Sample "Italian Application Form for National Visa (D) - Consulate General of Italy, Boston, Massachusetts, Usa" - Boston, Massachusetts

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Consulate General of Italy

Photo

Boston

A pplication for National V isa (D)

T his application form is free

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

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

1. Surname (s) (family name(s) ) (x)

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

Y O U R L AST N A M E E X A C T L Y AS I T A PP E A RS O N Y O U R P ASSPO R T

F O R E M B ASSY

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

/C O NSU L A T E USE O N L Y

M A I D E N N A M E I F A PP L I C A B L E O T H E R W ISE L E A V E B L A N K

3. F irst names (given names) (x)

Date of application:

F I RST A N D M I D D L E N A M E E X A C T L Y AS I T A PPE A RS O N Y O U R P ASSP O R T

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

5. Place of birth/.................

7. C u r r ent nationality

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

C I T Y A N D ST A T E O F

V isa application number :

E X A M PL E : M A R C H 24, 1991

BIR T H

U.S. A N D/ O R O T H E R N A T I O N A L I T Y

SH O U L D APPE A R 24 03 - 1991

Nationality at bi rth, if different:

6. C ount r y of bi r th/........................

A pplication lodged at:

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

C O U N T R Y O F B I R T H

D O N O T

U .S. A N D/ O R O T H E R N A T I O N A L I T Y

E mbassy/Consulate

A B B R E V I A T E

C ity hall C A C

8. Sex

9. M arital status

Service provider

C H E C K A PP R O P R I A T E B O X

Commercial Intermediary

M ale

Single

M a r r ied

O ther

F em ale

Sep a r ated

D ivor ced

W idow/er

Name:

C H E C K A PP R O P R I A T E B O X

O the r (please specify)

10. In the case of minors: Surname, fi rst name, addr ess (if different from applicant ) and nationality of pa rent al authority/

legal gua rdian/......................................... ...............................

F ile handled by:

I F A PPL I C A B L E , C O M P L E T E AS I NST R U C T E D

Name of person who received

11. N ational I dentity number , whe re applicable/......................................................................

L E A V E T H IS B L A N K

file at window:

12. T ype of t r avel documen t/................................................

You can find this

O r din a r y p asspor t

D iplom atic p asspor t

in your passport

Supporting documents:

stated under

Se r vice p asspor t

O fficial p asspor t

T ravel document

A uthority

Special passport.

Means of substance

O ther t r avel document (please specify)

C H E C K O R D I N A R Y P ASSP O R T

I nvitation

16. Issued by

13. N umbe r of t r avel

14. D ate of issue

15. V alid until

Means of transport

L IST T H E PL A C E

document

D A Y-M O N T H-Y E A R

(COUNTRY)

T ravel H ealth insurance

Y O U R P ASSP O R T W AS

Y O U R P ASSP O R T IS

W H E R E Y O U R

O ther

P ASSP O R T N U M B E R

P ASSP O R T W AS ISSU E D

ISSU E D

V A L I D U N T I L

T elephone number (s)

17.

-m ail ad d r ess

V isa decision:

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

Refused

B EST C O N T A C T N U M B E R I N C L.

Y O U R C O M P L E T E H O M E A D D R ESS A N D E M A I L A D D R ESS

Refused for SIS non

A R E A C O D E

cancellable.

18. R esidence in a count r y othe r than the count r y of cu r r ent nationality /.....................................

Suspended F ile

N o

Issued

C H E C K

N O

U N L E S S Y O U A R E L I V I N G I N A C O U N T R Y O T H E R T H A N Y O U R H O M E C O U N T R Y

Y es. R esidence pe r m it or eq u ivalen t / ................................ N o

V alid until

T ype of visa:

19. C ur rent occupation

W R I T E ST U D E N T

V alid:

. F or students, n ame and ad d r ess of ed ucation al

20.

establish m en t.

L I S T T H E U .S. S C H O O L Y O U A R E A T T E N D I N G W I T H C O M P L E T E A D D R E SS

from

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

until

21. M ain Purpose(s) of the journey/.........................................................

C H E C K ST U D Y

Number of entries:

F amily reunion/V isiting F amily

Religious

Sports

B usiness

D iplomatic

M ultiplie

M edical treatment

Study

A doption

E mployment

Self employment

O ther (please specify)

(x) In fields from 1 to 3 information must be inserted as it appears on travel documents.

