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[蹂꾩�� �젣30�샇�쓽3
�썵麗묋눊�셽訝딃쇅鼇긷룾(兩띌빓)�뵵獄뗦쎑
APPLICATION FOR(EXTENSION) TEMPORARY REFUGE
LANDING PERMIT
冶� SURNAME
轢℡춻冶볟릫
�릫 GIVEN NAMES
�뵹 NALE
癲� FEMALE
�뵟亮닸쐢�뿥 DATE OF BIRTH
癲� YEAR
�쐢 MONTH
�뿥 DAY
�쐦映� NATIONALITY
�뾽�댏�빁�솦 PASSPORT NO.
�겥葉� 諛� 璵��떃�릫
OCCUPATION
訝딃쇅(兩띌빓)�솗�릤 REASON FOR LANDING(EXTENSION)
訝딃쇅(兩띌빓)�뵵獄뗥끀�뼋 PERIOD OF LANDING
(EXTENSION)
�뀯歷�堊욕릫 FLIGHT NO./DISEMBARKATION
I hereby apply for temporary refuge landing permit, pursuant to the provision of the article
16-2 of the Immigration Law.
�뵵獄뗦뿥 DATE OF APPLICATION
�뵵獄뗤볶 營꿨릫 SIGNATURE OF APPLICANT
�뀶 �뵪 轝� OFFICIAL USE ONLY
鼇긷룾�끀�뼋 PERIOD OF PERMIT
掠끺퐦 DESIGNATED PLLACE OF STAY
烏뚦땿影꾢쐨 AREA OF MOVEMENT
�끀餓� OTHERS
23236-12711 �씪 182�렂횞257�렂
`94.6.1�듅�씤 �씤�뇙�슜吏�(2湲�)60g/�렊
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