ganmcxadeblis sacxovrebeli misamarTi da eleqtronuli
telefonis
fosta
nomeri/nomrebi
Number of entries:
1 2 Multiple
Number of days:
1
No logo is required for Norway, Iceland and Switzerland.
norvegiis, islandiisa da SveicariisaTvis logo saWiro ar aris.
18. Residence in a country other than the country of current nationality
cxovrobT Tu ara qveyanaSi romlis moqalaqe ar xarT
Yes /diax
No /ara
Residence permit or equivalent............................. No............................ Valid until …………………
cxovrebis nebarTva an sxva Sesabamisi sabuTi
nomeri
moqmedebis vada
* 19. Current occupation
amJamindeli saqmianoba
* 20. Employer and employer's address and telephone number. For students, name and address
of
damsaqmebeli, misi misamarTi da telefonis nomeri.
educational establishment
studentebisaTvis saswavlo dawesebulebis saxelwodeba da misamarTi
21. Main purpose(s) of the journey:
gamgzavrebis mTavari mizani (miznebi)
Tourism/turizmi
Business/saqmiani viziti
Visiting family or friends/naTesavebis an megobrebis monaxuleba
Cultural/kulturul RonisZiebaSi monawileoba
Sports /sportul RonisZiebaSi monawileoba
Official visit/oficialuri viziti
Medical reasons /mkurnaloba
Study/swavla
Transit/ tranziti
Airport transit/aeroportis tranziti
Other (please specify)/sxva (miuTiTeT)
22. Member State(s) of destination
23. Member State of first entry
daniSnulebis qveyana evrokavSirSi
evrokavSiris pirveli wevri qveyana
Sengenis zonaSi Sesvlisas
24. Number of entries requested
25. Duration of the intended stay or transit
moTxovnili Sesvlis ufleba
Indicate number of days
Sengenis zonaSi yofnis an tranzitis
Single entry / erTjeradi
vada
Two entries / orjeradi
miuTiTeT dReebis raodenoba
Multiple entries / mravaljeradi
The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) while exercising their right to free movement.
Family members of EU. EEA or CH citizens shall present documents to prove this relationship and fill in fields No 34 and 35.
evrokavSiris, evropis ekonomikuri Tanamegobrobis an Sveicariis konfederaciis moqalaqis ojaxis wevrebma (meuRle, Svili, an winapari, romelic mis xarjzea) ar unda Seavson *-iT moniSnuli
grafa. Uisini valdebulni arian mxolod warmoadginon naTesauri kavSiris damadasturebeli dokumentacia da Seavson grafa #34 da #35.
(x) Fields 1-3 shall be filled in in accordance with the data in the travel document.
(x) – iT moniSnuli grafa unda Seivsos samogzauro dokumentis monacemebis mixedviT.
26. Schengen visas issued during the past three years
bolo sami wlis manZilze miRebuli Sengenis vizebi
No /ara
Yes /diax. Date(s) of validity
from .................................. to..................................
ZalaSia (TariRi)
-dan
-mde
27. Fingerprints collected previously for the purpose of applying for a Schengen visa
Cabarebuli gaqvT Tu ara TiTis anabeWdis nimuSi Sengenis vizis misaRebad
No/ara
Yes/diax
Date, if known ……………………………………………………
TariRi, Tu cnobilia
28. Entry permit for the final country of destination, where applicable
I am aware of the need to have an adequate travel medical insurance for my first stay and any subsequent visits to the
territory of Member States.
me vici, rom evrokavSiris qveynebSi pirveli da yoveli momdevno yofnisas unda mqondes
saTanado samedicino dazRveva.
I am aware of and consent to the following: the collection of the data required by this application form and the taking of my photograph and, if applicable, the taking of
fingerprints, are mandatory for the examination of the visa application; and any personal data concerning me which appear on the visa application form, as well as my
fingerprints and my photograph will be supplied to the relevant authorities of the Member States and processed by those authorities, for the purposes of a decision on my visa
application.
Such data as well as data concerning 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
1
the Visa Information System (VIS) (
) for a maximum period of five years, during which it will be accessible to the visa authorities and the authorities competent for carrying
out checks on visas at external borders and within the Member States, immigration and asylum authorities in the Member States for the purposes of verifying whether the
conditions for the legal entry into, stay and residence on the territory of the Member States are fulfilled, of identifying persons who do not or who no longer fulfill these
conditions, of examining an asylum application and of determining responsibility for such examination. Under certain conditions the data will be also available to designated
authorities of the Member States and to Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious criminal offences.
The authority of Greece responsible for processing the data is: Ministry of Citizen Protection, Greek Police, International Police Cooperation Division, 3rd Division
I am aware that I have the right to obtain in any of the Member States notification of the data relating to me recorded in the VIS and of the Member State which transmitted the
data, and to request that data relating to me which are inaccurate be corrected and 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,
including the related remedies according to the national law of the State concerned. The national supervisory authority of that Member State The national supervisory authority
of that Member State {Hellenic Data Protection Authority, Kifisias str 1-3, 1st floor, GR – 115 23 Athens, Tel.: +30.210.6475600, Fax:+30.210.6475628, E-mail:
contact@dpa.gr} will hear claims concerning the protection of personal data.
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 Member State which deals with the application.
I undertake to leave the territory of the Member States before 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 Member 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 Regulation (EC) No 562/2006 (Schengen Borders Code) and I am therefore refused entry. The prerequisites for entry will
be checked again on entry into the European territory of the Member States.
gavecani da veTanxmebi, rom am anketaSi miTiTebuli Cemi piradi monacemebis Segroveba da Cemi fotosuraTis gadaReba da, saWiroebis
SemTxvevaSi, TiTis anabeWdebis aReba, aris savaldebulo savizo ganacxadis Sesafaseblad; da rom savizo ganacxadSi mocemuli
Pressing the PRINT button will only print the current page. Download the document to your desktop, tablet or smartphone to be able to print it out in full.