VISA ASSISTANCE

(ONE FORM PER PERSON)

Please use block capitals or type and return it to:

COOPERATIVES EUROPE asbl

avenue Milcamps 105
BE - 1030 Brussels
office@coopseurope.coop

FAMILY NAME

FIRST NAME

PLACE AND DATE OF BIRTH

NATIONALITY

GENDER

POSITION

ORGANISATION

ADDRESS

PHONE FAX E-MAIL

PRIVATE ADDRESS

ADDRESS OF THE RUSSIAN

EMBASSY (*)

PASSPORT N°

PASSPORT ISSUING DATE

PASSPORT EXPIRATION DATE

ARRIVAL DATE

DEPARTURE DATE

(*) OR CONSULATE/VISA OFFICE (+ PHONE & FAX NUMBER)