ON-LINE VISA APPLICATION FORM 20002-28354170 \ 19.06.
2018 18:12:58 CENTRAL DE VISADOS RUSOS MADRID - C/Principe de Vergara 126 (TWIM) 1. Nationality (if you formerly had PERU USSR or Russian citizenship, please indicate when and why you lost it).
2. Surname (as in passport). FERMINI CASTILLO
3. First name, other names, patronimic LUIS ALBERTO DE JESUS
(as in passport).
4. Date of birth (dd/mm/yyyy). 06/03/1995
5. Sex. MALE
6. Passport. Passport No: C448523 Date of issue: 20/05/2016 Valid until: 20/05/2021
7. Purpose of visit. STUDY
8. Category and type of visa. COMMON EDUCATIONAL
9. Number of entries. SINGLE
10. Date of arrival and departure. 10/09/2018 - 30/07/2019
11. Host organisation you intend to
visit. Company name: SAINT PETERSBURG UNIVERSITY TIN: NONE Invitation No: NONE Directive No: NONE Address: УНИВЕРСИТЕТСКАЯ НАБ., 7/9, САНКТ-ПЕТЕРБУРГ, Г. САНКТ-ПЕТЕРБУРГ, RUSIA, 199034
12. Route of journey (destination SAN PETERSBURGO
points).
Photograph and signature. Service information (automatically generated).
Application form recipient: CENTRAL DE VISADOS RUSOS MADRID
- C/Principe de Vergara 126 Basis (voucher, dir. No, inv. No): (TWIM) NONE The estimated date of visit to the RC: Place for Application No (web-site): 28354170 photograph The date of processing: 19/06/2018 *20002028354170*
Application No (VAC): The date of processing by the VAC:
Request No in Russian Consulate (RC):
I hereby agree to the processing and transfer of my personal data in electronic form for the purposes of making a decision on visa issuance. I declare that data provided in the application form are full and Date (dd/mm/yyyy), personal signature correct. I am aware that any false information may be a cause for the denial of visa or for the cancellation of the previously issued visa and may lead to other consequences provided for by the legislation of the Russian Federation. Subject to the receipt of visa, I pledge to leave the territory of the Russian Federation before the visa expiration date. I am aware that valid visa does not automatically allow to enter the territory of the Russian Federation. In case of denial of entry, I will not seek any compensation for potential losses.
Page 1 of 2 13. Children under 16 years and other relatives written in your passport. Do you travel with children under 16 NO years or other relatives written in your passport?
14. Your permanent address, telephone 19, LA PINTA ST - 45223 SESENA - TOLEDO / SPAIN, TEL: +34664696190, number, fax number, E-mail. EMAIL: lferminicas@hotmail.es
15. Current/latest place of work. "UNIVESIDAD REY JUAN CARLOS", STUDENT DEGREE IN ECONOMICS, LUCAS JORDAN ST, 2 - ARANJUEZ - MADRID - SPAIN, TEL: +34664696190, EMAIL: la.fermini.2017@alumnos.urjc.es
16. Information about your previous
trips to Russia. How many times have you been to Russia? -
17. Information about health insurance.
Do you have health insurance that is NO valid in Russia?
18. Other names used in the past NONE
(maiden, pen-name, religious, etc.).
19. Your place of birth (if you were LIMA
born in Russia, please specify when and which country you emigrated to).
20. Additional information about your
relatives. Do you currently have relatives in YES Russia? If yes, please indicate full name, FERMINI CASTILLO GIAMPIERO BARI, BROTHER (HERMANO), 02/05/1990, relation degree, date of birth, CHANGING DIRECTION FREQUENTLY address.
