| 1. Surname(s) (family name(s))
| For embassy / consulate use only
|
| 2. Surname(s) at birth (earlier family name(s))
| Date application :
|
| 3. First names (given names)
| |
| 4. Date of birth (year-month-day)
| 5. ID-number (optional)
| File handled by :
|
| 6. Place and country of birth
| Supporting documents:
|
| 7. Current nationality/ies
| 8. Original nationality (nationality at birth)
| – Valid passport
– Financial means
|
| 9. Sex
– Male – Female
| 10. Marital status :
– Single – Married – Separated – Divorced – Widow(er) – Other
| – Invitation
– Means of transport
– Health insurance
– Other :
|
| 11. Fathers name
| 12. Mothers name
|
|
| | |
| 13. Type of passport:
– National passport – Diplomatic passport – Service passport – Travel document (1951 Convention)
– Aliens passport –Seamans passport – Other travel document (please specify):
.
|
|
| 14. Number of passport
| 15. Issued by
|
|
| 16. Date of issue
| 17. Valid until
|
|
| 18. If you reside in a country other than your country of origin, have you permission to return to that country?
No Yes, (number and validity)
.
|
|
| * 19. Current occupation
| Visa :
|
| * 20. Employer and employers address and telephone number. For students, name and address of school.
| – Refused
– Granted
|
| | Characteristics of Visa :
|
| 21. Main destination
| 22. Type of Visa :
o Airport transit o Transit o Short stay o Long stay
| 23. Visa :
o Individual o Collective
| – LTV
– A
– B
– C
– D
– D + C
|
| 24. Number of entries requested
– Single entry – Two entries – Multiple entries
| 25. Duration of stay
Visa is requested for: ______ days
| Number of entries :
|
| 26. Other visas (issued during the past three years) and their period of validity
| – 1 – 2 – Multiple
|
| 27. In the case of transit, have you an entry permit for the final country of destination?
– No – Yes , valid until: Issuing authority:
| Valid from
..
To
|
| * 28. Previous stays in this or other Schengen states
| Valid for :
.
|
| | | | | | | | |
| 29. Purpose of travel
– Tourism – Business – Visit to Family or Friends – Cultural/Sports – Official – Medical reasons
– Other (please specify):
.
..
| For embassy / consulate use only
|
| |
|
| * 30. Date of arrival
| * 31. Date of departure
|
| |
| * 32. Border of first entry or transit route
| 33. Means of transport
|
|
|
|
|
| * 34. Name of host or company in the Schengen states and contact person in host company. If not applicable, give name of hotel or temporary address in the Schengen states
|
|
| Name
| Telephone and telefax
|
|
| Full address
| e-mail address
|
|
| |
|
| * 35. Who is paying for your cost of travelling and for your costs of living during your stay?
– Myself – Host person/s – Host company. (State who and how and present corresponding documentation):
.
|
|
| * 36. Means of support during your stay
– Cash – Travellers' cheques – Credit cards – Accommodation – Other:
– Travel and/or health insurance. Valid until:
..
|
|
| |
|
| 37. Spouses family name
| 38. Spouses family name at birth
|
|
| 39. Spouses first name
| 40. Spouses date of birth
| 41. Spouses place of birth
|
|
| 42. Children(Applications must be submitted separately for each passport)
Name First name Date of birth
|
|
| |
|
| 43. Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens.
|
|
| Name
| First Name
|
|
| Date of Birth
| Nationality
| Number of passport
|
|
| Family relationship :
of an EU or EEA citizen
|
|
| |
|
| 44. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in the Schengen states and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states.
At my express request, the consular authority processing my application will inform me of the manner in which I may exercise my right to check the personal data concerning me and have them altered or deleted, in particular, should they be inaccurate, in accordance with the national law of the state concerned.
I declare that to the best of my knowledge all particulars supplied by me are correct and complete.
I am aware that any false statements will lead to my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the law of the Schengen state which deals with the application.
I undertake to leave the territory of the Schengen states upon the expiry of the visa, if granted.
I have been informed that possession of a visa is only one of the prerequisites for entry into the European territory of the Schengen states. The mere fact that a visa has been granted to me does not mean that I will be entitled to compensation if I fail to comply with the relevant provisions of Article 5.1 of the Schengen Implementing Convention and am thus refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Schengen states.
|
|
| 45. Applicants home address
| 46. Telephone number
|
|
| 47. Place and date
| 48. Signature (for minors, signature of custodian/guardian)
|
|
| | | | | | | | | | | |
