ویزای درمانی ایران

 VISA application form

Passenger 1 (بیمار)

همراه         

First Name(s)

Family Name

Your father’s first name

Gender  (male/female)

Marital Status (married/not married)

Date of Birth

Current Nationality

Passport No.

Date Of Passport Issue

Date Of Passport Expiry

Address: ******************************

Postal code, City, Country

Phone No. (and/or cell no.)

Email ***

Your occupation/profession

If (ex) governmental, please mention

Travel Entrance To Iran (city)

Travel Plan in Iran

(cities & planned transport)

Booked/planned hotel

(Name hotel & city)

Where do you want to collect your visa? (country/place/Iran airport)

Have you been to Iran before?

 (which dates)

Arrival and Departure Information

(If you don’t have your tickets yet or travel overland, just fill out the date of your expected arrival and departure)

Flight to Tehran?

Flight No.

Arrival date/time Iran

Return Flight

Flight No.

Departure date/time Iran

Health Information

Do any of the above Passengers suffer from any pre-existing illness or disability that may affect travel or require special attention? No   (If yes, please state the nature of condition and fitness to travel) 

Emergency Contacts

Please advise a name, address and telephone number (needed in case of emergency only):

Visa process agreement

  2  I confirm the correctness of all the information given.  Iagree

Important Notes:

1. We will do our best to secure your visa; however the final decision rests with the Visa authorities in Tehran. Therefore we cannot 100% guarantee if and when your visa will be granted.

2. Your passport should be valid for at least 6 months after your return from Iran

1.     3. E-mail us a scan or digital photo of your passport (personal details page) in jpg format max 250kb.

4. Your passport cannot contain any stamps of Israelian customs

5. A medical insurance is required to travel in Iran