Application Form Filling Finished Please take down the Application Form Number below. When making appoinment and reviewing, you will need the Application Number. You will have access to downloading the Application Form after reading this page and clicking the button" I have studied and been aware of the Application Form Number ". ALG2240531AL2297504 Section 10 - Declaration / Review Please verify that all the information below is correct before finalizing the application form. Section 1 - Personal Information Edit Name - Family name (as shown on your passport or travel document) AMMARCHA Name - Given name(s) (as shown on your passport or travel document) SAMIR Name - Former name(s) - Leave empty if not applicable Samir Name - Chinese name (if applicable, in Chinese) عمارشة سمير Name - Your own photos Date of birth(yyyy-MM-dd) 1979-07-10 Gender Male Place of birth - Country / Region Algeria Place of birth - Province / State AIN DEFLA Place of birth - City KHE