FIRST NAME

LAST NAME

FATHER'S NAME

DATE & PLACE OF BIRTH

RELIGION

PROFESSION

MARITAL STATUS

NATIONALITY

ADDRESS OF RESIDENCE

PURPOSE OF VISITING

INTENDED PERIOD OF STAY

PLACE OF BUSINESS IN LIBYA

ADDRESS OF RESIDENCE IN LIBYA

HAVE YOU ENTERED LIBYA PREVIOSLY, AND ON WHAT DATE(S)?

PURPOSE OF PRIOR VISIT(S)

LAST DATE OF DEPARTURE FROM LIBYA

OTHER PLACE PREVIOSLY DOMICILED IN LIBYA (IF ANY)

PASSPORT NUMBER

PLACE OF ISSUE

DATE OF EXPIRATION

You must provide documents supporting this application. A copy of your passport details will suffice.

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