Numero di giorni:

Consulate General of Italy

Photo

Boston

A pplication for National V isa (D)

T his application form is free

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

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

1. Surname (s) (family name(s) ) (x)

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

Y O U R L AST N A M E E X A C T L Y AS I T A PP E A RS O N Y O U R P ASSPO R T

F O R E M B ASSY

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

/C O NSU L A T E USE O N L Y

M A I D E N N A M E I F A PP L I C A B L E O T H E R W ISE L E A V E B L A N K

3. F irst names (given names) (x)

Date of application:

F I RST A N D M I D D L E N A M E E X A C T L Y AS I T A PPE A RS O N Y O U R P ASSP O R T

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

5. Place of birth/.................

7. C u r r ent nationality

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

C I T Y A N D ST A T E O F

V isa application number :

E X A M PL E : M A R C H 24, 1991

BIR T H

U.S. A N D/ O R O T H E R N A T I O N A L I T Y

SH O U L D APPE A R 24 03 - 1991

Nationality at bi rth, if different:

6. C ount r y of bi r th/........................

A pplication lodged at:

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

C O U N T R Y O F B I R T H

D O N O T

U .S. A N D/ O R O T H E R N A T I O N A L I T Y

E mbassy/Consulate

A B B R E V I A T E

C ity hall C A C

8. Sex

9. M arital status

Service provider

C H E C K A PP R O P R I A T E B O X

Commercial Intermediary

M ale

Single

M a r r ied

O ther

F em ale

Sep a r ated

D ivor ced

W idow/er

Name:

C H E C K A PP R O P R I A T E B O X

O the r (please specify)

10. In the case of minors: Surname, fi rst name, addr ess (if different from applicant ) and nationality of pa rent al authority/

legal gua rdian/......................................... ...............................

F ile handled by:

I F A PPL I C A B L E , C O M P L E T E AS I NST R U C T E D

Name of person who received

11. N ational I dentity number , whe re applicable/......................................................................

L E A V E T H IS B L A N K

file at window:

12. T ype of t r avel documen t/................................................

You can find this

O r din a r y p asspor t

D iplom atic p asspor t

in your passport

Supporting documents:

stated under

Se r vice p asspor t

O fficial p asspor t

T ravel document

A uthority

Special passport.

Means of substance

O ther t r avel document (please specify)

C H E C K O R D I N A R Y P ASSP O R T

I nvitation

16. Issued by

13. N umbe r of t r avel

14. D ate of issue

15. V alid until

Means of transport

L IST T H E PL A C E

document

D A Y-M O N T H-Y E A R

(COUNTRY)

T ravel H ealth insurance

Y O U R P ASSP O R T W AS

Y O U R P ASSP O R T IS

W H E R E Y O U R

O ther

P ASSP O R T N U M B E R

P ASSP O R T W AS ISSU E D

ISSU E D

V A L I D U N T I L

T elephone number (s)

17.

-m ail ad d r ess

V isa decision:

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

Refused

B EST C O N T A C T N U M B E R I N C L.

Y O U R C O M P L E T E H O M E A D D R ESS A N D E M A I L A D D R ESS

Refused for SIS non

A R E A C O D E

cancellable.

18. R esidence in a count r y othe r than the count r y of cu r r ent nationality /.....................................

Suspended F ile

N o

Issued

C H E C K

N O

U N L E S S Y O U A R E L I V I N G I N A C O U N T R Y O T H E R T H A N Y O U R H O M E C O U N T R Y

Y es. R esidence pe r m it or eq u ivalen t / ................................ N o

V alid until

T ype of visa:

19. C ur rent occupation

W R I T E ST U D E N T

V alid:

. F or students, n ame and ad d r ess of ed ucation al

20.

establish m en t.

L I S T T H E U .S. S C H O O L Y O U A R E A T T E N D I N G W I T H C O M P L E T E A D D R E SS

from

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

until

21. M ain Purpose(s) of the journey/.........................................................

C H E C K ST U D Y

Number of entries:

F amily reunion/V isiting F amily

Religious

Sports

B usiness

D iplomatic

M ultiplie

M edical treatment

Study

A doption

E mployment

Self employment

O ther (please specify)

(x) In fields from 1 to 3 information must be inserted as it appears on travel documents.

Numero di giorni:

Count O N L Y the number of

days of the program from

Housing C heck In to

Housing C heck O ut.

22. C ity of destination

23. State of fi rst entr y

E V E N I F Y O U A R E

W R I T E I T A L Y, B O L O G N A

W R I T E C I T Y A N D C O U N T R Y W H E R E Y O U R F I RST

A R R I V I N G A F E W D A YS

F L I G H T L A N DS A F T E R D E P A R T I N G T H E U.S.

B E F O R E O R L E A V I N G A

F E W D A YS A F T E R T H E

24. Number of entries requested/ ...............................:

25. Dur ation of the stay. Indicate number

PR O G R A M. For full year

of days (max. 365 days) /

students, count from

O n e / . .. . . .

T w o/ . .. . . .

M ultiple/.............

.......................................................:

Housing C heck In of the

L IST T H E N U M B E R O F D A YS O F T H E T E R M

first term until the last day

C H E C K M U L T IP L E

of F inal E xams of the

26. Schengen visas issued during the past three years / ......................... ........................:

second term.

N o / . . .

L I S T O T H E R V I S A S O B T A I N E D , O T H E R W I S E , C H E C K

N O

Yes. Date(s) of validity / .............. from/....

to /..

