2Z Host or Host company :

2Z Host or Host company : (If not, indicate name or a temporary adress in Morocco) Name: ... ..... .......... 79a4 Address:... . . (176-',./ Ai A- Ya000 Teleph Email prr Zm 21e r .52 /)1 rse oq ra /4"--eoz/1 e-wi 2& Who is paying for your travel and your needs during your stay ? r-C( My Self O Host(s) O Host company (Indicate the names and the modalities and present corresponding documentation) 29. Financial Means used during your stay : Moyens de financement utilises au cours du sejour : 61 Money (Cash) O Traveller Cheques EVCredit Card ElAccommodation O Others: Di Travel Insurance and/or Medical Insurance — Valid until : 04?- / ad ief6 30. Children ,individual application for each passport) a17 Family Name 1- 2- 3- First Name Date of birth I declare that all information I advanced is correct and complete. I am conscious of the fact that any false declaration will lead to the rejection of application or the annulment of the the visa f already issued and may lead to legal proceedings according to the regulations in force in Morocco. Note : - In addition to your valid passport and visa, you should be able during your passage through the Moroccan frontier to present all documents that may justify your return and your stay, your subsistence means, insurance statement, etc - Entry to the Moroccan territory may be refused to the alien who does not fulfil all these requirements. Providing all the required documents does not necessarily open right to visa. 32. Phone : 33. City/State • A/ ti YO1' • EFTA01186518