Embassy of South Sudan
I, <Your Name>, am applying for a <Tourist or Business> visa to visit South Sudan. Please issue the visa from <entry date> to <exit date>.
Please explain the purpose of your trip to South Sudan.
The address and telephone number where I will be staying in South Sudan is:
<Name of host>
My address and telephone number in the United States:
My passport details are:
<Name as it appears in your passport>
Passport Expiration Date:
Thank you for your assistance.