Surname (given name)
First name
Middle name
Date of birth
Place of birth
Sex: Male Female Please select your sex
Nationality
Occupation
Home address
Phone number
Postal address if different from above (optional)
Passport number
Date of issue
Place of issue
Issuing authority
Date of expiry
Previous visits to Tajikistan
Have you ever been refused a visa for Tajikistan? Yes No Required
Date visa to start
Date visa to finish
Point of entry
Point of exit
Itinerary
Entry: Single Double Multi-entry Required
Tourist/business: Tourist Business Required
Contact Address in Tajikistan
Applying for a GBAO permit?
Visa number (if you already have one)
Date of visa start
Date of visa expiry
Issued by
Proposed date of entry to GBAO
Proposed date of exit from GBAO
Areas to be visited
Attach scanned copy of picture page of your passport
Attach scanned copy of Tajik visa if you already have one
Attach electronic passport standard photograph of yourself if possible
