NOM……………………………………………………………………………………….
NAME

PRENOMS ………………………………………………………………………………..
FIRST NAMES AND MIDLE NAMES

ADRESSE…………………………………………………………………………………
ADDREES

TELEPHONE ……………………………………………………………………………..
PHONE NUMBER

DATE DE NAISSANCE……………………………………………………………….
DATE OF BIRTH

NATIONALITÉ…………………………………………………………………………
NATIONALITY

PROFESSION………………………………………………………………………….
OCCUPATION

OBJET DU VOYAGE…………………………………………………………………..
PURPOSE OF TRIP

DATE APPROXIMATIVE D’ARRIVÉE……………………………………………..
APPROXIMATIVE DATE OF ARRIVAL

DURÉE DU SÉJOUR ………………………………………………………………..
LENGHT OF STAY

NUMÉRO DU PASSEPORT
PASSPORT NUMBER

Signature

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