationality
中国
e) 住址 Residential Address
海市静安区XX路XX号XX室（填写实际居住址）
f) 联系电话 Contact No
02166666666
6 学历 EDUCATION61 终学历 What is the highest degree or level of education you have completed
硕士博士 Master’sDoctoral Degree [ ] 学士 Bachelor’s Degree [ √ ]
高中 High School Diploma [ ] Other [ ]
→ 您选择请写具体容 IfOther’please provide details ( )
62 学校名称 Name of School
海XXXX学（填写毕业终学历）
63 学校址 Location of School(cityprovincecountry)
海市XX区XX路XX号
7 职业 EMPLOYMENT
71 职业 What are your current personal circumstances
企业家 Entrepreneur [ ] 体营 SelfEmployed [ ] 职员 Employed [ √ ]
公务员 Civil Servant [ ] 学生 Student [ ] 退休者 Retired [ ]
职 Unemployed [ ] Other [ ]
→ 您选择请写具体容 IfOther’please provide details ( )
72 职业详细信息 Employment Details
a) 单位机构学校（名称） Name of CompanyInstituteSchool
海XXXX限公司
b) 职位专业 Your PositionCourse
律师
c) 单位机构学校（址） Address of CompanyInstituteSchool
海市XX区XX路XX号
d) 电话号码 Telephone No
8 邀请信息 DETAILS OF SPONSOR
81 邀请邀请单位 Do you have anyone sponsoring you for the visa
否 No [ √ ] Yes [ ] → 您选择请写具体容 IfYes’please provide details
a) 邀请邀请单位（名称 ）Name of your visa sponsor (Korean foreign resident in Korea company or institute)
b) 出生日期营业执号码 Date of BirthBusiness Registration No b) 关系 Relationship to you
d) 址 Address e) 电话号码 Phone No
9 访问信息 DETAILS OF VISIT
91 赴韩目 Purpose of Visit to Korea
观光 TourismTransit [√ ] 参加会议Meeting Conference [ ] 医疗观光 Medical Tourism [ ]
短期商务 Business Trip [ ] 留学研修 StudyTraining [ ] 业 Work [ ]
贸易投资派驻TradeInvestmentIntra
Corporate Transferee [ ]
探亲Visiting
FamilyRelat ivesFriends [ ]
结婚移民 Marriage Migrant [ ]
外交公务 DiplomaticOfficial [ ] Other [ ]
→ 您选择请写具体容 IfOther’please provide details ( )
92 预定停留时间Intended Period of Stay
57天（填写概日期）
93 访韩预定日 Intended Date of Entry
201851（填写概日期）
94 韩国联系址(包括酒店) Address in Korea(including hotels) 95 韩国境联系方式 Contact No in Korea
96 5年否访问韩国 Have you travelled to Korea in the last 5 years
否 No [ ] Yes [ √ ] → 您选择请写具体容 IfYes’please provide details of any trips to Korea
( 1 ) 次 times 访韩目 Purpose of Recent Visit ( 旅游 )
97 5年否访问国家（韩国外）
Have you travelled outside your country of residence excluding to Korea in the last
5 years 否 No [ ] Yes [ √ ] → 您选择请写具体容 IfYes’please provide details of these trips国家 Name of Country 访问目 Purpose of Visit 访问期间 Period of Stay
(yyyymmdd)~ (yyyymmdd)
日 旅游 201661201666
98 行家属 Are you travelling to Korea with any family member
No [ ] Yes [ √ ] → 您选择请写具体容 If Yes’ please provide details of the family
members you are travelling with
姓名 Full name in English 出生日期 Date of Birth
(yyyymmdd)
国籍
Nationality 关系 Relationship to you
张萌萌 19901225 中国 夫妻
行家属包括亲属配偶学朋友出行填写
* 参考 家属范围 – 配偶 子女 父母 兄弟姐妹
Note Definition of a Family Member your spouse father mother children brothers and sisters
10 访问费 FUNDING DETAILS （处填写）
101 访问费(美元基准) Estimated travel costs(in US dollars) 2000美元
102 访韩费支付者 Who will pay for your travelrelated expenses (any person including yourself andor institute)
a) 姓名单位名称 Name of PersonCompany(Institute)
b) 关系 Relationship to you
c) 支援容 Type of Support d) 联系电话 Contact No
11 填写申请表时否接受帮助 ASSISTANCE WITH THIS FORM （处填写）
111 您填写申请表时否接受帮助？Did you receive assistance in completing this form
否[ √] No Yes [ ] → 您选择请写具体容
IfYes’please provide details of the person who assisted you姓名 Full Name 出生日期 Date of Birth
(yyyymmdd) 联系电话 Telephone No 关系
Relationship to you
12 誓约 DECLARATION
