application for schengen visa this application form is

APPLICATIO N FO R SCHENGEN VISA
PHO TO
THIS APPLICA TIO N FO RM IS FREE
1. Surname (Family name) ( x )
F O R O FFICIA L U SE O N LY
2. Surname at birth (Former family name(s)) (x)
Date of application :
3. First name(s) (Given name(s)) (x)
Visa application number:
4. Date of birth (day-m onth-year)
5. Place of birth
7.Current nation ality
6. Coun try of birth
Nationality a t birth, if
different:
Application lodged a t
□ Embassy/consulate
□ CAC
□ Service provider
8. Sex
9. M arital status
□ Commercial intermediary
□ M ale □ Female
□ Single □ M arried □ Separated □ Divorced □
□ Border
Widow(er) □ Other (please specify)
10. In the case of min ors: Surname, first name, a ddress (if different from applicant´s) and na tionality of
Name:
parental authority/le gal gu ardian
□ Other
File handled by:
11. National identity n umber, where applicable
Supporting documents:
□ Travel document
12. Type of travel document
□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport □ Special passport
□ Other travel doc ument (please specify)
13. Number of travel documen t
14. Date of issue
15. Valid un til
16. Issued by
□ M eans of subsistence
□ Invitation
□ M eans of transport
□ TM I
□ Other:
17. Applicant's home address and e -mail a ddress
Telephone number(s)
18. Residence in a country other than the c ountry of c urrent nationality
□ No
□ Yes. Residence permit or equivale nt ………………… No. …………………….. Valid u ntil
1
19. Current occ upation
□ Refused
□ Issued:
* 20. Employer an d employer's address and telephone number. For stude nts, name an d a ddress of
educational establishment.
□A
□C
□ LTV
21. M ain purpose(s) of the journey:
□ Tourism…….□ Business…….□ V isiting family or friends … .□ Cultural ……□ Sports ……..□ Official visit
□ M edical reasons
□ Stu dy ….. □ Transit □ Airport transit …… □ Other (please specify)
22. M ember State(s) of destination
Visa decision:
23. M ember State of first entry
□ Valid:
From
Until
Number of entries:
□ 1 □ 2 □ M ultiple
Number of days:
x Fields 1-3 s hall be filled in in accordance with the data in the travel document
1 The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or depe ndent ascen dant) while exercising their right
to free moveme nt. Family mem bers of EU, EEA or CH citizens shall present documents t o prove this relationship and fill in fie lds no 34 and 35.
24. Number of entries reques ted
25. Duration of the in tended stay or
□ Single en try….□ T wo en tries ….□ M ultiple entries
transit
Indicate n umber of days
26. Schen gen visas issued during the past three years
□ No
□ Yes. Date(s) of validity from ………………… . to
27.Fingerprints collected previously for the purpose of applying for a Schengen visa
□ No ………………………………□ Yes.
……………………………………. Date, if kn own
28. Entry permit for the final c oun try of destination, w here applicable
Issued by ………………………………..V alid from …………………………u ntil
……………………………………………….
29. Intende d da te of arrival in the Sc hengen area
30. Intende d da te of departure from the
Schengen area
* 31. Surname an d first name of the invitin g person(s) in the M ember State(s). If not applicable, name of
hotel(s) or temporary accommodatio n(s) in the M ember State(s)
Address and e-mail a ddress of invitin g person(s)/hotel(s)/temporary
Telephone and telefax
accommoda tion(s)
*32. Name an d a ddress of invitin g c ompany/organisa tion
Telephone and telefax of
company/organisation
Surnam e, first name, address, telephone, telefax, an d e -mail a ddress of contac t person in
company/organisation
*33. Cost of travelling a nd livin g during the applicant's stay is c overed
□ by the applicant himself/herself
□ by a sponsor (host, company,
organisation), please specify
…….□ referred to in field 31 or 32
…….□ other (please specify)
M eans of support
□ Cash
M eans of support
□ Traveller's cheques
□ Cash
□ Credit card
□ Accommodation provided
□ Pre-paid accommodation
□ All expenses covered during the s tay
□ Pre-paid transport
□ Pre-paid transport
□ Other (please specify)
□ Other (please specify)
34. Personal da ta of the family member who is an EU, EEA or CH citizen
Surname
Date of birth
First name(s)
Nationality
Number of
travel
document or
ID card
35. Family relationship with an EU, EEA or CH citizen
□ spouse ……………..□ c hild ……□ grandc hild ………………□ dependent ascendan t
36. Place an d date
37. Signature (for minors, signature of parental
authority/legal guardian)
I am aware that the visa fee is n ot refun ded if the visa is refused.
