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GEORGIA
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MAURITIUS
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NETHERLANDS ANTILLES
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NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORIES
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REPUBLIC OF ZIMBABWE
ROMANIA
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT MARTIN
SAINT PIERRE AND MIQUELON
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SENEGAL
SERBIA
SIERRA LEONE
SINGAPORE
SINT MAARTEN
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH SUDAN
SPAIN
SUDAN
SURINAME
SVALBARD AND JAN MAYEN
SWAZILAND
SWEDEN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UK - BRITISH NATIONAL(OVERSEAS)
UK - BRITISH OVERSEAS CITIZEN
UK - BRITISH PROTECTED PERSON
UK - BRITISH SUBJECT
UKRAINE
UNITED ARAB EMIRATES
UNITED NATION KOSOVO
UNITED NATIONS
UNITED STATES
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIET NAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
YEMEN
ZAIRE
ZIMBABWE
Country of Nationality
Country of Nationality
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
C?TE DIVOIRE
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS
COLOMBIA
COMOROS
CONGO, REPUBLIC OF
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
EUROPEAN UNION
FAEROE ISLANDS
FALKLAND ISLANDS
FIJI
FINLAND
FRANCE
FRANCE, Metropolitan
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA, THE
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HONDURAS
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
KAZAKHSTAN
KENYA
KIRIBATI
KUWAIT
KYRGYZSTAN
LAO PEOPLES DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LITHUANIA
LUXEMBOURG
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MOLDOVA
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORIES
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REPUBLIC OF ZIMBABWE
ROMANIA
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT MARTIN
SAINT PIERRE AND MIQUELON
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SENEGAL
SERBIA
SIERRA LEONE
SINGAPORE
SINT MAARTEN
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH SUDAN
SPAIN
SUDAN
SURINAME
SVALBARD AND JAN MAYEN
SWAZILAND
SWEDEN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UK - BRITISH NATIONAL(OVERSEAS)
UK - BRITISH OVERSEAS CITIZEN
UK - BRITISH PROTECTED PERSON
UK - BRITISH SUBJECT
UKRAINE
UNITED ARAB EMIRATES
UNITED NATION KOSOVO
UNITED NATIONS
UNITED STATES
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIET NAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
YEMEN
ZAIRE
ZIMBABWE
Residential Address
State / Province
Address During Visit (Address in Cambodia)
Passport Details
Passport Number
Passport Date of Issue
Passport Date of Expire
Country of Passport
Country of Passport
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
C?TE DIVOIRE
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS
COLOMBIA
COMOROS
CONGO, REPUBLIC OF
COOK ISLANDS
COSTA RICA
CROATIA
CUBA
CURACAO
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
EUROPEAN UNION
FAEROE ISLANDS
FALKLAND ISLANDS
FIJI
FINLAND
FRANCE
FRANCE, Metropolitan
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA, THE
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HONDURAS
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
KAZAKHSTAN
KENYA
KIRIBATI
KUWAIT
KYRGYZSTAN
LAO PEOPLES DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LITHUANIA
LUXEMBOURG
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MOLDOVA
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORIES
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REPUBLIC OF ZIMBABWE
ROMANIA
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT MARTIN
SAINT PIERRE AND MIQUELON
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SENEGAL
SERBIA
SIERRA LEONE
SINGAPORE
SINT MAARTEN
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH SUDAN
SPAIN
SUDAN
SURINAME
SVALBARD AND JAN MAYEN
SWAZILAND
SWEDEN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UK - BRITISH NATIONAL(OVERSEAS)
UK - BRITISH OVERSEAS CITIZEN
UK - BRITISH PROTECTED PERSON
UK - BRITISH SUBJECT
UKRAINE
UNITED ARAB EMIRATES
UNITED NATION KOSOVO
UNITED NATIONS
UNITED STATES
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIET NAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
YEMEN
ZAIRE
ZIMBABWE
Intended Date of Entry
Port of Entry
Port of Entry
Phnom Penh International Airport
Siem Reap International Airport
Cham Yeam (Koh Kong)
Poi Pet (Banteay Meanchey)
Bavet (Svay Rieng)
Tropaeng Kreal Border Post (Stung Treng)
Sihanoukville International Airport (Not Cruising Ships)
Other Details
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Visa Type
Tourist
Business
Entry purpose
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Business
General
Project
Retired
Student
Technical
Meeting
Other
Other Purpose
Support Document(s) (.JPG .JPEG .PNG .PDF, size 2MB..)
Letter Of Invitation
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Hotel Reservation Document(s)
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Other
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