Entry Visa Re-Entry Visa Edit Visa Application Complete Visa Appplication Visa Application Status Print Receipt Home
  IMM 22
This form must be completed in full, your application may be rejected for wrong or misleading information
*Title:
1
*Surname: *Othernames:
2
*Sex:
*Marital Status:
3
*Date Of Birth:
*Place Of Birth:
4
Colour Of Hair:
Colour Of Eyes:
Height:
5
*Visible Identification Marks:
6
*Present Nationality: Previous Nationality:
7
Passport Information
Passport Number Date Of Issue Expiry Date
* *
*
Place Of Issue Issuing Government
*
8 *
Residential Address: *Telephone No:
9
*Profession:
10
Office Address: Telephone No:
11
State the branch of the Armed Forces of your country you have served or are serving
In: From:
To:
12
*Purpose Of Journey (Please give details):
13
*No Of Entries Required:
14
*Intended Duration Of Stay:
15a
*Proposed Date Of Travel:
15b
Mode Of Travel To Nigeria:
16
*Indicate How Much Money You Have For This Trip:
17
If your reason for journey to Nigeria is for employment, State: 
Name Of Employer Post To Be Occupied
Give a full description of job
18
Persons joining spouses, parents or relations should give full particulars of the employment of parents or spouses in Nigeria
Name Of Employer Employer Phone Number
Employer Full Address (Not P.O Box)
19
How long has/have your spouse / parents been in Nigeria?:
20
Your intended address in Nigeria (Not P.O. Box):
21
Have you ever applied for a Nigerian Visa before?:
22
Where did you apply for the visa?:
23
Indicate whether visa was granted or rejected?:
24
Give reason if visa was rejected:
25
Have you ever visited Nigeria?:
26
If Yes, what for?:
27
State the period of previous visits to Nigeria and the addresses  which you stayed
From To Address
28
How long have you lived in the country from where you are applying for visa / entry permit?:
29
Have you:
Been infected by any contagious disease (e.g. Tuberculosis) or suffered serious mental illness?
Been arrested or convicted for an offence or crime even though subject to pardon, arrested or other such action?
Been involved in narcotic activities?
Been deported
If deported, from which country?
Sought to obtain visa by mis-representation or fraud?
30
Give a list of the countries you have lived for more than a year during the last five years
Country City Date