VISA SERVICES CANADAWWW.VISASERVICESCANADA.CA

VISA APPLICATION & FEES FOR COTE d’IVOIRE*** Visa fees and times are subject to change by embassies without notice ***

� - ENTRY VISA valid for 30-90 days $75.� - ENTRY VISA valid for 91+ days $150.

� - REGULAR SERVICE FEE (per person per visa) $75. Processing 15 days� - URGENT SERVICE FEE (per person per visa) $150. Processing 2 days

SPECIFIC VISA REQUIREMENTS FOR COTE d’IVOIRE

Business Visa� - passport, valid for 6 months at least, plus photocopy of passport,� - one (1) fully completed and signed visa application form,� - one (1) recent passport-style photograph (50 mm x 70 mm),� - Letter of invitation,� - confirmed air ticket,� - confirmation of hotel reservation,� - proof of financial means to stay, up to Cdn$135. per day,� - yellow fever international health certificate.

Private Visit Visa� - passport, valid for 6 months at least, plus photocopy of passport,� - three (3) fully completed and signed visa application forms,� - three (3) recent passport-style photographs,� - confirmed air ticket,� - confirmed hotel reservation or,� - letter of invitation, � - proof of financial means to stay, up to Cdn$135. per day,� - yellow fever international health certificate.

Tourist Visa� - passport, valid for 6 months at least, plus photocopy of passport,� - three (3) fully completed and signed visa application forms,� - three (3) recent passport-style photographs,� - confirmed air ticket,� - confirmation of hotel reservation,� - proof of financial means to stay, up to Cdn$135. per day,� - yellow fever international health certificate.

Ship all signed forms and documents to our office:Visa Services Canada, Inc.900 - 275 Slater StreetOttawa ON K1P 5H9ph. (613) 231-7054

VISA SERVICES CANADAWWW.VISASERVICESCANADA.CA

SECURE PAYMENT FORTOURIST & VISIT VISAS

Visa Services Canada, Inc. is pleased to offer the most secure means of payment available inCanada for the processing of your tourist or your visit visa. This is the mandatory payment form.As of January 2017 tourist/visit clients must pay by e-transfer. Credit card is no longer accepted.

INTERAC e-Transfer ®

Interac e-Transfer is a funds transfer service between personal and businessaccounts at Canadian banks and other financial institutions. You do not have toprovide any account details or even a credit card number to our company. Our staff never see any of your account details when you use an e-transfer methodof payment. You deal only with your bank or financial institutions to makepayment in a totally secure environment right from your home or office.

HOW IT WORKS

1. Fill in the entire visa application form, including the VSC cover page above, and send itto our office by courier or e-mail as applicable.

2. Our professional staff review your application and determine the total payment (includingtaxes and shipping) to be made by you.

3. Our staff send you an e-mail detailing the full and final charges. This email willcontain all the instructions for making the e-transfer. It will include the e-mail andsecurity codes, and step-by-step instructions for you.

4. You, or a friend or relative acting on your behalf, make the e-transfer to VSC for all thevisa processing charges and fees.

5. It takes about 30 minutes for the bank to send the e-transfer notification to our office. We then receive the funds and can then pay the embassy on your behalf. Payment must bereceived before the embassy can be approached with your application.

YOUR E-MAIL ADDRESS

Applicants MUST provide at least one (1) working and monitored e-mail address on the VSCcover page so that our staff can contact you with details of the payment. Please provide two.

An application form without a typed correct and monitored e-mail address cannot be processed.

Applicants who respond immediately are assisted first. Applicants who do not respond withinthree days (72 hours) will have their applications cancelled and their passports prepared forreturn. Failure to respond promptly may result in you missing your journey.

République de Côte d’Ivoire 

Formulaire de demande de Visa/ Application for Visa

RESERVE A L'ADMINISTRATION

Durée du séjour(Length of stay‐Duration) Date du dépôt de la demande

Dossier traité par:

Pièces jointes :

Nom (en majuscule)Surname(Capital letter)

Nom de jeune fille(Maiden name)

Prénom(s):  (Given name)

Nom du conjoint :(Husband name)

Date de naissance:(Date of birth)

J M A M F

Lieu de naissance:(Place of birth)

Situation matrimoniale(Marital's Status)

C M D V

Nationalité d'Origine(Origin Nationality)

Nationalité Actuelle :(Present Nationality)

Résidence actuelle :

Ambassade(Embassy)

Court séjour (un jour à trois mois)Short stay (from 1 to 3 months)

Service qui établit le Visa(Visa's establisher)

DST (Côte d'Ivoire)

Long séjour (1 à 2 ans)Long stay (from 1 to 2 years)

MINISTERE DE L'INTERIEUR

 

Transit (de 1 à 3 jours)Transit (from 1 to 3 days)

Sexe:(Gender)

Photo

1. ___________________

2.____________________

3.____________________

4.____________________

5.____________________

6.____________________

7.____________________

Résidence actuelle :(Present residence)

Profession (Occupation) :

Passeport N° (Passport N°) : 

Délivré le (issued on) : J M A Par : (by)

Valable jusqu'au (valid until) J M A

Type de passeport (Passport type)  : Passeport ordinaire (Ordinary passport) Passeport diplomatique (Diplomatic passport)

Passeport de service (Passport of Service) Tout autre document de voyage (Other travelling documents)

Nature du visa sollicité (Type of visa applied for)

Visa Ordinaire (Ordinary visa) Visa de courtoisie (Courtesy visa) Visa diplomatique (Diplomatic visa)

Durée du visa sollicité(Validity period of visa)

Motifs du voyage :(Reasons of travelling)  Affaires (Business)  Mission (Mission)

Vacances‐Loisirs (Holidays‐Leisure ) Etudes /Recherches (Study/Research)

