PERU- VISA REQUIREMENTS AND INSTRUCTIONS READ CAREFULLY: Incomplete or delayed submission of the visa application can result in missing your program. TO apply for your visa: □ □ □

Use the blank one-page visa application form contained in this document Please provide type-written responses for the visa application form, HANDWRITTEN APPLICATIONS AND DIGITAL SIGNATURES WILL NOT BE ACCEPTED If you have any questions about your visa application, please contact [email protected]

Heading Area: Leave blank. Section 1: Type of Visa Check VISA TEMPORAL (Temporary Visa). Section 2: General Information 1. Type No. Passport: Write “Comun USA.” Leave passport number blank 2. Primer Apellido (First Last name): Write your last name exactly as you will have it on your passport. (English Translation is incorrect on form) 3. Segundo Apellido (Second Last Name): Leave blank unless you have two last names that will appear on your passport. If you have two last names, the second one goes here. (English Translation is incorrect on form) Apellido Casada (Maiden Name): Please leave Blank 4. Nombres (First & Middle names): Write just your first name and middle name exactly as they will appear on your passport IMPORTANT: When filling out your name, make sure it appears exactly as they will appear on your Peace Corps passport. If you have suffixes such as “Jr,” “Sr,” or a “II,” that will appear on your passport, they must be listed on the visa application. 5. Sex: Check one 6. Marital status: Check one 7. Place of birth: Write city and state only. If you were born outside of the U.S., write city and country only 8. Nationality: Write “American” 9. Date of Birthday: Use Day/Month/Year format (one digit per a box) 10. Profession: Leave Blank 11. Full address in Peru: Write the following: Calle Via Lactea 132 Urb. Los Granados Surco, Lima 33 PERU Phone number in Peru: 011-511-617-2200 12. Permanent address: Write your home of record address in the United States and a working phone number. Section 3: Signature, Right Index Fingerprint and Picture Signature: Sign (no digital signatures are accepted) Right Index Fingerprint: Leave blank. Photo: Include 1 passport photo. Note: Photo must meet passport photo requirements. (2x2 inches, white background, photo paper, etc.). DO NOT staple the photo. Sections 4, 5, 6 Leave blank **Make Sure Signature line “Firma de Cónsul o Encargado” at bottom prints out- DO NOT SIGN here** □ Before Printing, confirm you have entered all fields correctly □ Print 1 completed visa form □ Make sure have signed in section 3 and attach 1 passport size color photograph using a paperclip.

Last Updated: 12/11/17

Uso interno Nro.Expediente : FORMULARIO DGC-005 SOLICITUD DE VISA

Plazo en el que puede hacer uso de esta Visa:

Ministerio de Relaciones Exteriores

Fecha Inicio : Fecha Fin : 1. PROCEDIMIENTO A REALIZAR / TYPE OF VISA.

Visa Temporal (Temporary Visa) Visa Residente (Resident Visa)

1. Tipo.Nro.Pasaporte : (Type, Num.Passport)

Comun USA

2. Primer Apellido: (First Name) 3. Segundo Apellido (Middle Name)

✔

2. DATOS DEL SOLICITANTE / GENERAL INFORMATION. Nro: 6. Estado Civil : Soltero (Single) (Num) (Marital Status) Casado (Married) 7. Lugar de nacimiento (País) : (Place of Birth) 8. Nacionalidad : (Nationality)

Apellido Casada :

4. Nombres : (Name) 5. Sexo : Masculino (Male) (Sex) Femenino (Female) 11. Domicilio o alojamiento en el Perú (Av.Jr.Calle) : (Full Address in Peru)

Viudo (Widowed) Divorciado (Divorced)

American

9. Fecha de nacimiento : (Date of Birth) 10. Profesión/Ocupación : (Profession/Ocupation)

dd

mm

aaaa

Calle Via Lactea 132 Urb. Los Granados Surco Lima, 33 Peru

Teléfono : (Phone)

011-511-617-2200

12. Domicilio en el Extranjero: (Permanent Address) País : Teléfono : (Country) (Phone) 3. FOTO FIRMA Y HUELLA DEL SOLICITANTE/ PHOTO, SIGNATURE AND FINGER PRINT.

Foto (Photo)

Firma (Signature) 4. RESERVADO PARA USO INTERNO / OFFICIAL USE ONLY.

Nombre de Funcionario Responsable : Tipo de funcionario : * Núm. Registro : Núm. Actuación :

Núm. Tarifa :

Huella (Finger)

Fecha Actuación :

Autorizado por Misión o Sección Consular (Para el caso de Visas Residentes considerar antecedentes) Tipo.Doc. (RREE)

Número (RREE)

Fecha (RREE)

Tipo Doc. (DIGEMIN)

Número (DIGEMIN)

Autorizado por Min.RR.EE., TRC Autorizado por Min.RR.EE., DGC 5. SOLO PARA VISAS DIPLOMATICAS, OFICIALES Y ESPECIALES Cargo : Motivo : XV ONUDI Institución que inicialmente solicita la visa : Institución a través del cual se realiza el trámite : Oficina de Cancillería que solicita autorización : Documento que autoriza la visa : * 6. OBSERVACIONES

Firma del Cónsul o Encargado

Fecha (DIGEMIN)