VISA APPLICATION FORM

		Chinese name     Former name 2"x2" Stick Two Photos here Surname Given Name Date of birth               Year        Month     Day     Place of birth     Nationality     Former nationality (if any)       Occupation and name of the company       Home address and phone no. 12.  No.                                                          Valid until                    Issued by       Purpose of journey and place to visit in China       Compnay or person to visit in China, name(s), address and phone no.      Intended date of entry        Year                                       Month                                   Day Number of entries Single Double Multiple Duration of each stay Have you ever applied for a Chinese visa before? Have you ever been declined for your Chinese visa application? If declined, when and where Accompanying persons included in passport     Full Name                                                  Date of birth                                   Relationship to applicant I hereby declare that the information given above is true, correct and complete. I shall bear the responsibility for the above information.     Year                          Month                                        Day                        Signature (For official use only) The Consulate General of the People's Republic of China in Los Angeles 443 Shatto Place, Los Angeles, CA 90020 Tel: (213) 380-2506¡EFax: (213) 380-1961 Mon. ~ Fri. 9:00 A.M. to 3:00 P.M.    I hereby authorize Golden Horse Travel to apply China Visa for myself.     Year                          Month                                        Day                        Signature
		Golden Horse Travel 302 Torito Lane, Diamond Bar, CA 91765   E-mail: sales@chinadventures.com