Nom de famille*
Prénom*
Date de naissance*
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Nationalité actuelle*
--
AFGHANISTAN (AFG)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (CYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLV)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
ETHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FAROE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMD)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (IDN)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSO)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SDN)
SURINAME (SUR)
SVALBARD AND JAN MAYEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Lieu de naissance*
Pays de naissance*
--
AFGHANISTAN (AFG)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (CYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLV)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
ETHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FAROE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMD)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (IDN)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSO)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SDN)
SURINAME (SUR)
SVALBARD AND JAN MAYEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Sexe*
État Matrimonial*
--
Marié
Séparés légalement
Divorcé
Mariage annulé
Veuf
Loi commune
Jamais marié / célibataire
Unique client identifier (UCI) / Previous Sultana of Cap-Vert visa or permit number*
Informations additionnelles
Adresse géographique*
Code Postal*
Ville*
Pays*
--
AFGHANISTAN (AFG)
ALBANIA (ALB)
ALGERIA (DZA)
AMERICAN SAMOA (ASM)
ANDORRA (AND)
ANGOLA (AGO)
ANGUILLA (AIA)
ANTARCTICA (ATA)
ANTIGUA AND BARBUDA (ATG)
ARGENTINA (ARG)
ARMENIA (ARM)
ARUBA (ABW)
AUSTRALIA (AUS)
AUSTRIA (AUT)
AZERBAIJAN (AZE)
BAHAMAS (BHS)
BAHRAIN (BHR)
BANGLADESH (BGD)
BARBADOS (BRB)
BELARUS (BLR)
BELGIUM (BEL)
BELIZE (BLZ)
BENIN (BEN)
BERMUDA (BMU)
BHUTAN (BTN)
BOLIVIA (BOL)
BOSNIA AND HERZEGOVINA (BIH)
BOTSWANA (BWA)
BOUVET ISLAND (BVT)
BRAZIL (BRA)
BRITISH INDIAN OCEAN TERRITORY (IOT)
BRUNEI (BRN)
BULGARIA (BGR)
BURKINA FASO (BFA)
BURMA (BUR)
BURUNDI (BDI)
CAMBODIA (KHM)
CAMEROON (CMR)
CANADA (CAN)
CANTON AND ENDERBURY ISLANDS (CTE)
CAPE VERDE (CPV)
CAYMAN ISLANDS (CYM)
CENTRAL AFRICAN REPUBLIC (CAF)
CHAD (TCD)
CHILE (CHL)
CHINA (CHN)
CHRISTMAS ISLAND (CXR)
COCOS (KEELING) ISLANDS (CCK)
COLOMBIA (COL)
COMOROS (COM)
CONGO (COG)
COOK ISLANDS (COK)
COSTA RICA (CRI)
COTE D IVOIRE (CIV)
CROATIA (HRV)
CUBA (CUB)
CYPRUS (CYP)
CZECH REPUBLIC (CZE)
DEMOCRATIC YEMEN (YMD)
DENMARK (DNK)
DJIBOUTI (DJI)
DOMINICA (DMA)
DOMINICAN REPUBLIC (DOM)
DRONNING MAUD LAND (DML)
EAST TIMOR (TMP)
ECUADOR (ECU)
EGYPT (EGY)
EL SALVADOR (SLV)
EQUATORIAL GUINEA (GNQ)
ERITREA (ERI)
ESTONIA (EST)
ETHIOPIA (ETH)
FALKLAND ISLANDS (FLK)
FAROE ISLANDS (FRO)
