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Application for Schengen Visa

This application form is free
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Surname (Family name) (x)

For official use only

2. Surname at birth (Former family name(s)) (x)

Date of application: Visa application number:

3. First name(s) (Given name(s)) (x)

4. Date ot birth (day-month-year)

5. Piace of birth 6. Country ot blrth

T.Curlent nationalily Naiionality at birlh. it differenl

Application lodged at

Otner (ptease specify) .l0.lnthecaseofminors:Surname.flrstname,"do'"""t,

authority/legal guardian
11. Nalional identily number, where applicable

I I

stngte

Married

Separared

Divorced

f,

woowle4

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D Embassy/consulate D cec
Service provider Commercial intermediary Border

Name:

other:

12. Type of lravel document

I I
1

Otcinury passport

oiptomatic passport

Service passport

Otnur (ptease specify)

14. Date ot issue

File handled by:

Om.iut passport

I
Supporting documents: Travel document E Means of subsistence

3. Number of travel documeni

17. Applicant's home address and e-mail address

I
of cunent nalionatity

f,

L Residence in a country other than that counlry

r.ro

lnvitation Means oftransport TMI

E]ur

Resident permit or equivatenl

..........................

No

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other:

Visa decision
Refused lssued: '20.. Emproyer and employei's address and terephone number. For stud"nt", nuru

establishmeni

"ndlilIIJIfJ[iJ

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tra
Lw

21. Main purpose(s) ofthe journey

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Visiting famity or friends

f,
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D

Tourism

ausiness

Cutturat

f]

Sports

omciat visit

vatio From...... -,......

ueoicat reasons

Until..............

sruoy

Transit

Airport lransit

Otnur (ptease specify)

23. Member state of flrst entry

Number of entries

22. Member Stale(s) of destination

24. Number of entries requested

D 1tr

2EMuttipre

Number of days: 6O oO o:
FN

f f,
D

Singte entry

25. Duration of the intended stay or transil

Two entries

lndicate number of days

O;

26. Schengen visas issued during the past three years

>9

ruo

n n

Yes. Date(s) of vatidity from..............

27. Fingerprints collecled previously for the purpose of applying for a Schengen Visa

ruo

Yes. Date if known.........

shalt

' not ue iitreo in uyE;it! mEmIEE tofreomoVement'ramilymemoJ[.}?.j:..:#,.r['"1?:::''"''"il'::*i;:#5i$(;:".",".i'::,i.;H::m

The fietd marked wirh

(x) Flelds 1-3 shall

be tjlled in accordance with the data in travel document

28. Entry permit for the final country of destination, where applicable

..Valid from
29. lntended date of arrival in lhe Schengen Area

For official use only Until..

.

30. lntended date of departure from lhe Schengen Area

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31. Surname and tirst name of the inviting person(s) in the Member State(s). It not applicable, name of holel(s) or temporary accommodation(s) in the Member State(s)

Address and e-mail address of inviting person(s)/hotel(s) temporary accommodation(s)

Telephone and telefax

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32. Name and address of inviting company / organisation

Telephone and telelax of company / organisation

Surname, first name, address, te'ephone, telefax and e-mail address of contact person in company / organisation

'33. Cost oftraveling and living during

th applicant's stay is mvered

n
I ! ! I I

Oy

tn" appticant himsetf/hersetf

I

Oy

tne sponsor (host, company, organisation), please specify

Means of

I casn
Traveler's Credit

suppoa
cheques card

I
I I

refened to in fietd 3,t or 32

f]
Means ofsupport

other (ptease specify)

casn
Accommodation provided Atl e"punses covered during the stay erepaid transport

l-l Prepaid accommodation I erepaid transport I otn"r (ptease specify) f,

I

Ot'er (ptease specify)

34. Personal dala of the family member who is an EU, EEA or CH citizen Sumame

Dale of birth

io*":'*''
Nationality
Number of travel document or lD card

35. Family relationship wilh an EU, EEA, or CH cjtizen

spouse

f,

chitd .........

fl

grandchitd

dependent ascendant

36. Place and daie

37. Signature (for minors, signature of parental authority/legal guardian)

Applicable in case a multiple-entry visa is applied for (cf. tield No 24): I am aware of the need to have an adequate travel medical insurance for my first stay and any subsequenl visits to lhe lenitory of Member stale.
i am aware of and consenl 10 the following: lhe colleclion of the data. required by this application torm and the taking of ,y pnotfrIf,ilil, it the taking of fingorprints, are mandalory f6r the examination of the- visa application; ano'any personat "p-f,If,Jf, data concerning me which appear on the visa abplication lorm, applrcarlon form, as well as my fingerprints and my photooraDh wll be suoolied to thc relevant e,trh^dii6llngerprints photograph will supplied the rplevanr authorities of rha rra6l^- States and' processed by those ^{ the Memier 0,6r^_ ^-! authorities, for the purposes of a decision on my visa appicjtion.

into,andsloredinthevisalnformationsyslem(vls)(r;foramaximumperiodofliveyear",orring

such data as well as data concerning th,e decision taken on my application or a decision whether to annul, revoke or extend a visa issued will be entered

the authorities competent for carrying out checks on visas at eliternal borders and within tne Member states, immigration and asylum authorities in lhe Member states for the purpose ol verifying whether the condition3 for tho legal untw into, resiaence on iiu-r#rorv Ji]u Member Stales are fulfilled, of indentifying persons who do not or who no longer fulfill th"se conoltions, "t"v "no asylum apptication and of determining it an responsibility for such examination. under cerlain conditions the data v;ll be also available to dulign"tuJ auin"orities ;f the Member stales and to Europol for the purpose of lhe prevention, delection and investigation of terrorist offences and of oth-er seriouscriminal orences. rG - the Member state responsible for processing lhe data is: The Swedish Migration Board, 601 70 Norrkdping, "rin"rilv "t Sweden, **w.rnior.tion"virr<eise. I am aware that I have the right to oblain in any of the Member States notilicalion of the data relating to me recorded in the VIS and of the Member Stale which transmltted lhe dala, and lo request thal the data relaling lo me which are inaccurate be corrected and that data relating io m procBssed unlawfully be deleted. At my express request, the authority examining m/application will intorm me of lhe manner in which I may exercjse my rjght io check the personal data concerning me and have them correcled or delelej, including the relaled remedies sccording to national law of the state concerned. The national supervisory authorityofthat Member Slate (The Swedish Data lnsiection Board, Boiatll, 104 20 Stockhotm. Sweden, ww.datainsoektionen.se ) wiil hear daims concerning the protection of peisonal data.

whichitwiilbeaccessibletolhevisaauthoriliesand

;il;id

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I declare lhat to lhe best of my knowledge all particulars supplied by me are correct and complele. I am aware that any false statemenls will lead to my application bing rejecled or to lhe annulmenl of a visa already granted and may also render me liable to pro"ecrtion 'rnJuitne iaw ot tne Member stale which deals with the application.

I undertake to leave the terrilory ol the Member State before the expiry of the visa, it granted. I have been informed lhat possession of a visa is only one of the pterequisits lor entry into the European territory of the Member Siates. The mer; fact that a visa has been granted io me does nol mean that t will be entitled to compensation if I fail to comply with the relevanl provisions of Artide 5 (1) of Regulation (EC) No 56zio06 (Schengen Borders code) and I am therefore refused entry. The prerequisites for entry will be checked again on entry'into euripean teirlto'ry th"

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Place and date

Signature (for minors, signature of parental authority/legal guardian)

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In so far

s oporational.