ReEntryVisa

Employer Information

Name Of Employer or Firm you are returning to

Employer Phone Number

Employer Full Address (Not P.O Box)

IMM 22A

*Surname:

*Othernames:

*Sex:

Male

Female

*Date Of Birth:

*Place Of Birth:

Nationality:

*Passport Information

Passport Number

Date Of Issue

Expiry Date

Place Of Issue

Issuing Government

*Address:

*Profession:

*Reasons for requiring visa:

*Date of last arrival in Nigeria:

*Proposed Re-Entry Date:

*Re-Entry Type

Single Re-Entry

Multiple Re-Entry

*Referencies

Name Of Referee	Phone No	Address

CERPAC Information (Where Applicable)

CERPAC Quota

Date Of Issue

Expiry Date

Issuing State

Issuing CERPAC Office

Visa Processing Information

Please select the type of visa you are requesting for and also the country you are applying from

*Type of visa Required

Visa Processing Information
Please select your Visa processing state and office
*Visa Processing State:
*Visa Processing Office:

I understand that I will be required to comply with the Immigration / Alien and other laws governing entry of the immigrants into the country to which I now apply for Visa / Entry Permit

Date ................................................................ Signature........................................................................

Please Note: Take printed, and signed form together with evidence of payment to the Nigerian Embassy / High Commission of your residence for further processing

*Compulsory Fields