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4Application for Schengen Visa
ganacxadi Sengenis vizis misaRebad
PHOTO
This application form is free
es anketa ufasoa
1. Surname (Family name) (x)
For official use only
gvari
ivseba sakonsulo
ganyofilebis mier
2. Surname at birth (Former family name(s)) (x)
qaliSvilobis (winandeli) gvari
Date of application:
3. First name(s) (Given name.(s))
(x)
saxeli/saxelebi
4. Date of birth (day-month-year)
5. Place of birth
7. Current nationality
Visa application number:
dabadebis TariRi (dRe-
dabadebis adgili
amJamindeli moqalaqeoba
Tve-weli)
Application lodged at
6. Country of birth
Nationality at birth, if different:
Embassy/consulate
dabadebis qveyana
moqalaqeoba dabadebisas, Tu
CAC
sxva iyo
Service provider
Commercial intermediary
Border
8. Sex /sqesi
9. Marital status /ojaxuri mdgomareoba
Name:
Single
Married
Separated
dauqorwinebeli
daqorwinebuli
ganSorebuli
Male
Other
mamrobiTi
Divorced
Widow(er)
Other (please specify)
File handled by:
ganqorwinebuli
qvrivi
sxva (miuTiTeT)
Female
mdedrobiTi
Supporting documents:
10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of
parental authority/legal guardian
Travel document
arasrulwlovanebis SemTxvevaSi: gvari, saxeli, misamarTi (Tu gansxvavebulia
ganmcxadeblis misamarTisagan) da mSoblis/meurvis moqalaqeoba
Means of subsistence
Invitation
Means of transport
11. National identity number, where applicable
TMI
piradi nomeri, aseTis arsebobis SemTxvevaSi
Other:
12. Type of travel document / samgzavro dokumentis tipi
Visa decision:
Ordinary passport
Diplomatic passport
Service passport
Cveulebrivi pasporti
diplomatiuri pasporti
samsaxurebrivi pasporti
Refused
Official passport
Special passport
Other travel document (please specify)
Issued:
oficialuri pasporti
specialuri pasporti sxva samgzavro sabuTi (miuTiTeT)
A
C
13. Number of travel
14. Date of issue
15. Valid until
16. Issued by
gacemis
moqmedebis
gamcemi organo
document samgzavro
LTV
TariRi
vada
dokumentis nomeri
Valid
From ................................
17. Applicant's home address and e-mail address
Telephone number(s)
Until ................................
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.
Application for Schengen Visa
ganacxadi Sengenis vizis misaRebad
PHOTO
This application form is free
es anketa ufasoa
1. Surname (Family name) (x)
For official use only
gvari
ivseba sakonsulo
ganyofilebis mier
2. Surname at birth (Former family name(s)) (x)
qaliSvilobis (winandeli) gvari
Date of application:
3. First name(s) (Given name.(s))
(x)
saxeli/saxelebi
4. Date of birth (day-month-year)
5. Place of birth
7. Current nationality
Visa application number:
dabadebis TariRi (dRe-
dabadebis adgili
amJamindeli moqalaqeoba
Tve-weli)
Application lodged at
6. Country of birth
Nationality at birth, if different:
Embassy/consulate
dabadebis qveyana
moqalaqeoba dabadebisas, Tu
CAC
sxva iyo
Service provider
Commercial intermediary
Border
8. Sex /sqesi
9. Marital status /ojaxuri mdgomareoba
Name:
Single
Married
Separated
dauqorwinebeli
daqorwinebuli
ganSorebuli
Male
Other
mamrobiTi
Divorced
Widow(er)
Other (please specify)
File handled by:
ganqorwinebuli
qvrivi
sxva (miuTiTeT)
Female
mdedrobiTi
Supporting documents:
10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of
parental authority/legal guardian
Travel document
arasrulwlovanebis SemTxvevaSi: gvari, saxeli, misamarTi (Tu gansxvavebulia
ganmcxadeblis misamarTisagan) da mSoblis/meurvis moqalaqeoba
Means of subsistence
Invitation
Means of transport
11. National identity number, where applicable
TMI
piradi nomeri, aseTis arsebobis SemTxvevaSi
Other:
12. Type of travel document / samgzavro dokumentis tipi
Visa decision:
Ordinary passport
Diplomatic passport
Service passport
Cveulebrivi pasporti
diplomatiuri pasporti
samsaxurebrivi pasporti
Refused
Official passport
Special passport
Other travel document (please specify)
Issued:
oficialuri pasporti
specialuri pasporti sxva samgzavro sabuTi (miuTiTeT)
A
C
13. Number of travel
14. Date of issue
15. Valid until
16. Issued by
gacemis
moqmedebis
gamcemi organo
document samgzavro
LTV
TariRi
vada
dokumentis nomeri
Valid
From ................................
17. Applicant's home address and e-mail address
Telephone number(s)
Until ................................
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
saboloo daniSnulebis qveyanaSi Sesvlis nebarTva (Tu aseTi moiTxoveba)?
