临时入境外国人担保人保证书

外国人临时入境申请表

Application Form of Alien’s Temporary Entry Permit

（请用黑色墨水笔填写内容，不能用圆珠笔填写）

Please complete the form with a black pen (no ballpoint)

1、英文姓名姓: 名:

Name in English: Surname Given Name

中文姓名: 性别：□男□女

Name in Chinese Gender □Male □Female

出生日期年月日国籍: 出生地:

Date of Birth Year Month Day Nationality Placeof Birth

本地住址: 联系电话：

Local Address Telephone No.

本地单位/担保人（关系）: 电话:

Local Company/Organization/Guarantor（Relationship）Telephone No.

境外地址: 紧急联系人姓名和电话: OverseasAddress Emergency Contact：

2、护照种类: □外交□公务（官员）□普通□其他Type of Passport □Diplomatic □Service(Official) □Ordinary □Other

护照号码: 有效期至年月日Passport No Valid until Year Month Day 3、申请事由：□不可抗力□政府会议□官方访问

Reason for Application: □Force Majeure □Government Meeting □Official Visit

□紧急就医□常驻外交、领事官员□其他（请说明）

□Medical Reason □As Resident Diplomat /Consular Officer □Other(Please Specify) 4、预计在华停留天数

Estimated Stay inChina Days

5、拟离境口岸名称

Intended DeparturePort

6、是否曾在中国超过签证或居留许可允许的期限停留？□是□否Have you ever overstayed inChina? Yes No

7、是否曾被拒绝颁发中国签证，或被拒绝进入中国？□是□否Have you ever been refused visa application forChina, or been denied entry intoChina? Yes No

8、是否在中国或其他国家有违法记录？□是□否Do you have any criminal record inChinaor any other country? Yes No

9、备注

Notes：

我保证以上填写的内容真实、准确、完整，并保证在停留居留期间遵守中华人民共和国的法律。

I hereby declare that the information given above is true, correct and complete, and I shall abide by the laws of the People's Republic ofChinaduring my stay.

申请人签字：代办人签字：

Applicant's Signature Agent's Signature

联系电话Tel: 联系电话Tel:

申请日期: 年月日

Application Date Year Month Day

所在单位：

Company/Organization