Treatment Visa - Charhengam

Treatment Visa

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Treatment Visa

Treatment Visa

1. Personal photo*
Accepted file types: jpg, jpeg, zip, png, gif, tif.
2. Passport image*
Accepted file types: jpg, jpeg, zip, png, gif, tif.
Passport details
Name*
First Last

Nationality	Your Father`s First Name	Gender (Male/Female)	Marital Statuse	Date Of Birth (YYYY/MM/DD)	Place Of Birth (City & Country)	Passport No	Passport Type	Date Of Passport Issue (YYYY/MM/DD)	Place Passport Issued	Date Of Passport Expiry (YYYY/MM/DD)

Personal information

Adress	Phone&Mobile No (Your City)	Email Adress	Your Occupation /Profession /Activity	Name Of Company/Organization	Field Of Activity/Study

Duration Of Stay In Iran	Travel Plan In Iran	Booked/Planned Hotel (Name &City)	Entrance To Iran Air Port (Date & City) By…?	Departrue To Iran (Date & City) By..?

Where Do You Want To Collect Your Visa?	The Last Date entry In Iran	Have you been to Iran before?	Do you have a host/hostess in Iran?	Do you need a leader (guide) in Iran?	Please advise a name, address and telephone number (needed in case of emergency only)

Further details
Initial diagnosis of the disease (summary of the patient's medical record in the country of residence)
Previous medical procedures performed in the country of residence
Radiograph of the patient
CT scan of the patient
Patient tests
Biography