REPUBLICA DE CHILE

MINISTERIO DE RELACIONES EXTERIORES

CONSULADO GENERAL DE CHILE
LOS ANGELES, CALIFORNIA

CONSULAR FORM FOR VISA

Before you apply, you must have with you all the requested documents. Please complete the form with all the information and
send me back by email. Incomplete applications may be rejected and all applications are subject to verification. Please apply at
least thirty (30) days before and not less that fifteen (15) working days in advance of the date you want your visa.

PLEASE CHECK WHAT VISA ARE YOU APPLYING FOR:

Tourist Visa
Single Entry

Business Visa
Single Entry

Resident Visa

Tourist Visa
Multiple Entries

Business Visa
Multiple Entries

Working Visa
(Under Contract)

Student Visa

WHEN DO YOU WISH TO VISIT CHILE?

From (DD/MM/YY)
31/07/2016
D a t e o f a p p l i c a t i o n (DD/MM/YY) 27/06/2016
YOUR DETAILS
Names((As shown in your passport)
First Name
Middle NAME
RAMESH

To (DD/MM/YY)

04/08/2016

Last Name
MAINALI

Mothers maiden Name

LOHANI
Date of Birth (Day/Month/Year)

Sex:
M

Marital Status (Single, married,

divorced or widowed):
MARRIED

31/12/1986
Passport Number
06006848
Any other name, alia or nickname
(if applicable)

Date of Issuance
10/07/2012

Country of issuance
NEPAL

Distinguishing Marks

Do you have children?

How many?
NO

MARKS ON LOWER CHIN

Height (In Meters)
1.67
Place of birth
CHAPAKHORI-4,
KAVREPALANCHOK,NEPAL
Your Profession or Degree
PHD
Color of your hair

m.

Weight (In Kilos)

69
Country of Birth
NEPAL

Kg.
Country of Current Citizenship

NEPAL

Your Occupation
STUDENT
Color of your eyes
BLACK

BLACK
Your current street address

Your complexion
BROWN
City:
TUCSON

th

951 E 10 ST, APT 39

State
AZ

Zip Code
85719

Country
U.S.A

REPUBLICA DE CHILE
MINISTERIO DE RELACIONES EXTERIORES
CONSULADO GENERAL DE CHILE
LOS ANGELES, CALIFORNIA

Home telephone number

e-mail address
rmainali@email.arizona.e
du

5204994019

YOUR INMIGTATION STATUS IN THE U.S.A.

TYPE OF VISA:
Number of visa or Green card

Cell phone number

5204994019

City, State of Issue

E.g., H1B , F1 , Permanent

Resident, Advance Parole

H6543761

F1

KATHMANDU

YOUR EMPLOYMENT / BUSINESS DETAILS:

Name of the Company
Street Address, City, Town
933 North Cherry Avenue,
UNIVERSITY OF ARIZONA
Tucson,87521-0065
Sate, Zip Code
AZ

Country
U.S.A

Your position
GRADUATE ASSISTANT

Telephone number
5206212288

Name of your supervisor or Contact Person and his/her job title

Daniel Paul Stark, Assistant Professor

SPOUSES FULL NAME (IF APPLICABLE)

First names and surnames
ANJU UPRETI
Male or Female

Place of Birth

Male
Female
Country of Birth
NEPAL

PATHARI-1, MORANG, NEPAL

Profession or Degree

Occupation
HOUSEWIFE

Date of birth
(dd/mm/yyyy)
29/12/1986
Country of Current
Citizenship
NEPAL
Home Telephone

Current Street address, City, State, Zip Code and Country

th

951 E 10 ST, APT 39, Tucson, AZ 85719, USA

MOTHERS FULL NAME
First name, Maiden surname
URMILA MAINALI
Is she living? (Yes/ No)

