|Received by:|| Date:
|Traveler's Name||Nationality||Passport No||Date of Birth||Type of Visa||Departure Date|
Make sure that you print 3 copies of this Form upon submitting your visa application (s).
record and send the other two with your Visa application
Algeria Visa Center acts as an outsourcing company to check the requirements of the visa application and accepts no responsibility for any delays, damages, actions, inaction or loss of documents/passports by the
embassy, or any courier, delivery and postal services.
Issuance of a visa or passport is a decision of the embassy of Algeria. Algeria Visa Center assumes no liability for any delays encountered in processing an application.