Santé (Health )

Date de départ                               (Departure date) J M A

Adresse en Côte d'Ivoire (Address in Côte d'Ivoire)

Repondant en Côte d'Ivoire (Relative in Côte d'Ivoire)Nom (Name)

Adresse (Address)

Télé h

Court séjour (de 1 jours à trois mois)(Short stay : from 1 day to 3 months)

Sortie‐retour (un an)(In an out : 1 year)

Transit (de 1 à 3 jours)(Transit : from 1 to 3 days)

Téléphone (Phone number)

RESERVE A L'ADMINISTRATION

Nom (Name)

Adresse (Address)

Nom (Name)

Adresse (Address)

Nom (Name)

Adresse (Address)

Signature du représentant de l'autorité (Authority's signature)Signature du requérant(Applicant's signature)

Ma signature engage ma responsabilité et m’expose, en sus de poursuites prévues par la loi en cas de FAUSSE déclaration, à me voir REFUSER TOUT VISA A L’AVENIR(My signature renders me responsible, and in case of any false statements, in addition to any penalties imposed by law, I understand that I may be refused any Côte d’Ivoire visa in the future)

Indiquez avec précision les noms et adresses (rue et n°) des commerçants ou industriels que vous désirez rencontrer s’il s’agit d’un voyage d’affaires : (Indicate precisely names and addresses of merchants and industrialists you wish to meet on your business trip)

(Do you agree not to accept any employment, either at a salary  or for room  and board during your stay in Côte d’Ivoire, not to remain in Côte d’Ivoire permanently and leave the territory of the expiration of the ration of the visa which may be granted to you?)

Vous engagez‐vous à n’accepter aucun emploi rémunéré ou au pair pendant votre séjour en Côte‐d’Ivoire, à ne pas chercher à vous y installer définitivement et a quitter le territoire ivoirien a l’expiration du visa qui vous sera éventuellement accordé ?

VISA SERVICES CANADAWWW.VISASERVICESCANADA.CA

EMBASSY REGISTRATION

For your personal safety and security we can register you with the embassy of Canada in the countryor countries to which you will travel on your upcoming business or tourist journey.

During times of national emergency such as natural disasters, war, or bombings, the government ofCanada may seek out all Canadian nationals in a disaster or security zone. Canadians who areregistered are the first ones found and can be the first evacuated in some cases.

This is a fast and efficient way of ensuring the Canadian Government can find you in case of anemergency, and can give your family some security during your travels.

- YES, please register my trip with the government ($20. fee per person)

ABOUT MELast name as in passport

First name as in passport

Date of birth: (DD/MM/YYYY)

Gender as in passport:

Canadian Passport number:

ABOUT MY TRIPDestination country

Region in country if known

Additional information (address or hotel name)

Arrival date at destination (DD/MM/YYYY)

Departure date from country (DD/MM/YYYY)

I do not know my departure date

MY CONTACT DETAILS OUTSIDE CANADAYou must provide at least one way of contacting you outside CanadaEmail address which you check regularly

Telephone number with area code

Mobile telephone number with area codeSend me a text message with destination travel advice and advisories upon arrival

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EMBASSY REGISTRATION continued

MY EMERGENCY CONTACT IN CANADA ISYou must provide at least one means of contacting this person.Emergency contact in Canada’s full name

Emergency contact in Canada’s Email

Emergency contact in Canada’s telephonenumber with area code

Emergency contact in Canada’s mobile numberwith area code

I AM GOING TO A SECOND COUNTRYSecond Destination country

Region in country if known

Additional information (address or hotel name)

Arrival date at destination (DD/MM/YYYY)

Departure date from country (DD/MM/YYYY)

I do not know my departure date

I AM GOING TO A THIRD COUNTRYThird Destination country

Region in country if known

Additional information (address or hotel name)

Arrival date at destination (DD/MM/YYYY)

Departure date from country (DD/MM/YYYY)

I do not know my departure date

PRIVACY STATEMENTThe information collected here will be shared with the Government of Canada in order to register you as aCanadian abroad. The data will not be shared with any other government or with any private company. By fillingout this form you acknowledge that you understand how your data will be used and retained, and that Visa ServicesCanada is not liable for the data after it has been given to the Government of Canada.

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VISA SERVICES CANADASuite 900 - 275 Slater St.

Ottawa, ON, K1P 5H9, CANADAW W W .VISASERVICESCANADA.CA

613-231-7054

I, ___________________________________, authorize Visa Services Canada to act on my behalf in acquiring avisa for my passport. Visa Services Canada is authorized to drop-off and pick-up my passport and any otherpersonal documents from the embassy, high commission, consulate, diplomatic mission of the country of__________________________ while aiding me in acquiring a visa. Visa Services Canada is also authorized toreceive information about my application from the visa office while acting on my behalf.

Signed on this _____ day of the month of _____________ in the year ______, in the city of ___________________ in the province of __________________, in Canada.

Signature_________________________________________

OFFICE COPY

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VISA SERVICES CANADASuite 900 - 275 Slater St.

Ottawa, ON, K1P 5H9, CANADAW W W .VISASERVICESCANADA.CA

info@visaservicescanada.ca613-231-7054 toll-free 866-378-1229

I, ___________________________________, authorize Visa Services Canada to act on my behalf in acquiring avisa for my passport. Visa Services Canada is authorized to drop-off and pick-up my passport and any otherpersonal documents from the embassy, high commission, consulate, diplomatic mission of the country of__________________________ while aiding me in acquiring a visa. Visa Services Canada is also authorized toreceive information about my application from the visa office while acting on my behalf.

Signed on this _____ day of the month of _____________ in the year ______,

in the city of ___________________ in the province of __________________, in Canada.

Signature_________________________________________

EMBASSY COPY