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اطلاعات شخصی متقاضی
								
								
									
										
											
												* نام خانوادگی :
												
												آمای
												
											
											
												نام در زمان تولد :
												
												صونا
												
											
											
												نام:
												
												صونا
												
											
										
										
											
												اریخ تولد :
												
												1944-11-04
												
											
											
												* محل تولد :
												
												تهران
												
											
											
												* کشور تولد :
												
												ایران
												
											
										
										
											
												* جنسیت :
												
												زن
												
											
											
												* وضیت تاهل :
												
												متاهل
												
											
											
												* ملیت کنونی :
												
												ایرانی
												
											
										
										
											
												* ملیت اصلی :
												
												ایرانی
												
											
											
												
												
											
											
												
												
											
										
									
								
								اطلاعات شغلی
								
								
									
										
											
												* شغل کنونی:
												
												بازنشسته
												
											
											
												* نام شرکت و یا محل شغل :
												
												دانشگاه علوم پزشکی تهران
												
											
											
												* آدرس محل کار :
												
												دانشگاه علوم پزشکی تهران
												
											
										
										
											
												* ایمیل محل کار :
												
												Tumspr@tums.ac.ir
												
											
											
												لفن محل کار :
												
												81631
												
											
											
												 فکس محل کار :
												
											
										
									
								
								2 اطلاعات تماس
								
								
									
										
											
												* آدرس:
												
												نیاوران سه راه یاسر خیابان عمار کوچه صالحی پلاک ۲۴ برج آلتون واحد ۹۰۱
												
											
											
												* کد پستی :
												
												1936663868
												
											
											
												* موبایل:
												
												borna.soleymani@gmail.com
												
											
										
										
											
												لفن:
												
												26451085
												
											
											
												* ایمیل:
												
												borna.soleymani@gmail.com
												
											
											
												
												
											
										
									
								
								3 مدارک
								
								
									
										
											
												* نوع گذرنامه :
												
												عادی
												
											
											
												* شماره گذرنامه :
												
												56352751
												
											
											
												کد ملی :
												
												0041445589
												
											
										
										
											
												تاریخ صدور :
												
												2022-03-31
												
											
											
												اریخ انقضا :
												
												2027-03-31
												
											
											
												* کشور صادر کننده :
												
												ایران
												
											
										
										
											
												صادر شده توسط :
												
												پلیس مهاجرت و گذرنامه تهران
												
											
											
												
												
											
											
												
												
											
										
									
								
								اطلاعات مربوط به انگشتنگاری
								
								
									
										
											
												آیا تابحال جهت دریافت ویزای شینگن انگشت نگاری کرده اید؟
												
											
											
												 تاریخ انگشتنگاری (درصورت اطلاع) :
												
											
											
												
												
											
										
									
								
								اطلاعات مربوط به سفر
								
								
									
										
											
												* هدف از سفر :
												
												توریستی با رزرواسیون هتل
												
											
											
												سایر اهداف :
												
												دیدار همسر و سفر خانوادگی به جنوب فرانسه
												
											
											
												* اولین کشور ورود :
												
												فرانسه
												
											
										
										
											
												* کشور اصلی محل اقامت شما :
												
												فرانسه
												
											
											
												عداد ورود درخواستی :
												
												چندبار ورود
												
											
											
												اریخ رفت سفر :
												
												2023-11-22
												
											
										
										
											
												اریخ بازگشت :
												
												2023-12-22
												
											
											
												عداد روز درخواستی :
												
												۳۰
												
											
											
												آیا در سه سال گذشته ویزای شینگن داشته اید؟
												
											
										
										
											
												تاریخ شروع آخرین ویزا :
												
											
											
												تاریخ اتمام آخرین ویزا :
												
											
											
												
												
											
										
									
								
								 اطلاعات مربوط به اقامت سایر کشورها
								
								
									
										
											
												نوع اقامت:
												
												توریستی
												
											
											
												سایر :
												
												ویزا کانادا
												
											
											
												شماره اقامت :
												
											
										
										
											
												صادر شده توسط :
												
											
											
												شروع اقامت :
												
											
											
												اتمام اقامت :
												
											
										
									
								
								میزبانی در مقصد
								
								
									
										
											
												* نوع میزبانی :
												
												توسط شخص دعوت کننده
												
											
											
												نام:
												
											
											
												آدرس:
												
											
										
										
											
												ایمیل:
												
											
											
												شماره تلفن:
												
											
											
												کد پستی :
												
											
										
										
											
												سایر اطلاعات:
												
											
											
												
												
											
											
												
												
											
										
									
								
								 هزینه های سفر و اقامت
								
								
									
										
											
												چگونگی پوشش هزینه ها در طول سفر :
												
												توسط خود مسافر 
 
 
سایر 
												
											
											