FIJI (FJI)
FINLAND (FIN)
FRANCE (FRA)
FRANCE METROPOLITAN (FXX)
FRENCH GUIANA (GUF)
FRENCH POLYNESIA (PYF)
FRENCH SOUTHERN TERRITORIES (ATF)
GABON (GAB)
GAMBIA (GMB)
GEORGIA (GEO)
GERMANY (DEU)
GHANA (GHA)
GIBRALTAR (GIB)
GREECE (GRC)
GREENLAND (GRL)
GRENADA (GRD)
GUADELOUPE (GLP)
GUAM (GUM)
GUATEMALA (GTM)
GUINEA (GIN)
GUINEA-BISSAU (GNB)
GUYANA (GUY)
HAITI (HTI)
HEARD AND MC DONALD ISLANDS (HMD)
HONDURAS (HND)
HONG KONG (HKG)
HUNGARY (HUN)
ICELAND (ISL)
INDIA (IND)
INDONESIA (IDN)
IRAN (IRN)
IRAQ (IRQ)
IRELAND (IRL)
ISRAEL (ISR)
ITALY (ITA)
JAMAICA (JAM)
JAPAN (JPN)
JOHNSTON ISLAND (JTN)
JORDAN (JOR)
KAZAKHSTAN (KAZ)
KENYA (KEN)
KIRIBATI (KIR)
KOSOVO (KVV)
KUWAIT (KWT)
KYRGYZSTAN (KGZ)
LAOS (LAO)
LATVIA (LVA)
LEBANON (LBN)
LESOTHO (LSO)
LIBERIA (LBR)
LIBYA (LBY)
LIECHTENSTEIN (LIE)
LITHUANIA (LTU)
LUXEMBOURG (LUX)
MACAU (MAC)
MACEDONIA (MKD)
MADAGASCAR (MDG)
MALAWI (MWI)
MALAYSIA (MYS)
MALDIVES (MDV)
MALI (MLI)
MALTA (MLT)
MARSHALL ISLANDS (MHL)
MARTINIQUE (MTQ)
MAURITANIA (MRT)
MAURITIUS (MUS)
MAYOTTE (MYT)
MEXICO (MEX)
MICRONESIA - FEDERATED STATES OF (FSM)
MIDWAY ISLANDS (MID)
MOLDOVA (MDA)
MONACO (MCO)
MONGOLIA (MNG)
MONTSERRAT (MSR)
MOROCCO (MAR)
MOZAMBIQUE (MOZ)
MYANMAR (MMR)
NAMIBIA (NAM)
NAURU (NRU)
NEPAL (NPL)
NETHERLANDS (NLD)
NETHERLANDS ANTILLES (ANT)
NEUTRAL ZONE (NTZ)
NEW CALEDONIA (NCL)
NEW ZEALAND (NZL)
NICARAGUA (NIC)
NIGER (NER)
NIGERIA (NGA)
NIUE (NIU)
NORFOLK ISLAND (NFK)
NORTH KOREA (PRK)
NORTHERN MARIANA ISLANDS (MNP)
NORWAY (NOR)
OMAN (OMN)
PAKISTAN (PAK)
PALAU (PLW)
PALESTINIAN TERRITORIES (PSE)
PANAMA (PAN)
PAPUA NEW GUINEA (PNG)
PARAGUAY (PRY)
PERU (PER)
PHILIPPINES (PHL)
PITCAIRN ISLANDS (PCN)
POLAND (POL)
PORTUGAL (PRT)
PUERTO RICO (PRI)
QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SDN)
SURINAME (SUR)
SVALBARD AND JAN MAYEN ISLANDS (SJM)
SWAZILAND (SWZ)
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TUVALU (TUV)
UGANDA (UGA)
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UNITED KINGDOM (GBR)
UNITED STATES (USA)
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URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
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WAKE ISLAND (WAK)
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WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Adresse e-mail*
Numéro de téléphone*
Information de voyage
Numéro de passeport*
Numéro de passeport confirmation*
Pays émetteur*
--
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MICRONESIA - FEDERATED STATES OF (FSM)
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NIGER (NER)
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PAKISTAN (PAK)
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POLAND (POL)
PORTUGAL (PRT)
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QATAR (QAT)
REUNION (REU)
ROMANIA (ROM)
RUSSIA (RUS)