* 签证发认定书持者须填写
Those who possess confirmation of visa issuance must only complete section 12 and 12 of this form根知信声明陈述均真实准确完整遵守韩民国出入境理法律法规
I declare that the statements made in this application are true and correct to the best of my knowledge and belief
and that I will comply with the Immigration Act of the Republic of Korea
申请日期 (年 月 日) DATE OF APPLICATION (yyyymmdd)
2018 ▪ 1 ▪ 1 ▪（填写填表日期）
申请（签名） SIGNATURE OF APPLICANT
王明
申请未满17岁父母法定监护签名
Signature of Parent or Legal Guardian´s for a person under 17 years of age
附件
ATTACHMENT 1 「出入境理法实行规」 第76条第1项[表格 5]签证发申请等附件
注意事项 Notice
1 关述事项表够填写加附页追加提供相关材料
If extra space is needed to complete any item record on a separate sheet of paper or submit relevant documents which could
support your application
2 您韩民国签证批准遗失损毁等原次签发必须通知签证处理机构变更护信息便准确反
映信息
If you received Korean visa approval and have new passport issued thereafter in lieu of lostdamaged passport you must
notify the concerned visa office of changes in your passport information
3 申请入境韩民国时发现许入境者持韩国签证权入境
Possession of a visa does not entitle the bearer to enter the Republic of Korea upon arrival at the port of entry if heshe is
found inadmissible
4 根「出入境理法施行规」第9条第1项C类签证持者入境韩国变更滞留资格
Please note that category C visa holders are not able to change their status of stay after their entry into the Republic of Korea in
accordance with Article 9(1) of the Enforcement Regulations of the Immigration Act
处理程序
填写申请表
Application → 接受
Reception → 审查
Review → 批准
Approval → 签发签证
Issuance
申请
Applicant
处理机关
(驻外公馆)
Diplomatic Mission
处理机关
(驻外公馆)
Diplomatic Mission
处理机关
(驻外公馆)
Diplomatic Mission
处理机关
(驻外公馆)
Diplomatic Mission
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签证发申请表（样表）
APPLICATION FOR VISA
<申请表填写方法>
‣ 申请须事实根空格处完整记载
‣ 申请必须中文英文填写申请表
‣ 相关选项[ ]钩
‣ 您选择请写具体容
‣ You must fill out this form completely and correctly
‣ You must write in block letters either in English or Korean
‣ For multiplechoice questions you must check [√] all that apply
‣ If you selectOther’ please provide us with more information in the given space
1 信息 PERSONAL DETAILS
PHOTO
护规格片
(35㎜×45㎜)
6月拍摄正面免冠
彩色相片相片背景颜色
须纯白色
A color photo taken within la
st 6 months(full face without
hat front view against whit
e or offwhite background)
11 护英文姓名Full name in English (as shown in your passport)
姓 Family Name
WANG
名 Given Names
XIAOMING
12 中文姓名 漢字姓名
王明
13 性 Sex
男Male[ √ ] 女Female[ ]
14 出生日期 Date of Birth (yyyymmdd)
19900214
15 国籍 Nationality
中国
16 出生国 Country of Birth
中国
17 身份证号码 National Identity No
123456789123456789
18 访韩时否姓名
Have you ever used any other names to enter or depart Korea
否 No [√ ] Yes [ ] → 选择’选项时填写详细容 IfYes’please provide details
(姓 Family Name 名 GivenName )
19 否双重国籍 Are you a citizen of more than one country 否 No [ √ ] Yes [ ]
→选择’选项时记载详细容 IfYes’please write the countries ( )
领馆审核栏 FOR OFFICIAL USE ONLY（处填写）
기본사항 체류자격 체류기간 유효기간 사증종류 S ▪ D ▪ M
접수사항 접수일자 접수번호 처리과
허가사항 허가일자 인정번호 고지사항
결 재
담당
가 [ ]
부 [ ]
심사의견>
< 邮票粘贴处>
<수입인지 부착란>
BL
출입국사항
복수대상사유
사건부
불허경력
기타
2 签证发认定书签发信息（反签号） DETAILS OF VISA ISSUANCE CONFIRMATION
※ 仅限韩民国出入国理事务·办事处收签证发认定书（处填写）
(Section 2 is only for those who possess confirmation of visa issuance issued by the Immigration Office of the Republic of Korea)21 签证发认定号码(反签号)
Confirmation No
22 签发日期 Issue Date
23 护号码 Passport No 24 护效期Passport Expiry Date