Issued by ............................................. Valid from .............................................. until .....................
gamcemi organo
ZalaSia
-dan
-mde
29. Intended date of arrival in the Schengen area /
30. Intended date of departure from the
SengenSi Sesvlis dagegmili TariRi
Schengen area / Sengenidan gamosvlis
dagegmili TariRi
* 31. Surname and first name of the inviting person(s) in the Member State(s). If not applicable, name of
hotel(s) or temporary accommodation(s) in the Member State(s). “Sengenis” qveynidan
Tqveni momwvevi pir(eb)is gvari da saxeli. sxva SemTxvevaSi sastumro(ebi)s
dasaxeleba da “Sengenis” qveyanaSi Tqveni droebiTi misamarT(eb)i
Address and e-mail address of inviting person(s) /hotel(s)/ temporary
Telephone and telefax
tel. da faqsi
accommodation(s) momwvevi pir(eb)is/
sastumro(ebi)s/droebiTi sacxovrebl(eb)is misamarTi
da el. fosta
* 32. Name and address of inviting company/organisation
Telephone and telefax of
momwvevi kompaniis/organizaciis saxelwodeba da
company/organisation
kompaniis/organiza
misamarTi
ciis tel. da faqsi
Surname, first name, address, telephone, telefax, and e-mail address of contact person in
company/organisation momwvev kompaniaSi/organizaciaSi sakontaqto piris gvari,
saxeli, misamarTi, telefoni, faqsi da el. fosta
* 33. Cost of travelling and living during the applicant's stay is covered
ganmcxadeblis mgzavrobis da cxovrebis xarjebis dafarva xdeba
by the applicant himself/herself
by a sponsor (host, company, organisation), please
Tavad ganmcxadeblis mier
specify sponsoris (mimwvevi piris,
kompaniis, organizaciis) mier (miuTiTeT)
Means of support/gadaxdis saSualeba
referred to in field 31 or 32 ……………………….
Cash / naRdi fuli
31 an 32 grafaSi miTiTebuli
naRdi fuli
Traveller's cheques/samgzavro Cekebi
other (please specify) ……………………………..
sxva (miuTiTeT)
Credit card / sakredito baraTi
Means of support/gadaxdis saSualeba
Prepaid accommodation/winaswar
Cash / naRdi fuli
gadaxdili sacxovrebeli
Prepaid transport /winaswar gadaxdili
Accommodation provided/
mgzavroba
sacxovrebliT uzrunvelyofa
Other (please specify) / sxva (miuTiTeT)
All expenses covered during the stay/
yvela xarji ifareba yofnis
periodSi
Prepaid transport /winaswar
gadaxdili mgzavroba
Other (please specify) /
sxva (miuTiTeT)
34. Personal data of the family member who is an EU, EEA or CH citizen
piradi informacia evrokavSiris, evropis ekonomikuri Tanamegobrobis an
Sveicariis konfederaciis moqalaqis ojaxis wevris Sesaxeb
Surname / gvari
First name(s) /saxeli
Date of birth/
Nationality / erovneba
Number of travel document or ID card
dabadebis TariRi
/piradobis mowmobis an samgzavro
dokumentis nomeri
35, Family relationship with an EU, EEA or CH citizen
naTesauri kavSiri evrokavSiris, evropis ekonomikuri Tanamegobrobis an
Sveicariis konfederaciis moqalaqesTan
spouse
child
grandchild
dependent ascendant
meuRle
Svili
SviliSvili
moqalaqis kmayofaze myofi winapari
37. Signature (for minors, signature of parental
36. Place and date / Sevsebis adgili
da TariRi
authority/legal guardian)
xelmowera (mcirewlovanis SemTxvevaSi
mSoblis/meurvis xelmowera)
I am aware that the visa fee is not refunded if the visa is refused
vici, rom vizaze uaris miRebis SemTxvevaSi savizo mosakrebelis dabruneba ar xdeba
Applicable in case a multiple-entry visa is applied for (cf. field No 24):
mravaljerad vizaze ganacxadis SemTxvevaSi (ix. grafa 24)
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
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 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
CemTan dakavSirebuli nebismieri informacia, aseve Cemi foto da TiTis anabeWdebi gadaecema “Sengenis” qveynebis Sesabamis
kompetentur uwyebebs da Seswavlil iqneba maT mier Cemi vizis moTxovnis ganxilvis mizniT.