27. F inger pr ints ta ken previously for the pur pose of applying for a Schengen visa

T he Schengen area

................................................ .................... . . .............................................:

includes: A ustria,

C H E C K N O U N L E SS T H IS A PP L I E S T O Y O U

Belgium, Denmar k,

N o/...

Y es/.... Date, if known/......................

F inland, F rance,

Must

Germany, G reece,

match

28. Number of no objection document issued for family reunification/accompanying family/employment (only in

Iceland, Italy,

flight

case where required by legislation gover ning the type of being requested)/ ...........................................................

L uxemburg, T he

itinerary

Issued by SU I of /..........................................

D O E S N O T A PP L Y W R I T E N A

Netherlands, Norway,

V alid f rom/.....................

until/....

Portugal, Spain and

29. Intended date of a r r ival in the Schengen a rea

30. Intended date of depar ture from the Schengen area

Sweden.

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

(only for visas valid for stays of between 91-364 days)

DD/MM/YYYY

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

DD/MM/YYYY

A C T U A L D A T E Y O U W I L L A R R I V E

A C T U A L D A T E Y O U W I L L D E PA R T

31. Sur name and first name of the inviting person or employer. If not applicable, in case of visa for A doption,

Religious reasons, M edical reasons, Spor ts, Study, M ission: address of institution in Italy.

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

L IST I NSI T U T I O N I N I T A L Y

B rown in Italy, V ia Belmeloro 7, 40126 Bologna, Italy

Phone: 39-051-2960906

A ddress and e-mail address of inviting person(s) or

T elephone and fax of inviting person(s) or

employer...............................................

employer

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

32. Name and address of inviting company/organisation

T elephone and fax of company/organisation

/.......................................................

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

Sur name and first name, address, telephone, fax and e-mail address of contact person in company/organisation/

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

33. Cost of travelling and living expenses is covered by /.......................................................................:

by the applicant himself/herself/

by sponsor (host, company, organisation),

specify/ ........................................................

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

C H E C K H I MSE L F/ H E RSE L F

Refe r r ed to in field 31 or 32 / .......................

Means of support/..........................................:

othe r (please

C H E C K A L L T H A T APPL Y

specify)/..........................

C ash/ ..............................

T raveller's cheques/................................

C redit ca r d/..................................

Means of support/..............................:

Prepaid accommodation/..........................

Pr epaid tr anspor t/...............................

C ash/....................

O ther (please specify)/...............:..................................

Accommodation provided..................................

A ll expenses covered during the stay/

STATEMENT NOT NECESSARY FOR FOLLOWING

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

VISAS:

Prepaid transport/.....................

Family reunion, Accompanying Family, Employment/Self-

O ther (please specify)/ ..........(..........

employed, Business, Diplomatic, Adoption.

W R I T E N/ A . I F Y O U A R E A N E U C I T I Z E N C O N T A C T T H E O IP

34. Personal data of the family member who is an E U, SE E or C H citizen / .........................................................................

Surname / ................

F irst name(s) / ......................

Date of birth / ....................

Nationality / .......................

Number of travel document or I D card

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

35. Family relationship with an E U, SE E or C H citizen/ ........................................................................:

spouse/................

child/ ........./..

other direct descendant/............

dependent ascendant/.............................

36. Place and date / ................................

37. Signature (for minors, signature of parental

authority/legal guardian)/ .......... (............................................)

W R I T E B OST O N A N D T H E D A T E D D-M M-Y Y Y Y

SI G N Y O U R N A M E I N B L U E I N K

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

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

I am aware that the visa fee is not refunded if the visa is refused.

N/A LEAVE BLANK

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

I am aware of and consent to the collection of the data required by this application form and the ta king of my photograph and , if applicable, the

ta king of fingerprints. I understand these, are mandatory for the examination of the visa application. A ny 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 Italian authorities 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, and stored in the Information System of this Consulate G eneral, and the Ministry of Foreign Affairs. Such data will be accessible to the

competent Italian visa authorities. It will be accessible to the competent Schengen authorities in order to check 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 in the territor y the Member States are fulfilled, of identifying persons who do not or who no longer fulfil these

conditions, of examining an asylum application and of determining responsibility for such examination. Under certain conditions the data will also

be accessible to authorities designated by the Member States and to E uropol for the purpose of the prevention, detection and i nvestigation of

ter rorist offenses and of other serious criminal offenses..

I am aware that I have the right to obtain the data transmitted relating to me recorded in the information systems and to request that data

relating to me which are inaccurate be cor rected and that data relating to me processed unlawfully be deleted. A t 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 cor rected or deleted, including the related remedies according to the national law.

T he national controlling A uthority is the G uarantor of protection of personal data.

I declare that to the best of my knowledge all information supplied by me are complete and correct. 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

Representative country under State legislation (articolo 331 c.p.p.).

T he 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 A rticle 5, paragraph 1 of Regulation (E U) No. 562/2006 (Schengen Borders Code) and of A rticle 4 of D. Lgs. 286/98 and I am

therefore refused entry.

A N N O T A T I O NS (

Office use only)

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