(as in passport) Date of Birth (yyyy-mm-dd) Plan to apply visa in a Embassy of P.R. China Consulate General of Office of the Commissioner in (HK SAR/Macao the in ( country ) / P.R. China in (city)/ of MFA of P.R.China SAR) Passport No. Gender Current Employer/Institution Title Residential A

mbassy of El. ( country ) / Consulate the China in USA General of China in of MFA of SAR) New York (city)/ Office of the Commissioner in (HK SAR/Macao Passport No. Gender Male Current Employer/Institution Southern Trust Corporation Title President Residential Address in China Current Occu