Á¦¸ñ ½Ì°¡Æú ÃâÀÔ±¹Ä«µåÀÛ¼º¹ý  
ÀÛ¼ºÀÚ °ü¸®ÀÚ ÀÛ¼ºÀÏ 2012-09-21



1. Full Name as it appears in passport/ travel d0cument (BLOCK LETTERS) -

    ¿©±Ç¼­·ù¿¡ ÀûÈù´ë·Î º»ÀÎÀÇ Àüü À̸§ (´ë¹®ÀÚ)

2. Passport Number - ¿©±Ç ¹øÈ£

3. ¼ºº°  - MALE ³²ÀÚ  / FEMALE ¿©ÀÚ

3. Place of lssue - ¿©±Ç ¹ßÇà µµ½Ã

4. Date of Expiry - ¿©±Ç ¸¸±âÀÏ

5. Country of Birth - ±¹Àû : ž ³ª¶ó

6. Date of Birth (DD-MM-YYYY) - »ý³â¿ùÀÏ (ÀÏ-¿ù-³âµµ)

7. Nationality - ±¹Àû

8. Identity Card Number(for MALAYSIAN only) - ½Å»ó ¹øÈ£ (¸»¿¡ÀÌ½Ã¾Æ »ç¶÷¸¸)

9. Tick if Malaysian - ¸»·¹ÀÌ½Ã¾Æ »ç¶÷ÀÌ¸é ¿©±â¿¡ üũÇϽÿÀ

10. Flight No/Vessel Name/Vehicle No - Ç×°ø Æí¸í / Ç×°ø»ç À̸§ / ÀÚµ¿Â÷ ¹øÈ£

11. OFFICE USE ONLY - °ü°èÀÚ »ç¿ë¿ë

12. Place of Residence - °ÅÁÖÁö. CITY - µµ½Ã / STATE / COUNTRY - ±¹Àû

13. Last City/ Port of Embarkation Before Singapore -

     ½Ì°¡Æú ÀÔ±¹ ¹Ù·ÎÀü¿¡ ÀÖ¾ú´ø µµ½Ã/ºñÇà±â ź µµ½Ã

14. Next City/ Port of Disembarkation After Singapore -

     ½Ì°¡Æú ´ÙÀ½¿¡ °ÅÄ¥ µµ½Ã/ºñÇà±â¿¡¼­ ³»¸± µµ½Ã

15. Address In singapore - ½Ì°¡Æú ³»ÀÇ ÁÖ¼Ò - ½Ì°¡Æú ü·ùÁö ÁÖ¼Ò

16. Length of Stay Days - ü·ù ±â°£ Àϼö(¸îÀÏ)

17. Have you been to Africa or South America during the last 6 days?+

     Áö³­ 6Àϵ¿¾È¿¡ ¾ÆÇÁ¸®Ä«³ª ³²¹ÌÁö¿ª¿¡ °£ ÀûÀÌ ÀÖ½À´Ï±î?

18. Have you ever used a passport under different name to enter Singapore?

     Áö±Ý°ú ´Ù¸¥ À̸§À¸·Î µÈ ¿©±ÇÀ» °¡Áö°í ½Ì°¡Æú¿¡ ÀÔ±¹ÇÑÀûÀÌ ÀÖ½À´Ï±î?

19. Have you ever been prohibited from entering Singapore?+ -

     ÇѹøÀÌ¶óµµ ½Ì°¡Æú ÀÔ±¹À» °ÅÀý´çÇÑÀûÀÌ ÀÖ½À´Ï±î?

20. If 'yes'state name(s) different from current passport. -

     ¸¸ÀÏ "³×"¶ó°í ´äÇßÀ¸¸é, Áö±Ý ¿©±Ç°ú ´Ù¸¥ À̸§(µé)À» ±âÀÔÇϽʽÿÀ.

    + Please tick (/) appropriate box  ÀûÀýÇÑ ¹Ú½º¿¡ ºø±Ý(/)À» Ãļ­ Ç¥ÇϽʽÿÀ.

21. Signature - ¼­¸í

22 : ¿©±Ç»óÀÇ À̸§.

23 : ±¹Àû.

24 : ¸»·¹À̽þƸ¸±âÁ¦

25 :  OFFICE USE ONLY - °ü°èÀÚ »ç¿ë¿ë (µ¿¹ÝÀÚ³à¶ó°í À§ »çÁø¿¡ À߸ø ³ª¿Í ÀÖ½À´Ï´Ù.)

22-25 ´Â ¸Ç ¿À¸¥ÂÊ Ä­ ( 3µîºÐÇؼ­ )

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