Mail documents to: VisaHQ.com Inc.

2005 Massachusetts Avenue

Washington, DC 20036
Tel: (800)345-6541
VisaHQ.com Inc., 2005 Massachusetts Avenue, Washington, DC 20036 T: (202)558-2216 E: info@visahq.com
Mozambique Tourist visa Application
Please enter your contact information
Name:
Email:
Tel: Mobile:
The latest date you need your passport returned in time for your travel:
Mozambique tourist visa checklist
Filled out and signed Mozambique tourist visa application form. The form is enclosed.
Original passport. Passport must have at least 6 months remaining validity and have at least 1 visa page.
2 Photographs. Standard passport photographs 2x2 inches on a white background.
Payment. Credit Card Authorization form, Certified Check, or Money Order payable to VisaHQ.com.
Return mailer. Prepaid self-addressed return label or payment for FedEx.
If you wish to prepay return shipping, please add the shipping fee to the total and provide return address:
FedEx 2nd day delivery - add $15
FedEx Standard Overnight - add $20
FedEx Priority Overnight - add $25
FedEx Saturday delivery - add $45
FedEx First Overnight - add $65
Prepaid self addressed mailer - $0
Local pick up in Washington, D.C. - $0
Name:
Company:
Address:

City:
State: Zip:
Itinerary. Copy of round trip tickets or confirmed itinerary.
Hotel Reservations. Copy of confirmed hotel reservations.
Mail documents to: VisaHQ.com Inc.
2005 Massachusetts Avenue
Washington, DC 20036
Tel: (800)345-6541
VisaHQ.com Inc., 2005 Massachusetts Avenue, Washington, DC 20036 T: (202)558-2216 E: info@visahq.com
Mozambique tourist visa fees for citizens of United States
Type of visa Max. validity Embassy fee Our fee Processing time Total
Single entry up to 60 days $60.00 $54.95 5-7 business days $114.95
Single entry up to 60 days $70.00 $55.95 3 business days $125.95
Single entry up to 60 days $80.00 $62.95 Next business day $142.95
Double entry up to 60 days $90.00 $57.95 5-7 business days $147.95
Double entry up to 60 days $100.00 $58.95 3 business days $158.95
Double entry up to 60 days $110.00 $65.95 Next business day $175.95
Multiple entry up to 90 days $90.00 $57.95 5-7 business days $147.95
Multiple entry up to 90 days $100.00 $58.95 3 business days $158.95
Multiple entry up to 90 days $120.00 $66.95 Next business day $186.95
Multiple entry up to 180 days $135.00 $61.95 5-7 business days $196.95
Multiple entry up to 180 days $150.00 $63.95 3 business days $213.95
Multiple entry up to 180 days $180.00 $72.95 Next business day $252.95
Mail documents to: VisaHQ.com Inc.
2005 Massachusetts Avenue
Washington, DC 20036
Tel: (800)345-6541
VisaHQ.com Inc., 2005 Massachusetts Avenue, Washington, DC 20036 T: (202)558-2216 E: info@visahq.com
Credit Card Authorization Form
I authorize VisaHQ.com to charge my credit card for the amount of $
Name on the Credit Card:
Credit Card number: - - -
Exp. date: /
Credit Card Billing Address:

Signature:
Comments:
Thank you!
We accept all major credit cards.


3(','2 '( (175$'$ (0 02&$0%,48(
REQUEST FOR ENTRY VSA TO MOZAMBQUE

RECIBO
35((1&+(5 &20 /(75$ /(*,9(/
TO BE FLLED N LEGBLE LETTERS

VISTO

UMA ENTRADA
Single entry
DATA DE EMISSAO

......../...../ ....
DUPLAS ENTRADAS
Double entry
VALIDADE

MULTIPLAS ENTRADAS
Multiple entries
5(6(59$'2 $26 6(59,&26
FOR OFFCAL USE:

.../..../ ...
APELIDO
Surname

NOME COMPLETO
Full name
NOME DE SOLTEIRA
Maiden name

PAIS E LOCAL DE NASCIMENTO
Country and place oI birth

DATA DE NASCIMENTO
Date oI birth


SEXO
Sex

ESTADO CIVIL
Marital status

NACIONALIDADE
Nationality
PASSAPORTE
Passport
DATA DE EMISSAO
Date oI issue
.../.../ ....
Validade
Validity
.../.../ ....
NACIONALIDADE DO P.te
P.te nationality

PROFISSAO/OCUPACAO
ProIession/Occupation

CARGO QUE OCUPA
Position you hold

INSTITUICAO, ORGANIZACAO OU EMPRESA ONDE TRABALHA
Institution, organization or Iirm you work


ENDERECO DA RESIDENCIA PERMANENTE
Address oI the permanent residence


ESTEVE ALGUMA VEZ EM MOCAMBIQUE ? SIM NAO
Have you ever beIore been in Mozambique ? Yes No


1A FOI RESIDENTE EM MOCAMBIQUE ? SIM NAO
Have you ever been a resident in Mozambique ? Yes No


PORQUE SAIU DE MOCAMBIQUE ? DATA DE SAIDA
Why did you leave Mozambique ? Date oI exit ] ..../...../ .....


INDIQUE AS INSTUICOES E EMPRESAS A QUE ESTEVE LIGADO
Mention the institutions and Iirms to which you were attached


2 35((1&+,0(172 ,1&255(&72 28 ,1&203/(72 ,03/,&$ 5(63267$ 7$5',$ '(92/8&$2
28 ,1'()(5,0(172
NCOMPLETE OR NCORRECT FLLNG N OF THS FORM MAY RESULT N DELAY DEVOLUTON
OR REJECTON



DETALHE OS MOTIVOS DA ENTRADA EM MOCAMBIQUE
In detail give reasons Ior your entry in Mozambique



TEMPO DE ESTADA EM MOCAMBIQUE
Length oI stay in Mozambique


DATA DE ENTRADA
Date oI entry

..../..../ ....

DATA DE SAIDA
Date oI exit

..../..../ ...

FRONTEIRA DE ENTRADA
Entry border


FRONTEIRA DE SAIDA
Exit border


ENDERECO DA HOSPEDAGEM EM MOCAMBIQUE - Address oI residence in Mozambique


PROVINCIA
Province


DISTRITO
District


CIDADE
City


AVENIDA/RUA
Avenue/street


CASA
House


FAMILIARES/AMIGOS RESIDENTES EM MOCAMBIQUE - Relatives, Iriends living in Mozambique


NOME COMPLETO
Full name

NACIONALIDADE
Nationality

PARENTESCO
Relationship

ENDERECO
Address




RESERVADO AOS SELOS
Reserved for stamps







DATA ......................................................................................................................................
Date ] ..../..../ ..... ASSUNATURA DO REQUENTE OU DA ENTIDADE SOLICITANTE
Signature of applicant or of the applying entity


ASSINATURA RECONHECIDA POR SEMELHANCA A EXISTENTE NO .......................
.......... EMITIDO A ........../.../ .... EM ........................

RESERVADO AOS SERVICOS
For oIIicial use




DATA DE RECEPCAO


........../.../ ....



....................................................................................................................................................

ASSINATURA DO FUNCIONARIO



DATA DE ENTREGA


........../.../ ....