First and middle names (As in passport)

Surname (As in passport)

Previous name(s)  (if any)

Date of birth

Place of birth

Nationality

Former nationality

Sex

Male        Female

Father´s name

Father´s nationality

Passport  number

Date of passport  issue

Date of expiry

Occupation

Educational qualifications

E-mail

Work or school address and telephone

Home address and telephone

Marital status

Name of spouse

Nationality of spouse

Name and the relationships of persons travelling with you

Have you ever applied for Iran visa?

Have you ever been refused Iran visa?

Have you ever visited Iran?

If yes, please give dates and lengths of each stay?

When do you intend to enter Iran (date)?

How long do you intend to stay in Iran?

At what address will you stay in the Iran

What is the purpose of your trip to Iran?

Name(s) of person(s) & organization(s) you are going to meet in Iran

The countries you have stayed more than six month?

If you have any relative currently living in Iran, please write theirs complete particulars.

If you intend to visit Iran with an Iranian travel agency, indicate the name of travel agency.

Have you been treated for any serious physical or mental disorders or any communicable or chronic diseases?

Yes              No

Have you ever used narcotics or ever been an addict?

Yes              No

Have you committed any criminal offence in any country?

Yes              No

Yes              No

Name, address and tel. nr. of foreign national sponsor(s)/contact(s) in Iran?

On which following fields does your information about Iran fall?

                     Art and Cultural                            Social                       Political

                           Geographic                                                   Place of tourist intrest

Category of visa requested? 

Transit

Tourist or pilgrimage

Journalistic

Business

Official

Research and study

Work permit visa

Multiple entry