Applicable in case a multiple -entry visa is applied for (cf. field N o 24):
I am aware of the need to h ave an a dequate travel medical insurance for my first sta y an d an y subsequent visits to the te rritory of
M ember States.
I am aware of a nd consent to the following: the collection of the da ta required by this application form an d the takin g of my photograph
and, if applicable, the taking of fingerprints, are mandatory f or the examina tion of the v isa application; an d an y personal data
concerning me whic h appear on the visa application f orm, as well as my fingerprints and my photograph will be supplied to the relevant
authorities of the M ember States and processed by those authorities, for the purpo ses of a decision on my visa application .
Such da ta as well as data concernin g the decision taken on my application or a decision whether to annul, revoke or extend a visa issued
will be entered into, and stored in the Visa Information System (VIS) 2 for a maximum period of five years, during which it will be
accessible to the visa authorities an d the authorities competent f or carrying ou t checks on visas at external borders and wit hin the
M ember States, immigration and asylum authorities in the M ember Stat es for the purposes of verifying whether the conditions for the
legal entry into, stay an d residence on the territory of the M ember States are fulfilled, of identifying persons who do not o r who n o
longer fulfil these conditions, of examining an asylum app lication a nd of de termining responsibility for such examination. Under certain
conditions the data will be also available to designated authorities of the M ember States and to Europol for the pu rpose of t he
prevention, detection an d investigation of terror ist offences and of other serious criminal offences. The authority of Greece
responsible for processing the data is : M inistry of Citizen Protection, Greek Police, International Police Cooperation Division, 3rd
Division SIRENE, Kanellopoulou 4, GR– 101 77 Athens, Tel.:+30.210.6977000, Fax:+30.210.6929764, Email: info@ sirene-gr.com
I am aware that I have the right to obtain in any of the M ember States notification of the data relating to me recorded in th e VIS and
of the M ember State which transmitted the da ta, an d to request tha t da ta relating to me which are inaccurate be corrected an d that
data relating to me processed unlawfully be deleted. At my express request, the authority examining 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 corrected or deleted, incl udin g
the related remedies according to the nation al law of the Sta te concerned. The na tional supervisory authority of tha t M ember State
{H ellenic Data Protection Auth ority, Kifisias str 1 -3, 1st floor, GR – 115 23 Athens, Tel.: +30.210.6475600, Fax:+30.210.6475628,
E-mail: contac t@ dpa.gr } will hear claims concerning the protection of pers onal data .
I declare that to the best of my knowledge all particulars supplied by me are correct and c omplete. I am aware that an y false
statements will lead to my application being rejected or to the a nnulment of a visa already granted a nd may also rende r me liable to
prosecution un der the law of the M ember State which deals with the application.
I undertake to leave the territory of the M ember States before the expiry of the visa, if granted. I h ave been informed tha t
possession of a visa is only one of the prerequisites for entry into the European territory of the M ember States. The mere fact that a
visa has been granted to me does not mean that I will be entitled to c ompensation if I fail to c omply with the relevant provi sions of
Article 5(1) of Regulation (EC) No 562/2006 (Schen gen B orders Code) and I am therefore refused entry. The prerequisites for entry
will be checked again on en try in to the European territory of the M ember States.
Place and da te
Signa ture
(for minors, signature of parental au thority /legal guardian):
2 In so far as the VIS is operational.