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Uzbekistan visa application form
day month year
Intended date of entry to Uzbekistan
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January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
Intended date of depature from Uzbekistan
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:
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January
February
March
April
May
June
July
August
September
October
November
December
2010
2011
2012
First name
*
:
Last name
*
:
Middle name:
Maiden name:
Sex
*
:
M
F
day month year
Birthday
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:
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January
February
March
April
May
June
July
August
September
October
November
December
Country of birth
*
:
Choose one
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Chad
Channel Islands
Chile
China
Colombia
Cook Islands
Costa Rica
Croatia
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea DPR (North)
Korea (Republic of)
Kuwait
Kyrgyzstan
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar/Burma
Namibia
Nepal
Netherlands Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saba
Saipan
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tanzania
Thailand
Togo
Tortola
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Virgin Islands
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
City of birth
*
:
Passport number
*
:
day month year
Passport issued
*
:
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11
12
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15
16
17
18
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24
25
26
27
28
29
30
31
--
January
February
March
April
May
June
July
August
September
October
November
December
Passport expiration
*
:
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15
16
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18
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26
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28
29
30
31
--
January
February
March
April
May
June
July
August
September
October
November
December
Present sitizenship
*
:
Choose one
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Chad
Channel Islands
Chile
China
Colombia
Cook Islands
Costa Rica
Croatia
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Ivory Coast
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea DPR (North)
Korea (Republic of)
Kuwait
Kyrgyzstan
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar/Burma
Namibia
Nepal
Netherlands Antilles
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saba
Saipan
San Marino
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovak Republic
Slovenia
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tanzania
Thailand
Togo
Tortola
Tunisia
Turkey
Turkmenistan
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Virgin Islands
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis & Futuna
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Marital status
*
:
single
married
Your spouse's name & surname:
Your company name:
Your company address:
Your position in company:
Home address
*
:
Country
*
:
City
*
:
State/Province:
Zip/Postal Code:
country/city code telephone number
If you want to be contacted by telephone,
please type you number:
Time you wish to be called by phone:
E-mail
*
:
Retype e-mail
*
:
Title
*
:
Message
*
:
See also
in this
section
Uzbekistan visa support
Uzbekistan visa types
Uzbekistan visa FAQ
Uzbekistan customs
Uzbekistan border regulations
Uzbekistan embassies abroad
Foreign embassies in Uzbekistan
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