‣ 签证发认定书持者直接移第12部分(誓约)填写空格提交申请表(写第3~11部分)
Those who have confirmation of visa issuance must move to section 12 (Declaration) to complete this from (Those
with visa issuance confirmation must not fill out section 3~11)
3 护信息 PASSPORT INFORMATION
31 护种类 Passport Type
外交 Diplomatic [ ] 公务 Official [ ] 公务普通 Official [ ] 私 Regular[√ ] Other [ ]
→ 您选择’请写具体容 IfOther’please provide details
( )
32 护号码 Passport No
G12345678
33签发国家 Country of Passport
中国
34 签发点 Place of Issue
海
35 签发日期 Date of Issue
20170902
36 效期间 Date Of Expiry
20270901
37 否持护 Do you have any other valid passport 否 No [ √ ] Yes [ ]
→ 您选择’请写具体容 IfYes’please provide details
a) 护种类 Passport Type
外交 Diplomatic [ ] 公务 Official [ ] 公务普通 Official [ ] 私 Regular[√ ] Other [ ]
b) 护号码 Passport No c) 签发国家 Country of Passport d) 效期间 Date Of Expiry
4 联系方式 CONTACT INFORMATION
41 国址 Address in Your Home Country 海市静安区XX路XX号XX室（填写身份证址）
41 现居住 Current Residential Address *仅限现居住国址者
Write if it is different from the above address海市静安区XX路XX号XX室（填写实际居住址）
43 手机号码 Cell Phone No
13900000000
44 固定电话 Telephone No
02122222222
45 电子邮箱 Email
123456789@qqcom
46 紧急情况联系信息 Emergency Contact Information
a) 姓名 Full Name 王帅 b) 居住国家 Country of residence 中国
c) 电话号码 Telephone No 02111111111 d) 关系 Relationship to you 父子
5 婚姻状况 MARITAL STATUS DETAILS
51 婚姻状况 Current Marital Status
已婚 Married [ √ ] 离婚 Divorced [ ] 未婚 Single [ ] 丧偶 Widowed [ ]
52 配偶信息 *标记已婚时填写 IfMarried’please provide details of your spouse
a) 姓 Family Name (in English)
张（中文填写）
b) 名 Given Names (in English)
萌萌（中文填写）
c) 出生日期 Date of Birth (yyyymmdd)
19901225
d) 国籍 Nationality
中国
e) 住址 Residential Address
海市静安区XX路XX号XX室（填写实际居住址）
f) 联系电话 Contact No
02166666666
6 学历 EDUCATION61 终学历 What is the highest degree or level of education you have completed
硕士博士 Master’sDoctoral Degree [ ] 学士 Bachelor’s Degree [ √ ]
高中 High School Diploma [ ] Other [ ]
→ 您选择请写具体容 IfOther’please provide details ( )
62 学校名称 Name of School
海XXXX学（填写毕业终学历）
63 学校址 Location of School(cityprovincecountry)
海市XX区XX路XX号
7 职业 EMPLOYMENT
71 职业 What are your current personal circumstances
企业家 Entrepreneur [ ] 体营 SelfEmployed [ ] 职员 Employed [ √ ]
公务员 Civil Servant [ ] 学生 Student [ ] 退休者 Retired [ ]
职 Unemployed [ ] Other [ ]
→ 您选择请写具体容 IfOther’please provide details ( )
72 职业详细信息 Employment Details
a) 单位机构学校（名称） Name of CompanyInstituteSchool
海XXXX限公司
b) 职位专业 Your PositionCourse
律师
c) 单位机构学校（址） Address of CompanyInstituteSchool
海市XX区XX路XX号
d) 电话号码 Telephone No
8 邀请信息 DETAILS OF SPONSOR
81 邀请邀请单位 Do you have anyone sponsoring you for the visa
否 No [ √ ] Yes [ ] → 您选择请写具体容 IfYes’please provide details
a) 邀请邀请单位（名称 ）Name of your visa sponsor (Korean foreign resident in Korea company or institute)
b) 出生日期营业执号码 Date of BirthBusiness Registration No b) 关系 Relationship to you
d) 址 Address e) 电话号码 Phone No
9 访问信息 DETAILS OF VISIT
91 赴韩目 Purpose of Visit to Korea
观光 TourismTransit [√ ] 参加会议Meeting Conference [ ] 医疗观光 Medical Tourism [ ]
短期商务 Business Trip [ ] 留学研修 StudyTraining [ ] 业 Work [ ]
贸易投资派驻TradeInvestmentIntra
Corporate Transferee [ ]
探亲Visiting
FamilyRelat ivesFriends [ ]
结婚移民 Marriage Migrant [ ]
外交公务 DiplomaticOfficial [ ] Other [ ]
→ 您选择请写具体容 IfOther’please provide details ( )
92 预定停留时间Intended Period of Stay
57天（填写概日期）
93 访韩预定日 Intended Date of Entry
