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15.5 N mero de Visa Nota: Colocar aqu s lo los datos para los cuales aporta constancia al momento de presentar esta solicitud. 16. Alguna vez le han cancelado o revocado una visa Dominicana? Si 17. Alguna vez se le ha negado una visa Dominicana? Si No (en caso afirmado, especifique lo siguiente): 17.1 Fecha (dd/mm/aa) 17.2 Pa s No 17.3 Ciudad 17.4 Clase de Visa 18. Tiene intenci n de trabajar y/o estudiar en la Rep blica Dominicana? Si No (si es afirm.

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