A.是否有被拒绝进入马来西亚 Have you ever been prohibited from entering Malaysia: 是 Yes 否 No B.是否有被遣送出马来西亚 Have you ever been prosecuted in Malaysia: 是 Yes 否 No C.是否有在马来西亚犯罪记录 Have you ever committed an offence in Malaysia: 是 Yes 否 No D.是否有任何有效的马来西亚签证 Any valid Malaysia visa/permit: 是 Yes 否 No E.是否护照有任何的涂改或破损 Whether there is any altered passport, or damage in any way: 是 Yes 否 No 1.全名（大写字母） Full Name（Capital Letter） F.重要事项 DECLARATION BY APPLICANT(IMPORTANT) 我特此声明并确认，我的护照在进入马来西亚时有至少6个月的有效期 I hereby acknowledged and confirmed that my passport validity is at least six months upon arriving Malaysia. 我已阅读并理解此表所有问题，并对填表内容的真实性和准确性负责，我理解签证种类、有效期及停留期将由使领馆决定，任何信息不实、误导或填写不完整，均可能导致签证申请被拒绝或被拒绝进入马来西亚。 I have read and understood all the questions in this application form and declared all information given are correct and true. I understand that the outcome of my application will be decided by Embassy/Consulate General of Malaysia. Any false, misleading or incomplete statement may result in rejection to my application. 申请人/担保人签名 Signature of Applicant/Sponsor _________________ 日期 Date _________________ E.其他 OTHERS INFORMATION 2.性别 Gender 男M 女F 3.出生地 Place/Country of Birth （日Day/月Month/年Year） 5.国籍 Nationality 申请人照片 Photograph of Applicant 近期正面免冠半身白色背景彩色照片 Latest 3months white background photo 照片大小 35mm*50mm Photo size 头部大小 21-24mm Head Size 头部长度 28-33mm Head Length A.申请人详情 PARTICULARS OF APPLICANT 6.职业 Occupation 8.住址 Address 7.婚姻状况 Marital Status 单身 Single 已婚 Married 离婚 Divorced 其它 Others 9.电话号码 Tel No ________________________ 4.出生日期 Date of Birth B.护照详情 PARTICULARS OF PASSPORT/TRAVEL DOCUMENT 10.护照种类 Travel Document 12.签发地 Place/Country of Issue 13.有效期 Expiry Date 11.护照号码 Passport Number C.担保人详情 PARTICULARS OF SPONSOR IN MALAYSIA (仅限多次往返申请 ONLY FOR MEV APPLICATION) 14.全名（大写字母） Full Name(Capital Letter) 17.地址 Address 16.电话号码 Tel No ___________________________ 15.身份证/护照号码 Identity Card/Passport No. 20.旅行目的 Purpose of Stay 21.申请签证类型 Type of Visa 观光/休闲 Sightseeing/Leisure 过境 Transit 商务 Business 留学 Study 访亲友 Visiting Friends/Relatives 会议 Conference 官方 Official Visit 就业 Employment 其他 Others（Specify）_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Single Entry 单次入境 Multiple Entries 多次入境 ( ) 19.预计停留时间 Estimate Duration of Stay （日Day/月Month） D.申请详情 DETAILS OF APPLICATION 18.预计入境马来西亚日期 Estimated date of travel to Malaysia （日Day）

VisaMalaysia Form China

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A. Have you ever been prohibited from entering Malaysia: Yes NoB. Have you ever been prosecuted in Malaysia: Yes NoC. Have you ever committed an offence in Malaysia: Yes NoD. Any valid Malaysia visa/permit: Yes NoE. Whether there is any altered passport, or damage in any way: Yes No

1. Full NameCapital Letter

F. DECLARATION BY APPLICANT(IMPORTANT)

6I hereby acknowledged and confirmed that my passport validity is at least six months upon arriving Malaysia.I have read and understood all the questions in this application form and declared all information given arecorrect and true. I understand that the outcome of my application will be decided by Embassy/Consulate General ofMalaysia. Any false, misleading or incomplete statement may result in rejection to my application.

/ Signature of Applicant/Sponsor _________________ Date _________________

E. OTHERS INFORMATION

2. Gender M F

3. Place/Country of Birth

Day/Month/Year 5. Nationality

Photograph of Applicant

Latest 3months whitebackground photo 35mm*50mm

Photo size 21-24mm

Head Size 28-33mm

Head Length

A. PARTICULARS OF APPLICANT

6. Occupation8. Address

7. Marital Status

Single Married Divorced Others9. Tel No ________________________

4. Date of Birth

B. PARTICULARS OF PASSPORT/TRAVEL DOCUMENT

10. Travel Document12. Place/Country of Issue

13. Expiry Date

11. Passport Number

C. PARTICULARS OF SPONSOR IN MALAYSIA ( ONLY FOR MEV APPLICATION)

14. Full Name(Capital Letter)

17. Address

16. Tel No ___________________________

15./ Identity Card/Passport No.

20. Purpose of Stay

21. Type of Visa

/ Sightseeing/Leisure Transit Business Study Visiting Friends/Relatives Conference Official Visit Employment OthersSpecify_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Single Entry Multiple Entries ( )

19. Estimate Duration of Stay Day/Month

D. DETAILS OF APPLICATION

18. Estimated date of travel to Malaysia

Day