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DEPARTMENT OF IMMIGRATION AND EMIGRATION
REPUBLIC OF SRI LANKA
Form “A”
Regulation 60
APPLICATION FOR THE ISSUE/ EXTENSION OF A RESIDENCE VISA FOR SRI LANKA
Passport no
Date of issue
Place of issue
Day Month Year Day Month Year
Date of expiry
Details of previous passports held if any:
(01) Name in full as
appearing in passport
(02) (i) Father's name
(ii) Place of birth
(03) Nationality
If naturalized,
Day Month Year Place of
(i) Date
naturalization
(ii) Former nationality
(04) Sex Male Female Civil status Single Married Divorced Widowed
(05) Date of birth
Day Month Year
(06) Place of birth
(07) If married,
(i) Full name of spouse
(ii) Nationality
(08) Height feet inches
(09) Any identification marks or peculiarities
(10) Applicant’s address
(i) In the country
of domicile
(ii) Abroad

(11) Occupation
(12) Salary/ income per mensem
(Certificate of employer to be forwarded)
(13) If an employee, name and address of employer
(i) Name
(ii) Address
(14) If in business and / or owning landed property in Sri Lanka full particulars of same:
(i)
(ii)
(iii)
(iv)
The most recent Income Tax Assessment Notice to be forwarded.
Particulars of evidence furnished in support of cage 14
Name of business / Landed property Shares owned Nature of evidence produced
(15) (i) Reasons for applying for a Residence Visa
(16) Period for which a Residence visa is required Months / Years
(17) Was a Residence visa issued previously, If so, state -
(i) No. of the visa
(ii) Date of issue
Day Month Year

(iii) Purpose for which
it was issued
(iv) Period for which it was issued
Years
(v) Particulars of the
Passport on which the
permit was issued
(18) (i) Number of present Residence Visa of spouse or parent, if any,
(ii) date of issue
Day Month Year
(19) Particulars of applicants own children only for whom application is also made:
(Children under 16 should be included.)
Name
Date of birth
Sex
M/F
Place of birth
(20) Particulars of responsible persons, relations or friends in Sri Lanka to whom reference can be made
regarding applicant or who are likely to undertake responsibility, if required, for applicant's maintenance
and repatriation from Sri Lanka:
Full name Nationality Address Relationship
I solemnly declare that the information furnished by me in this application is true and that I have not willfully suppressed
any information that is required, that in the event of issue of visa I shall comply with the terms and conditions subject to
which the visa is granted, and that I shall notify the Controller of Immigration and Emigration of any change in my
address during my stay in Sri Lanka.
……………………………….
Date
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Signature of applicant

Notes:
(1) Any person whose admission has been authorized would be prevented from landing or may be required to
leave Sri Lanka if found that he has given false or misleading information or suppressed any information that
he is required to give on his application furnish.
(2) An application for Residence Visa should be made at least one month before (a) the date of intended travel.
(b) date of expiry of the Residence Visa in the case of extension.
(3) Applicant is required to submit four copies of his photograph (passport size) for issue of visa
(4) Tax and fee for the grant or issue of Residence Visa is Rs. 15,000 for each period of 12 months or part thereof
reckoned from the date of grant or issue. Holders of Diplomatic or Official passports will be granted or issued
visas free of charge. If the purpose of the visit is official.
(5) An application for a Residence Visa in respect of a child under sixteen years may be completed and must be
signed by the child's father or if he is not living by the child's mother or by the duly appointed guardian.
……………………………………….
Specimen signature