Date:

To,

The Visa Officer

Embassy of

Address:

Dear Sir/Madam,

I am writing to apply for a Medical Treatment Visa to travel to for the purpose of undergoing medical treatment. The details of my application are as follows:

Applicant's Name:

Passport Number:

Date of Birth:

Nationality:

Contact Information:

Medical Condition Requiring Treatment:

Medical Institution / Hospital in :

Duration of Treatment:

Accompanying Person(s) (if any):

I have enclosed the required medical documents, doctor’s recommendation, and correspondence from the hospital/institution in . I respectfully request you to kindly consider my application and grant me a visa for the duration of my treatment.

Thank you for your consideration.

Yours sincerely,

Name:

Signature: