Passport copy
Full name as in passport :________________
Passport Number :_____________
Nationality :_______________
Date of Birth :_______________
Position Title :_________________(Post-Doc, Prof. or Head/Director)
Detailed Itinerary From ____ (MM) _____(DD) _______(YYYY)
To ____ (MM) _____(DD) _______(YYYY)
Which city/country will you apply for the visa :_____________
Postal address (where to send this I.L.) :_______________
Contact telephone :_______________
