Media Links

Links dos Mídia

MEDIA ACCREDITATION FORM

FAVOR REMETER ESTA FICHA AO / Please send this form to:       

Gabinete de Informação 
Av. Francisco Orlando, 780, Maputo, Moçambique
Telefone:  (258-1) 49 10 87 / 49 10 88
Fax: 49 23 86
E-mail: gabinfo@zebra.uem.mz

Por favor preencher em letra de imprensa / Please type or fill in block letters

1.    NOME COMPLETO / Full Name                                                           

2.    DATA DE NASCIMENTO / Date of Birth                  /          /         

3.    LUGAR E PAIS DE NASCIMENTO / Place and Country of birth                                  

4.    NACIONALIDADE / Nationality                                                              

5.    No. do PASSAPORTE / Passport Number                                                    

6.    NACIONALIDADE DO PASSAPORTE / Nationality of the Passport                               

7.    VALIDADE / Validity                                                                 

8.    JORNALISTA / Jornalista               OPERADOR DE CÂMARA / Camera Operator                     OPERADOR DE SOM / Sound operator           TECNICO /Technician              FOTOGRAFO / Photographer            OUTROS / Others                

9.    NOME DO ORGAO DE INFORMAÇÃO / Name of the News Organization                                           

11.    IMPRENSA / Press          TV / TV            RADIO / Radio              

12.    MOTIVO DA VISITA / Purpose of the visit                                                

                                                                                                                                           

                                                                                                                                      

13.    DATA DE CHEGADA A MOÇAMBIQUE / Arrival date in Mozambique                        /                   /                     

14.    DATA DE PARTIDA DO PAIS / Departure date from the country                 /              /              

15.    Maputo,              /             /             

16.    ASSINATURA DO CANDIDATO / Signature of the Applicant