201851（填写概日期）
94 韩国联系址(包括酒店) Address in Korea(including hotels) 95 韩国境联系方式 Contact No in Korea
96 5年否访问韩国 Have you travelled to Korea in the last 5 years
否 No [ ] Yes [ √ ] → 您选择请写具体容 IfYes’please provide details of any trips to Korea
( 1 ) 次 times 访韩目 Purpose of Recent Visit ( 旅游 )
97 5年否访问国家（韩国外）
Have you travelled outside your country of residence excluding to Korea in the last
5 years 否 No [ ] Yes [ √ ] → 您选择请写具体容 IfYes’please provide details of these trips国家 Name of Country 访问目 Purpose of Visit 访问期间 Period of Stay
(yyyymmdd)~ (yyyymmdd)
日 旅游 201661201666
98 行家属 Are you travelling to Korea with any family member
No [ ] Yes [ √ ] → 您选择请写具体容 If Yes’ please provide details of the family
members you are travelling with
姓名 Full name in English 出生日期 Date of Birth
(yyyymmdd)
国籍
Nationality 关系 Relationship to you
张萌萌 19901225 中国 夫妻
行家属包括亲属配偶学朋友出行填写
* 参考 家属范围 – 配偶 子女 父母 兄弟姐妹
Note Definition of a Family Member your spouse father mother children brothers and sisters
10 访问费 FUNDING DETAILS （处填写）
101 访问费(美元基准) Estimated travel costs(in US dollars) 2000美元
102 访韩费支付者 Who will pay for your travelrelated expenses (any person including yourself andor institute)
a) 姓名单位名称 Name of PersonCompany(Institute)
b) 关系 Relationship to you
c) 支援容 Type of Support d) 联系电话 Contact No
11 填写申请表时否接受帮助 ASSISTANCE WITH THIS FORM （处填写）
111 您填写申请表时否接受帮助？Did you receive assistance in completing this form
否[ √] No Yes [ ] → 您选择请写具体容
IfYes’please provide details of the person who assisted you姓名 Full Name 出生日期 Date of Birth
(yyyymmdd) 联系电话 Telephone No 关系
Relationship to you
12 誓约 DECLARATION
* 签证发认定书持者须填写
Those who possess confirmation of visa issuance must only complete section 12 and 12 of this form根知信声明陈述均真实准确完整遵守韩民国出入境理法律法规
I declare that the statements made in this application are true and correct to the best of my knowledge and belief
and that I will comply with the Immigration Act of the Republic of Korea
申请日期 (年 月 日) DATE OF APPLICATION (yyyymmdd)
2018 ▪ 1 ▪ 1 ▪（填写填表日期）
申请（签名） SIGNATURE OF APPLICANT
王明
申请未满17岁父母法定监护签名
Signature of Parent or Legal Guardian´s for a person under 17 years of age
附件
ATTACHMENT 1 「出入境理法实行规」 第76条第1项[表格 5]签证发申请等附件
注意事项 Notice
1 关述事项表够填写加附页追加提供相关材料
If extra space is needed to complete any item record on a separate sheet of paper or submit relevant documents which could
support your application
2 您韩民国签证批准遗失损毁等原次签发必须通知签证处理机构变更护信息便准确反
映信息
If you received Korean visa approval and have new passport issued thereafter in lieu of lostdamaged passport you must
notify the concerned visa office of changes in your passport information
3 申请入境韩民国时发现许入境者持韩国签证权入境
Possession of a visa does not entitle the bearer to enter the Republic of Korea upon arrival at the port of entry if heshe is
found inadmissible
4 根「出入境理法施行规」第9条第1项C类签证持者入境韩国变更滞留资格
Please note that category C visa holders are not able to change their status of stay after their entry into the Republic of Korea in
accordance with Article 9(1) of the Enforcement Regulations of the Immigration Act
处理程序
填写申请表
Application → 接受
Reception → 审查
Review → 批准
Approval → 签发签证
Issuance
申请
Applicant
处理机关
(驻外公馆)
Diplomatic Mission
处理机关
(驻外公馆)
Diplomatic Mission
处理机关
(驻外公馆)
Diplomatic Mission
处理机关
(驻外公馆)
Diplomatic Mission
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