												 نوع پرداخت هزینه
												
												نقدی 
 
 
پرداخت هزینه های اقامت قبل از سفر 
 
پرداخت هزینه های رفت وآمد قبل از سفر

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<!doctype html>
<html xmlns="http://www.w3.org/1999/xhtml" dir="rtl" lang="fa-IR">
<head>
<title>فرم اپلیکیشن ویزا</title>
</head>
<body>
<table style="background: #ffffff; border-collapse:collapse; mso-table-lspace:0pt; mso-table-rspace:0pt;" width="100%" cellspacing="0" cellpadding="0" border="0" bgcolor="ffffff" align="center">
	<tbody>
		<tr>
			<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;" width="100%">
				<table dir="rtl" class="full" style="mso-table-lspace:0pt; mso-table-rspace:0pt; margin: 0 auto; max-width: 100%; " width="600" cellspacing="0" cellpadding="0" border="0" align="center">
					<tbody>
						<tr>
							<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;" valign="top">
								<h3>اطلاعات شخصی متقاضی
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* نام خانوادگی :
												</h4>
												<p>آمای
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>نام در زمان تولد :
												</h4>
												<p>صونا
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>نام:
												</h4>
												<p>صونا
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>اریخ تولد :
												</h4>
												<p>1944-11-04
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* محل تولد :
												</h4>
												<p>تهران
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* کشور تولد :
												</h4>
												<p>ایران
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* جنسیت :
												</h4>
												<p>زن
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* وضیت تاهل :
												</h4>
												<p>متاهل
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* ملیت کنونی :
												</h4>
												<p>ایرانی
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* ملیت اصلی :
												</h4>
												<p>ایرانی
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3>اطلاعات شغلی
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* شغل کنونی:
												</h4>
												<p>بازنشسته
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* نام شرکت و یا محل شغل :
												</h4>
												<p>دانشگاه علوم پزشکی تهران
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* آدرس محل کار :
												</h4>
												<p>دانشگاه علوم پزشکی تهران
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* ایمیل محل کار :
												</h4>
												<p>Tumspr@tums.ac.ir
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>لفن محل کار :
												</h4>
												<p>81631
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4> فکس محل کار :
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3>2 اطلاعات تماس
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* آدرس:
												</h4>
												<p>نیاوران سه راه یاسر خیابان عمار کوچه صالحی پلاک ۲۴ برج آلتون واحد ۹۰۱
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* کد پستی :
												</h4>
												<p>1936663868
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* موبایل:
												</h4>
												<p>borna.soleymani@gmail.com
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>لفن:
												</h4>
												<p>26451085
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* ایمیل:
												</h4>
												<p>borna.soleymani@gmail.com
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3>3 مدارک
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* نوع گذرنامه :
												</h4>
												<p>عادی
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* شماره گذرنامه :
												</h4>
												<p>56352751
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>کد ملی :
												</h4>
												<p>0041445589
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>تاریخ صدور :
												</h4>
												<p>2022-03-31
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>اریخ انقضا :
												</h4>
												<p>2027-03-31
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* کشور صادر کننده :
												</h4>
												<p>ایران
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>صادر شده توسط :
												</h4>
												<p>پلیس مهاجرت و گذرنامه تهران
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3>اطلاعات مربوط به انگشتنگاری
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>آیا تابحال جهت دریافت ویزای شینگن انگشت نگاری کرده اید؟
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4> تاریخ انگشتنگاری (درصورت اطلاع) :
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3>اطلاعات مربوط به سفر
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* هدف از سفر :
												</h4>
												<p>توریستی با رزرواسیون هتل
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>سایر اهداف :
												</h4>
												<p>دیدار همسر و سفر خانوادگی به جنوب فرانسه
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* اولین کشور ورود :
												</h4>
												<p>فرانسه
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* کشور اصلی محل اقامت شما :
												</h4>
												<p>فرانسه
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>عداد ورود درخواستی :
												</h4>
												<p>چندبار ورود
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>اریخ رفت سفر :
												</h4>
												<p>2023-11-22
												</p>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>اریخ بازگشت :
												</h4>
												<p>2023-12-22
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>عداد روز درخواستی :
												</h4>
												<p>۳۰
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>آیا در سه سال گذشته ویزای شینگن داشته اید؟
												</h4>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>تاریخ شروع آخرین ویزا :
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>تاریخ اتمام آخرین ویزا :
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3> اطلاعات مربوط به اقامت سایر کشورها
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>نوع اقامت:
												</h4>
												<p>توریستی
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>سایر :
												</h4>
												<p>ویزا کانادا
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>شماره اقامت :
												</h4>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>صادر شده توسط :
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>شروع اقامت :
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>اتمام اقامت :
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3>میزبانی در مقصد
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>* نوع میزبانی :
												</h4>
												<p>توسط شخص دعوت کننده
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>نام:
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>آدرس:
												</h4>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>ایمیل:
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>شماره تلفن:
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>کد پستی :
												</h4>
											</td>
										</tr>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>سایر اطلاعات:
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
								<h3> هزینه های سفر و اقامت
								</h3>
								<table  width="600" cellspacing="0" cellpadding="0" border="0" align="center">
									<tbody>
										<tr style="background: #eaf8e6">
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>چگونگی پوشش هزینه ها در طول سفر :
												</h4>
												<p><label>توسط خود مسافر </label><br />
<label> </label><br />
<label> </label><br />
<label>سایر </label>
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4> نوع پرداخت هزینه
												</h4>
												<p><label>نقدی </label><br />
<label> </label><br />
<label> </label><br />
<label>پرداخت هزینه های اقامت قبل از سفر </label><br />
<label> </label><br />
<label>پرداخت هزینه های رفت وآمد قبل از سفر </label><br />
<label> </label>
												</p>
											</td>
											<td  style="font-size:13px; font-family: 'tahoma' , arial; line-height:35px; text-align:right; padding: 0 10px; color: #000000;">
												<h4>
												</h4>
											</td>
										</tr>
									</tbody>
								</table>
							</td>
						</tr>
					</tbody>
				</table>
			</td>
		</tr>
	</tbody>
</table></body>
</html>


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