※ 이 서식은 법정서식의 규격에 따른 84㎜×124㎜ 규격입니다.

A4 용지 서식은 2쪽을 출력하여 사용하세요.

상륙허가신청서
上陸許可申請書 APPLICATION FOR	□CREW(SINGLE, MULTIPLE) □EMERGENCY □DISASTER	LANDING PERMIT
SURNAME	漢字姓名
GIVEN NAMES	男 MALE 女 FEMALE
生年月日 DATE OF BIRTH	國籍 NATIONALITY
年 YEAR	月 MONTH	日 DAY
旅券番號 PASSPORT No.	職業 및 職場名 OCCUPATION
上陸理由 REASON FOR LANDING	上陸申請期間 PERIOD OF LANDING
入港便名 FLIGHT No./ DISEMBARKATION	出港便名 FLIGHT No./ EMBARKATION
前寄港地 PORT ARRIVED FROM	次港地 NEXT PORT OF CALL
I declare that I will faithfully observe the IMMIGRATION LAW OF THE REPUBLIC OF KOREA, and notify to all crew members and passengers that they must observe the LAW, and assume whole responsibility for all the charges which might be occurred by them.
署名 SIGNATURE OF APPLICANT(AGENT/MASTER)
公 用 欄 OFFICIAL USE ONLY
行動範圍 AREA OF MOVEMENT	許可期間 PERIOD OF PERMIT
制限‧條件 RESTRICTIONS OR CONDITIONS
23236-01521 민 ’95. 10. 5 승인	84㎜×124㎜ 인쇄용지(NCR) 75g/㎡

상륙허가신청서 (앞 쪽)
上陸許可申請書 APPLICATION FOR	{	□CREW(SINGLE, MULTIPLE) □EMERGENCY □DISASTER	}	LANDING PERMIT
SURNAME	漢字姓名
GIVEN NAMES	男 MALE 女 FEMALE
生年月日 DATE OF BIRTH	國籍 NATIONALITY
年 YEAR	月 MONTH	日 DAY
旅券番號 PASSPORT No.	職業 및 職場名 OCCUPATION
上陸理由 REASON FOR LANDING	上陸申請期間 PERIOD OF LANDING
入港便名 FLIGHT No./ DISEMBARKATION	出港便名 FLIGHT No./ EMBARKATION
前寄港地 PORT ARRIVED FROM	次港地 NEXT PORT OF CALL
I declare that I will faithfully observe the IMMIGRATION LAW OF THE REPUBLIC OF KOREA, and notify to all crew members and passengers that they must observe the LAW, and assume whole responsibility for all the charges which might be occurred by them.
署名 SIGNATURE OF APPLICANT(AGENT/MASTER)
公 用 欄 OFFICIAL USE ONLY
行動範圍 AREA OF MOVEMENT	許可期間 PERIOD OF PERMIT
制限‧條件 RESTRICTIONS OR CONDITIONS
23236-01521 민 ’95. 10. 5 승인	84㎜×124㎜ 인쇄용지(NCR) 75g/㎡