ON-LINE VISA APPLICATION FORM 20002-44690535 \ 23.02.
2025 [Link]
EMBASSY OF THE RUSSIAN FEDERATION IN
CONGO
1. Nationality (if you formerly had REPUBLIC OF CONGO
USSR or Russian citizenship, please
indicate when and why you lost it).
2. Surname (as in passport). KOUMBA BITOUMBOU
3. First name, other names, patronimic STEVINE TATIANA
(as in passport).
4. Date of birth (dd/mm/yyyy). 26/09/1999
5. Sex. FEMALE
6. Passport.
Passport No: OA0665979
Date of issue: 19/01/2024
Valid until: 18/01/2029
7. Purpose of visit. STUDY
8. Category and type of visa. COMMON EDUCATIONAL
9. Number of entries. SINGLE
10. Date of arrival and departure. 28/02/2025 - 10/04/2025
11. Host organisation you intend to
visit.
Company name: ГОСУДАРСТВЕННЫЙ ИНСТИТУТ РУССКОГО ЯЗЫКА ИМ. А. С. . ПУШКИНА
TIN: NONE
Invitation No: NONE
Directive No: NONE
Address: Г. МОСКВА, УЛ. АКАДЕМИКА ВОЛГИНА, Д. 6.
12. Route of journey (destination MOSCOW
points).
Photograph and signature. Service information (automatically generated).
Application form recipient: EMBASSY OF THE RUSSIAN
FEDERATION IN CONGO
Basis (voucher, dir. No, inv. No): NONE
The estimated date of visit to the RC:
Place for Application No (web-site): 44690535
photograph The date of processing: 23/02/2025
*2000244690535*
Application No (VAC):
The date of processing by the VAC:
Request No in Russian Consulate (RC):
I hereby agree to the processing and transfer of my personal data in
electronic form for the purposes of making a decision on visa issuance.
I declare that data provided in the application form are full and
Date (dd/mm/yyyy), personal signature correct. I am aware that any false information may be a cause for the
denial of visa or for the cancellation of the previously issued visa and
may lead to other consequences provided for by the legislation of the
Russian Federation. Subject to the receipt of visa, I pledge to leave
the territory of the Russian Federation before the visa expiration date.
I am aware that valid visa does not automatically allow to enter the
territory of the Russian Federation. In case of denial of entry, I will
not seek any compensation for potential losses.
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13. Children under 16 years and other
relatives written in your passport.
Do you travel with children under 16 NO
years or other relatives written in
your passport?
14. Your permanent address, telephone 10 AVENUE DE LA CORNICHE, TEL: 056093853, EMAIL:
number, fax number, E-mail. stevinekoumba@[Link]
15. Current/latest place of work. ГОСУДАРСТВЕННЫЙ ИНСТИТУТ РУССКОГО ЯЗЫКА ИМ А С ПУШКИНА, STUDENT, Г.
МОСКВА, УЛ. АКАДЕМИКА ВОЛГИНА, Д. 6., TEL: +7 (495) 330-88-01, EMAIL:
inbox@[Link]
16. Information about your previous
trips to Russia.
How many times have you been to Russia? 3
Date of last trip to Russia 02/12/2021 - 04/02/2025
(dd/mm/yyyy):
17. Information about health insurance.
Do you have health insurance that is YES
valid in Russia?
Name of the insurance company, МЕДСАНЧАСТЬ 03 0041100784106920
insurance number:
18. Other names used in the past NONE
(maiden, pen-name, religious, etc.).
19. Your place of birth (if you were BRAZZAVILLE
born in Russia, please specify when and
which country you emigrated to).
20. Additional information about your
relatives.
Do you currently have relatives in NO
Russia?
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