Place of Birth
PARASI
City of Residence

YES

Date of Birth
(dd/mm/yyyy)
21/10/1960

Country of Birth
NEPAL

Country of Citizenship
NEPAL

Country of Residence
NEPAL

BHAKTAPUR
Current Street address, City, State, Zip Code and Phone number

REPUBLICA DE CHILE
MINISTERIO DE RELACIONES EXTERIORES
CONSULADO GENERAL DE CHILE
LOS ANGELES, CALIFORNIA

Katunje-4, Bhaktapur, Nepal Phone:9779843318279

FATHERS FULL NAME
First names and surnames
KRISHNA PRASAD MAINALI
Is He living? (Yes/ No)
Place of Birth

YES
Country of Birth
NEPAL

Date of Birth dd/mm/yyyy)

12/08/1950
Country of Citizenship
NEPAL

CHAPAKHORI-4,
KAVREPALANCHOK
City of Residence

Country of Residence
NEPAL

BHAKTAPUR
Current Street address, City, State, Zip Code and Phone number
Katunje-4, Bhaktapur, Nepal Phone:9779849178168
ABOUT YOUR TRIP TO CHILE
YES

Have you previously applied for the visa to Chile/ (yes or no)
When ? (Year)

2015

Where? (Country and City)

LOS ANGELES, USA

If you were previously in Chile, please indicate date of last entry

01/11/2015

If you were previously in Chile, please indicate in with capacity (as tourist, for business, as
resident with working contract, as permanent resident, as student, etc.)

TOURIST

Are any of the following persons in Chile? Your Spouse, Your Fianc/Fiance, Your
Brothers/Sisters, Your Father/Mother or other immediate relatives.

NO

List of countries where you have lived for more than six months, during the last five years,
commencing, with your current resident.

U.S.A

List of countries you have visited within the last year: CHILE
Contact Person in Chile (the Person whom you are visiting, e.g. your Sponsor, your Chilean friend, your Chilean relative, your
Hotel, your Travel Agency or responsible Party in any Exchange Program.

MIGUEL ROTH
Address and Telephone number

Colina El Pino S/N, Casilla 601, La Serena-Chile CONTACT NUMBER: 5651207301

Address and telephone where you will be staying in Chile (house of friends, house of relatives, Hotel, Travel Agency, etc.) If it
is the same as your Contact Persons address, write SAME AS ABOVE.

SAME AS ABOVE
Reason for this trip to Chile (Tourist, business, familiar matters,
working contract, residence, studies, congress, etc.)

2 nights astronomical observation using BAADE 6.5m

telescope from Las Campanas Observatory, from
August 2-3

REPUBLICA DE CHILE
MINISTERIO DE RELACIONES EXTERIORES
CONSULADO GENERAL DE CHILE
LOS ANGELES, CALIFORNIA
How long are you planning to stay in Chile (months or days).
5 days
Estimated arrival date in Chile (dd/mm/yyyy)

31/07/2016

Arrival fly number

LA 8660

Estimated departure date in Chile (dd/mm/yyyy)

04/08/2016

Departure fly number

LA 8658

For business visa, Name and title of the company in Chile (If Applicable)

For business visa Address of the company in Chile (Street address, Township, City, Region))

For business visa, contact telephone number and email address.

Please be advised of the following:

1.- A foreigner in Chile must observe all regulations applicable to aliens, especially the length os stay allowed in Chile.
Failure to comply will result in deportation.

2.- If the Holder of the visa overstays, the contact person or the inviting person may be subject to a fine in the amount of
US$ 80.- for every day overstayed.

3.- You declare that you are aware that during your stay in Chile you will not seek any gainful employment not specially
authorized by your visa, nor engage in the internal politics, nor commit any offences or acts against the Political
Constitution, laws, decrees or any provision of law applicable in Chile.

4.- You declare that you understand that during your stay in Chile you may not be able to change the status of your visa.

5.- All the visitors to Chile must be able to show that:

- You are genuinely seeking entry as a visitor (Tourist or Business) for up to here (3) months.
- You intend to leave in Chile at the end of your visit.
- You do not intend to seek employment in Chile (Tourist, Business, Student visa)).
- You have sufficient funds or credit to support yourself without recourse to public funds or seeking employment.
- You can meet the cost of a return or onward journey.

I FUTHER DECALRE THAT ALL THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE

27/06/2016
DATE

SIGNATURE OF THE
APPLICANT