Nigerian order form

NIGERIAN VISA ORDER FORM

This questionnaire will allow us to complete a Nigerian visa application on your behalf. Please provide all information requested, making sure answers exactly match the information in your passport. Any unanswered questions will delay your application.

Title:

Middle name(s):

Gender:

Date of birth:

First name:

Last name:

Marital status:

Place of birth:

Email address:

Present nationality:

Colour of hair:

Identification marks:

Previous nationality:

Colour of eyes:

Height (in centimetres):

Permanent Address

Address line 1:

City:

Postcode:

Telephone number:

Address line 2:

State:

Country:

Profession:

Office Address

Use home address as office address.

Address line 1:

City:

Postcode:

Office telephone number:

Address line 2:

State:

Country:

Have you ever served in the military?

Passport Information

Passport number:

Issuing country:

Date of issue:

Place of issue:

Date of expiry:

Visa Processing Information

Type of visa required:

Purpose of journey:

How much money do you have for this trip (in USD)?

Please click here if you need help converting the amount to US dollars.

Number of entries requested:

Intended duration of stay (in days):

Proposed date of travel:

Mode of travel to Nigeria:

Intended address in Nigeria

Address line 1:

City:

Address line 2:

Country:

State:

District:

Postcode:

Previous Application Details

Have you ever applied for a Nigerian visa before?

Have you ever visited Nigeria before?

Travel History

How long have you lived in the United Kingdom?

Have you ever been infected by any contagious disease (e.g. tuberculosis) or suffered serious mental illness?

Have you ever been arrested or convicted for an offence (even if subject to pardon)?

Have you ever been involved in narcotic activity?

Have you ever been deported?

Have you sought to obtain a visa by mis-representation or fraud?

Please provide a list of countries where you have lived for more than one year.

PERIOD 1

Country:

City:

Date of departure:

PERIOD 2

Country:

City:

Date of departure:

PERIOD 3

Country:

City:

Date of departure:

Please provide a list of countries you have visited in the last 12 months.

PERIOD 1

Country:

City:

Date of departure:

PERIOD 2

Country:

City:

Date of departure:

PERIOD 3

Country:

City:

Date of departure:

Agent Details (if applicable)

Name:

Reference:

Email address:

Telephone number:

Please use the box below to add any special instructions, additional information, etc...

CERTIFICATION

I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.

I understand that I will be required to comply with immigration/alien and other laws governing entry of immigrants into the country to which I now apply for Visa/Entry permit.

VISA BASE TERMS & CONDITIONS (click to view)

I have read and agree to the Terms and Conditions, and agree to pay the Visa Base handling fee for this service.

NB. If the form does not submit when you press the button below, please check you've answered all of the questions. Any you've missed or left out will be highlighted in red.