Volunteer Visa Instructions

Togo

General Information On page three of this document you will find a blank visa application. Please complete all fields as indicated in the instructions. If you make a mistake on your visa application, please fill out a new one. The embassy will not accept visa applications that contain information which has been whited out or crossed out. Any entries colored blue have been prefilled for you on the fillable visa application form. If you have any questions on completing this application please contact your Country Desk Officer: [email protected]

Application Instructions  No. du visa: Leave blank 1. Surname: Input your last name(s) as it appears on your passport 2. Given Names: Input your first name(s) (and middle name if applicable) as it appears on your passport 3. Date, place & country of birth: Input your date of birth (e.g. 01 Mar 1961), city and country of birth 4. Sex: Input your appropriate gender 5. Nationality of Origin: Input nationality of birth 6. Current Nationality: American 7. Marital Status: Input as relevant 8. Profession: Peace Corps Volunteer 9. Home address & E-mail and Tél: Input your preferred contact information 10. Type of travel document: Service Passport  Leave questions 11-14 blank 15. Reason for journey: Peace Corps Volunteer 16. Visa required: Yes 17. Date of arrival in Togo: Input the date of departure provided by your volunteer assignment description (e.g. 01 Mar 1961) 18. Length of stay in Togo: 27 months 19. Person to be notified in your country of residence (address and tel.) in the United States: Input personal emergency contact (e.g. mother, father, etc.) 20. Have you ever lived in Togo?: Check appropriate box 21. If yes, could you provide a reference contact (name/tel or Hotel) in Togo: Input if applicable 22. Do you intend to settle down yourself in Togo?: No 23. Do you commit to leave Togo upon your visa expiration?: Yes SIGN AND DATE APPLICATION LEGIBLY

Travel and Transportation • Volunteer Visas – Togo • Updated 2018.10.16

Make sure that no blanks are left unmarked (unless noted above). If something does not apply to you, simply write “N/A”

Photo Requirements □ □ □ □ □

You will need four 2”x2” photos, this size is the same as your passport photos Photos must be printed on glossy photo paper For more guidelines and examples please visit the Department of State Website Write your full name and country on the back of all photos Place your photos in a small envelope with your name and country of service written on the front

Mailing Instructions □ Print two copies of your visa application single sided □ Verify that all of the information is correct, if any of the information is incorrect please correct and reprint, do not cross out information or use whiteout □ SIGN AND DATE BOTH APPLICATIONS LEGIBLY! o Each signature must be clearly written enough so that your name can be read from it □ Mail both signed applications and photos to the address below o Do not attach the photos, instead place them in a separate envelope with your name and country of service written on the front Melwood Warehouse 5606 Dower House RD CTC Building—BSC/Peace Corps Upper Marlboro MD 20772

Travel and Transportation • Volunteer Visas – Togo • Updated 2018.10.16

AMBASSADE DU TOGO 2208 MASSACHUSETTS AVE, NW WASHINGTON, D.C. 20008

REPUBLIQUE TOGOLAISE TRAVAIL – LIBERTE - PATRIE

Tel: (202) 234-4212 Fax: (202) 232-3190 No. du visa:_______________________

FORMULAIRE DE DEMANDE DE VISA/VISA APPLICATION FORM 1. Nom/Surname 2. Prénoms/Given Names 3. Date, Lieu et Pays de naissance/Date, place & country of birth

5. Nationalité d’origine/ Nationality of Origin

4. Sexe/Sex M F 6. Nationalité actuelle/Current Nationality American

7. Etat Civil/Marital Status

8. Profession Peace Corps Volunteer

9. Adresse physique et électronique/Tél./Home address & E-mail and Tél. 10. Type de document de voyage/Type of travel document Passeport ordinaire/Regular passport ✔ Passeport de service/Service Passport Passeport diplomatique/Diplomatic Passport Autre document de voyage (à préciser)/Other document (Please specify) : 11. Numéro du document de voyage/ 12. Date de délivrance/ Travel document number Date of issue 15. Motif du voyage/Reason for journey Peace Corps Volunteer

17. Date d’arrivée/Date of arrival in Togo

13. Date d’expiration/ Expiration date

14. Délivré par/ Issued by

16. Visa sollicité/Visa required Yes

18. Durée du séjour/Length of stay in Togo 27 months

19. Personne à prévenir dans le pays de résidence (adresse et Tél.) aux Etats-Unis/Person to be notified in your country of residence (address and tel.) in the United States 20. Avez-vous déjà résidé au Togo ?/Have you ever lived in Togo ? oui/yes non/no 21. Si oui, pouvez-vous donner les références d’une personne au Togo (nom/ tél. ou de l’hôtel) /If yes, could you provide a reference contact (name/tel or Hotel) in Togo 22. Avez-vous l’intention de vous installer au Togo ?/Do you intend to settle down yourself in Togo ? oui/yes ✔ non/no 23. Vous engagez-vous à quitter le territoire de la Répulique du Togo à l’expiration de votre visa?/ Do you commit to leave Togo upon your visa expiration? ✔ oui/yes no/non Ma signature engage ma responsabilité et m’expose à des poursuites pénales prévues par la loi en cas de fausse déclaration et à un refus de tout visa à l’avenir/My signature engages my responsibility and exposes me to penalties provided for by law in the event of false declaration, and to a visa refusal in the future.

Fait à/ in________________, le/on_______________

Signature du demandeur/Applicant signature