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1. |
Mbiemri
Family name
Mbiemri i vajzėrisė
Women state maiden name |
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2. |
Emri
Given name |
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3. |
Datėlindja
Date of birth |
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4. |
Vendlindja
Place of birth |
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5. |
Shtetėsia
Citizenship
Nė rast tė mė shume se njė, deklarojini te gjitha/If more than one, each should be stated
Aktuale
Present
Mėparshme
Former |
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6. |
Kombėsia
Nationality |
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7. |
Gjendja Civile
Personal Status |
□ beqar(e) □ i/e martuar qė nga data............................. □ i/e ndarė □ i/e ve
□ single □ married since .................................................. □ divorced □ widowed |
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8. |
Bashkėshortja* - Emri
Spouse Name
Mbiemri i vajzėrisė - (pėr gra tė martuara)
Maiden name
Datėlindja
Date of birth
Vendlindja
Place of birth
Shtetėsia
Citizenship
Vendbanimi
Residence |
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9. |
Fėmijėt*
Children* |
Emri
Name |
Data / Vendi i lindjes
Date/Place of birth |
Shtetėsia
Citizenship |
Vendbanimi
Residence |
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11. |
Atėsia* e aplikantit - Mbiemri
Father * (of the applicant) Family name
Emri
Given name
Amėsia* e aplikantit - Mbiemri
Mother * (of the applicant) Family name
Emri
Given name |
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12. |
Pasaportė ose dokument tjetėr udhėtimi
Passport or other travel document
Numri
Number
E vlefshme deri
Valid until
Autoriteti lėshues
Issued by
Data e lėshimit
Issued on |
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13. |
Koha qė doni tė qėndroni nė Shqipėri.
Time that you fant to stay in Albania. |
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14. |
Keni pasur mė parė vizė shqiptare?
Have you ever had Albanian visa in before?
Nėse po. Ēfarė tipi dhe pėr sa kohė?
If so. Enter dates and places |
□ po □ jo
□ yes □ no
Tipi i vizės......................
Type of visa..................
nga .................... deri .................... nė .........................................
from to in
nga .................... deri .................... nė .........................................
from to in |
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15. |
Qėllimi i ardhjes nė Shqipėri.
Purpose of coming in Albania |
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16. |
Data e hyrjes
Entered on
Nga
From |
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17. |
Pritėsi nė Shqipėri.
Expectant in Albania
Adresa e pritėsit.
Adress of Expectant
Telefoni i pritėsit
Expectant telephone |
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18. |
A jeni i punėsuar? Nė se po cili ėshtė
Profesioni juaj?
Do you have any job? If yes which is your
profession? |
□ jo □ po ...........................................................................
□ no □ yes........................................................................... |
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19. |
Pagesa juaj mujore varion nga:
Your salary varied from
to |
200 - 400 □
401 - 600 □
601 - 800 □
801 - 1000 □
more □ |
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20 |
Cilat janė mjetet financiare dhe ekonomike qė do tė mbėshtesin qėndrimin tuaj nė Shqipėri
what are your means of subsistence? |
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21. |
A vini pėr tė punuar nė Shqipėri?
Are you coming to work in Albania?
Nėse po
If Yes
Punėdhėnėsi
Employer
Adresa e tyre
Their addresses
Profesioni qė do tė kryeni (specifikoni)
Intended employment (occupation to be exercised) |
□ jo □ po ................................................................................
□ no □ yes ...............................................................................
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22. |
A jeni pajisur me leje pune shqiptare?
Are you already in possession of Albanian Work permit? |
□ po □ jo
□ yes □ no |
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23. |
A vuani nga ndonjė sėmundje?
Do you suffer from any diseases?
Nėse po, nga cila?
If so, which?
A keni sigurim shėndetėsor qė pėrfshin edhe Shqipėrinė?
Do you have health insurance cover for Albania? |
□ po □ jo
□ yes □ no
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24. |
Informacione false ose jo korrekte tė vendosura nė kėrkesėn pėr aplikim sjellin refuzimin apo anulimin e vizės. |
If false or inappropriate information is supplied in this application, the visa will be rejected or withdrawn. |
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25. |
Deklaroj se mbėshtetur nė njohuritė e mia mė tė mira, informacionet qė kam dhėnė mė sipėr janė tė sakta dhe tė plota. |
I declare that the best of my knowledge the above particulars are correct and complete. |
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26. |
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Ambasada / Konsullata ..............................................................
Embassy ?Consulate
Data...............................................................................................
Date
Firma e aplikantit ....................................................
Applicants signature |
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27. |
Pėr konsullin
For Consul/Do not write here
Data e dėrgimit tė aplikimit nė MPJ
Data e pėrgjigjes nga MPJ
Numri i faksit miratues
Statusi
Nr i vizės |
Data...............................................................................................
Data...............................................................................................
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Refuazuar □ Miratuar □
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