신청자이름(Applicant’s Name)

성별(Sex)

난날(Date of Birth)

난곳(Place of Birth)

국적(Nationality) 

민족별 

(Nationality by Birth)

여권번호 

(Passport No)

영주권번호 

(Permanent Residence Permit No.)

이민날자(Date of Immigration)

집주소(Home Address)

직장이름, 주소, 직위( Name of Employer & Address, Occupation) 

신청서제출목적(Purpose of Application)   가족찾기(To Look for Family member(s))

                                                 가족상봉( To Meet Family Member(s)) 

아버지 이름 

(Father’s Name)

난날 

(Date of Birth)

난곳 

(Place of Birth)

주소 (Address)

어머니 이름 

(Mother’s Name)

난날 

(Date of Birth)

난곳 

(Place of Birth)

주소 (Address)

찾거나 만나려는 가족 (Family member(s) to Look for  or Meet in DPRK)

관계 

(Relation)

이름 

(Name)

성별(Sex)

난날 

(Date of Birth) 

난곳 

(Place of Birth)

헤어질당시/현재주소 

(Address at the time of Separation or at present)

헤어질당시/현재 직장,직위 

(Occupation at the time of Separation or at present) 

조국의 가족(들)과 언제, 어떻게 헤어지게 되었습니까? (Account of Separation, How and When)

조국의 가족(들)과 언제, 어떻게 연계 되었습니까? (How and When could you contact your family member(s) in DPRK?) 

조국방문회수 

(Number of Visit to DPRK)

첫방문날자 

Date of First Visit)

마지막방문날자 

(Date of Last Visit)

가족만난회수 

(Number of Reunion(s))

처음만날 날자 

(Date of First Meeting)

마지막 만날 날자 

(Date of last Meeting)

지난시기 만난 조국의 가족, 친척(DPRK based Family Members You Met in the Past)

관계 

(Relation)

이름 

(Name)

언제 

(When)

어디서 

(Where)

관계 

(Relation) 

이름 

(Name)

언제 

(When)

어디서 

(Where)

신청자 이름(Name of Applicant)                /수표(Signature) 생략 /  날자(Date)   년  월 일