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| 1. Nombre: | _________________ | Apellidos: | _________________ |
| (First name) | (Last name) |
| 2. Nacionalidad: |
_____________________________ |
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(Nationality) |
| 3. Número de pasaporte: |
________________________ |
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(Passport number) |
| 4. Dirección actual: |
________________________________________________________________________________ |
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(Current address) |
| 5. Motivo del viaje: | ________________________________________________________________________________ |
| (Purpose
of trip) |
6.
Sub-categoría migratoria (favor elegir una):
(Migratory sub-category – please choose one below)
TURISTA (tourist)
AGENTE
VIAJERO (travel agent)
DELEGADOS
COMERCIALES (trade delegates/businessmen)
TRIPULANTES
DE MEDIOS DE TRANSPORTE INTN’L (air/ship crewmember)
| 7. LUGAR Y FECHA DEL PRIMER ARRIBO A COSTA RICA: | __________________________ | _____/_____/______ |
| (date)-(month)-(year) |
(Place and date of first arrival to Costa Rica)
| 8. FECHA Y FIRMA: |
______________________________ |
|
(date and signature) |