es monacemebi, aseve monacemebi Cem gancxadebasTan dakavSirebuli gadawyvetilebis an vizis gauqmebis, gawvevis an gagrZelebis
1
Taobaze aRiricxeba da Seinaxeba savizo sainformacio sistemaSi (VIS) (
) maqsimum xuTi wliT, da am drois ganmavlobaSi es
informacia xelmisawvdomi iqneba vizebze pasuxismgebeli uwyebebisaTvis, agreTve uwyebebisaTvis romlebic uflebamosilni arian
Caataron
vizebis Semowmeba evrokavSiris sagareo sazRvrebze da mis wevr saxelmwifoebSi, evrokavSiris wevri saxelmwifoebis
saimigracio da TavSesafris miniWebaze pasuxismgebeli uwyebebisaTvis, raTa ganisazRvros, dakmayofilda Tu ara evrokavSiris wevri
saxelmwifos teritoriaze Sesvlis, gaCerebisa da cxovrebis pirobebi, gamovlindnen pirebi romlebic ar an aRar akmayofileben am
pirobebs, ganxilul iyos ganacxadi TavSesafris miRebis Taobaze da ganisazRvros am ganxilvaze pasuxismgebeli mxare. garkveul
SemTxvevebSi es monacemebi aseve
xelmisawvdomi iqneba evrokavSiris wevri saxelmwifoebisa da evropolis saTanado uwyebebisaTvis
teroristuli danaSaulisa da sxva seriozuli kriminaluri danaSaulis prevenciis, gamovlenisa da gamoZiebis mizniT. evrokavSiris
wevr saxelmwifoSi am monacemebis damuSavebaze pasuxismgebeli uwyeba aris saberZneTis adamianis uflebaTa dacvis saministro,
saberZneTis policiis xelmZRvaneli uwyeba, saerTaSoriso sapolicio TanamSromlobis ganyofileba, sirenes 3-e qveganyofileba,
kanelopulu 4, 101 77, aTeni. tel: +30.210.6977000 faqsi: +30.210.6929764. eleqtronuli misamarTi : info@sirene-gr.com
vici, rom maqvs ufleba evrokavSiris wevr nebismier saxelmwifoSi miviRo Setyobineba CemTan dakavSirebuli monacemebis VIS
monacemTa bazaSi da Tu evrokavSiris wevri romeli saxelmwifos mier moxvda am monacemebis gadagzavna, da moviTxovo CemTan
dakavSirebul monacemebSi arsebuli uzustobebis Sesworeba da CemTan dakavSirebuli ukanonod damuSavebuli informaciis waSla.
Cemi moTxovnis safuZvelze, uwyeba romelic ganixilavs Cem ganacxads ganmimartavs Tu rogor visargeblo uflebiT, Sevamowmo
Sevacvlevino
an
wavaSlevino
CemTan
dakavSirebuli
piradi
informacia,
agreTve
Sesabamis
saxelmwifos
kanonmdeblobiT
gaTvaliswinebuli dacvis saSualebebis Sesaxeb. erovnuli sazedamxedvelo organo (uwyeba, romelic icavs adamianis piradul
monacemebs ,l. kifisias 1-3, 115 23, aTeni tel: + 30 210. 6475600, faqsi: + 30.210.645628, el. misamarTi contact@dpa.gr) ganixilavs saCivrebs
piradi monacemebis dacvasTan dakavSirebiT.
vacxadeb, rom ramdenadac CemTvis cnobilia Cems mier warmodgenili monacemebi sruli da sworia. vici, rom yalbi informaciis
warmodgenam SeiZleba gamoiwvios vizis moTxovnis uaryofa, an ukve gacemuli vizis gauqmeba, aseve Cems winaaRmdeg SesaZlebeli
samarTlebrivi proceduris aRZvra Cemi ganacxadis ganxilviT dakavebuli evrokavSiris wevri qveynis kanonmdeblobis Tanaxmad.
viReb valdebulebas davtovo Sengenis qveynebis teritoria aRniSnuli vizis moqmedebis gasvlisTanave. vici, rom vizis qona Sengenis
qveynebis teritoriaze Sesvlis aucilebel pirobaTagan mxolod erTia. mxolod vizis qona ar maZlevs uflebas moviTxovo raime
saxis kompensacia Tu ver davakmayofileb evrokavSiris wesdeba 562/2006-is (Sengenis sasazRvro kodeqsi) muxli 5(1)-is moTxovnebs da
Sesabamisad qveyanaSi Sesvlisas sazRvarze miRebuli uaris SemTxvevaSi. QSengenis qveynebis evropul teritoriaze Sesvlisas kidev
erTxel iqneba Semowmebuli Tu ramdenadaa daculi qveyanaSi Sesvlis pirobebi.
Place and date /
Signature (for minors, signature of parental authority/legal guardian)
Sevsebis adgili da TariRi
xelmowera (mcirewlovanis SemTxvevaSi mSoblis/meurvis
xelmowera)
1
(
) In so far as the VIS is operational im SemTxvevaSi Tu VIS sistema moqmedebs
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Most Popular Documents
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DA Form 2062 "Hand Receipt/Annex Number"
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DD Form 2977 "Deliberate Risk Assessment Worksheet"
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DA Form 31 "Request and Authority for Leave"
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DD Form 1750 "Packing List"
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IRS Form W-2 "Wage and Tax Statement"
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DD Form 1351-2 "Travel Voucher or Subvoucher"
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DD Form 2923 "Privacy Act Data Cover Sheet"
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DD Form 2813
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DD Form 2656 "Data for Payment of Retired Personnel"
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