Citizenship and Immigration Spocania

Immigration

 1 
 		  IH
 

KINDISTEE SPOOKSOLIY
KINGDOM OF SPOCANIA

 2 
 		  Surname
 		  3 
 		  Given names
 
 4 
 		  Date of birth
 		  5 
 		  Place of birth
 
 6 
 		  Country of birth
 		  7 
 		  Sex
 		  8 
 		  Marital Status
 
 9 
 		  Citizen of country
 		  10 
 		  Passport No.
 		  Valid until
 
 11 
 		  If applicable, Country of
 Issue or Travel Document		  12 
 		  Family Status
 
 13   Accompanying Family Members
 Name
 
 
 
 
 
 
 
 
 
 
 		  Date of Birth  Relationship
 Have you other dependants other than those listed above?   YES/NO
 14   Full Name, Address and Relationship of Person willing to assist
 
 
 
 
 15 
 		  Intended Occupation
 		  16 
 		  Mother tongue
 

I certify that the above statements are true and correct.
Signature                          Date

 

 17 
 		  Imm.Cat.
 		  18 
 		  Educ.Qual.
 		  19 
 		  Years of Schooling
 
 20 
 		  Employment Code
 		  21 
 		  Spocanian language
 ability		  22 
 		  Medical File No.
 
 23 
 		  Date Issued
 		  24 
 		  Office of Issue
 		  25 
 		  Code
 
 26 
 
 
 		  Original Entry in
 Spocania
 
 		  27 
 
 
 		  Signature of
 Immigration Officer
 
 		  28 
 
 
 		  Remarks
 
 
 

See back of this paper for Warning and Privacy Statement. This form has been established by the
Minister of Citizenship and Immigration. This document is the property of the Government of Spocania.

 

 

 

 

Remarks

 

 

 

 

 

 

 

 

 

 

Warning

Photocopies of this document are not valid for travel to Spocania. Use of this document by persons other than the holder may result in criminal prosecution under the Immigration Act.

Privacy Statement

The information provided on this form is collected under the authority of the Immigration Act for the purpose of granting you landing in Spocania.
This information will be stored in Personal Information Banks, code IDafiy 55, and you have the right of access to it and to its protection under the Privacy Act.