RWANDA (RWA)
SAINT KITTS AND NEVIS (KNA)
SAINT LUCIA (LCA)
SAINT VINCENT AND THE GRENADINES (VCT)
SAMOA (WSM)
SAN MARINO (SMR)
SAO TOME AND PRINCIPE (STP)
SAUDI ARABIA (SAU)
SENEGAL (SEN)
SERBIA (SRB)
SERBIA AND MONTENEGRO (SCG)
SEYCHELLES (SYC)
SIERRA LEONE (SLE)
SINGAPORE (SGP)
SLOVAKIA (SVK)
SLOVENIA (SVN)
SOLOMON ISLANDS (SLB)
SOMALIA (SOM)
SOUTH AFRICA (ZAF)
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS)
SOUTH KOREA (KOR)
SPAIN (ESP)
SRI LANKA (LKA)
ST. HELENA (SHN)
ST. PIERRE AND MIQUELON (SPM)
SUDAN (SDN)
SURINAME (SUR)
SVALBARD AND JAN MAYEN ISLANDS (SJM)
SWAZILAND (SWZ)
SWEDEN (SWE)
SWITZERLAND (CHE)
SYRIA (SYR)
TAIWAN (TWN)
TAJIKISTAN (TJK)
TANZANIA (TZA)
THAILAND (THA)
TIMOR-LESTE (TLS)
TOGO (TGO)
TOKELAU (TKL)
TONGA (TON)
TRINIDAD AND TOBAGO (TTO)
TUNISIA (TUN)
TURKEY (TUR)
TURKMENISTAN (TKM)
TURKS AND CAICOS ISLANDS (TCA)
TUVALU (TUV)
UGANDA (UGA)
UKRAINE (UKR)
UNITED ARAB EMIRATES (ARE)
UNITED KINGDOM (GBR)
UNITED STATES (USA)
UNITED STATES MINOR OUTLYING ISLANDS (UMI)
URUGUAY (URY)
UZBEKISTAN (UZB)
VANUATU (VUT)
VATICAN CITY STATE (HOLY SEE) (VAT)
VENEZUELA (VEN)
VIETNAM (VNM)
VIRGIN ISLANDS (BRITISH) (VGB)
VIRGIN ISLANDS (U.S.) (VIR)
WAKE ISLAND (WAK)
WALLIS AND FUTUNA ISLANDS (WLF)
WESTERN SAHARA (ESH)
YEMEN (YEM)
ZAIRE (ZAR)
ZAMBIA (ZMB)
ZIMBABWE (ZWE)
Date de délivrance*
-- Jour --
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-- Mois --
Janvier
Février
Mars
Avril
Mai
Juin
Julliet
Août
Septembre
Octobre
Novembre
Décembre
-- Année --
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
Date d'expiration*
-- Jour --
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2
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6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-- Mois --
Janvier
Février
Mars
Avril
Mai
Juin
Julliet
Août
Septembre
Octobre
Novembre
Décembre
-- Année --
2040
2039
2038
2037
2036
2035
2034
2033
2032
2031
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
2020
Motif du voyage*
--
AFFAIRES
VISITE OFFICIELLE
TOURISME
SANTÉ
ÉTUDES
AUTRE
Date de départ :*
-- Jour --
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-- Mois --
Janvier
Février
Mars
Avril
Mai
Juin
Julliet
Août
Septembre
Octobre
Novembre
Décembre
-- Année --
2020
2021
Date de retour :*
-- Jour --
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-- Mois --
Janvier
Février
Mars
Avril
Mai
Juin
Julliet
Août
Septembre
Octobre
Novembre
Décembre
-- Année --
2020
2021
Aéroport / point d'entrée*
Boa Vista
Praia
Sal
Sao Vicente
Numéro de vol*
Addresse au Cap-Vert*
Hotel
Famille
Autre
Déclaration et acceptation
Je sais qu'une fausse déclaration constitue un délit et peut entraîner une interdiction de territoire au Cap-Vert ou un renvoi de Cap-Vert.
Je reconnais qu'en cliquant sur SUIVANT, je signe électroniquement ma demande et accepte les termes et conditions .
