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Personal Information
Surname
Previous Surname
(if changed)
First Name
Previous First Name
(if changed)
Other Names
Previous Other Names
(if changed)
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Sex
Male
Female
Date of Birth
January
February
March
April
May
June
July
August
September
October
November
December
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Country of Birth
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
CAR
Chad
Chile
China
Colombia
Comoro Islands
Congo
Costa Rica
Cote dIvoire
Croatia
Cuba
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican
East Timor
Eastern Samoa
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Fiji Islands
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Grenada
Guadeloupe
Guatemala
Guinea
Guinea Ecuatorial
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
International (UN)
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxemburg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Melilla
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar\ Burma
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
Saint Lucia
Saint Vincent
Saint-Pierre
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Christopher
Stateless
Sudan
Surinam
Swaziland
Sweden
Switzerland
Syria
Tadjikistan
Taiwan
Tanzania
Thailand
The Western Sahara
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
UAE
Uganda
Ukraine
Uruguay
USA
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
West Berlin
Western Samoa
Yemen
Zaire
Zambia
Zimbabwe
Place of Birth
(city or province)
Citizenship
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
CAR
Chad
Chile
China
Colombia
Comoro Islands
Congo
Costa Rica
Cote dIvoire
Croatia
Cuba
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican
East Timor
Eastern Samoa
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Fiji Islands
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Grenada
Guadeloupe
Guatemala
Guinea
Guinea Ecuatorial
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
International (UN)
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxemburg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Melilla
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar\ Burma
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
Saint Lucia
Saint Vincent
Saint-Pierre
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Christopher
Stateless
Sudan
Surinam
Swaziland
Sweden
Switzerland
Syria
Tadjikistan
Taiwan
Tanzania
Thailand
The Western Sahara
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
UAE
Uganda
Ukraine
Uruguay
USA
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
West Berlin
Western Samoa
Yemen
Zaire
Zambia
Zimbabwe
Previous Citizenship
(if changed)
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
CAR
Chad
Chile
China
Colombia
Comoro Islands
Congo
Costa Rica
Cote dIvoire
Croatia
Cuba
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican
East Timor
Eastern Samoa
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Fiji Islands
Finland
France
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Grenada
Guadeloupe
Guatemala
Guinea
Guinea Ecuatorial
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
International (UN)
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxemburg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Melilla
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar\ Burma
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russian Federation
Rwanda
Saint Lucia
Saint Vincent
Saint-Pierre
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
St Christopher
Stateless
Sudan
Surinam
Swaziland
Sweden
Switzerland
Syria
Tadjikistan
Taiwan
Tanzania
Thailand
The Western Sahara
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
UAE
Uganda
Ukraine
Uruguay
USA
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
West Berlin
Western Samoa
Yemen
Zaire
Zambia
Zimbabwe
Passport Type
Ordinary
Service
Official
Diplomatic
Other
Passport Number
Date of Issue
January
February
March
April
May
June
July
August
September
October
November
December
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
Expiration Date
January
February
March
April
May
June
July
August
September
October
November
December
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
2046
2047
2048
2049
2050
2051
2052
2053
2054
2055
2056
2057
2058
Issued By
Marital Status
Single
Married
Separated/Divorsee
Widower/Widowed
Spouse's Surname, First and Other Names
Travel Information
Period of Visit, from
January
February
March
April
May
June
July
August
September
October
November
December
2013
2014
2015
2016
to
January
February
March
April
May
June
July
August
September
October
November
December
2013
2014
2015
2016
2017
2018
Number of Entries
One
Two
Three
Four
Five
Six
Eight
Ten
Multiple
Transit one
Transit two
Duration of Stay
(days, for each entry)
Duration of Visa Procedure
(effects in visa fee)
Usual
Urgent
Place of Visa Issuance
Abu Dhabi
Almaty
Ankara
Ashkhabad
Athens
Baku
Bangkok
Beijing (Peking)
Berlin
Bishkek
Brussels
Cairo
Dubai
Dushanbe
Frankfurt am Main
Islamabad
Istanbul
Jakarta
Jeddah
Kabul
Kiev
Kuala Lumpur
Kuwait
London
Madrid
Mazare-Sharif
Moscow
New-Delhi
New-York
Novosibirsk
Paris
Riga
Riyadh
Rome
Seoul
Shanxay
Singapur
Tashkent (Airport)
Tashkent (MFA)
Tehran
Tel Aviv
Termez
Tokyo
Vienna
Warsaw
Washington
Purpose of Visit
(in detail)
Inviting Party
(inviting organization or person, phone)
Additional Information
Address in Uzbekistan
(address while in Uzbekistan, phone)
List fill form visitor (max: 15 person)
Previous Visits to Uzbekistan
(date, purpose and inviting party)
Accompanied Persons
(persons travelling together and inserted into applicant's passport)
Occupation
Diplomats and employees of international organizations
Chiefs of government structures and eminent government and public figures
Employees of government structures
Chiefs and employees of law enforcement authority, military personnel
Representatives of non-governmental and public organizations
Representatives of business groups and persons, engaging in individual enterprise
Journalists, including engaged in journalistic activities independently or in retirement
Religious leaders, officers and employees of religious organizations
Scientists, representatives of academic groups and think tanks
Drivers of commercial vehicles
The crew members of aircraft and trains
Students
Students and children under school age
Retirees
Housewives are temporarily not workings, etc.
Athletes
Place of Work (Study) and Position
(full name of organization and applicant's position)
Work (Study) Address and Phone
(coutry, city, street, house No., phone and email)
Home Address and Phone
country, city, street, house No., phone and email)
Continue (print form)
Add next person (for persons travelling together)
Print page
Type digits from the image
Refresh picture
Download Forms (Print)
Back and edit
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Информация
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Ministry of Foreign Affairs of the Republic of Uzbekistan
Consular department
9, Uzbekistan Street, Tashkent, 100029
Phone:(+998 71) 233-45-01
Fax: (+998 71) 239-15-17