"Schengen Visa Application Form - Embassy of Italy"

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Download "Schengen Visa Application Form - Embassy of Italy"

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Embassy of Italy
Harmonised application form
PHOTO
Application for Schengen Visa
This application form is free
1. Surname (Family name) (x)
F
OR 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)
Application lodged at
□ Embassy/consulate
□ CAC
□ Service provider
4. Date of birth (day-month-year)
5. Place of birth
7.Current nationality
□ Commercial
intermediary
6. Country of birth
Nationality at birth, if different:
□ Border
8. Sex
9. Marital status
Name:
□ Male □ Female
□ Single □ Married □ Separated □ Divorced □ Widow(er)
□ Other (please specify)
□ Other
10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parental
File handled by:
authority/legal guardian
Supporting documents:
□ Travel document
11. National identity number, where applicable
□ Means of subsistence
□ Invitation
□ Means of transport
□ TMI
12. Type of travel document
□ Other:
□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport □ Special passport
□ Other travel document (please specify)
13. Number of travel document
14. Date of issue
15. Valid until
16. Issued by
Visa decision:
□ Refused
□ Issued:
17. Applicant's home address and e-mail address
Telephone number(s)
□ A
□ C
□ LTV
18. Residence in a country other than the country of current nationality
□ Valid:
□ No
From
□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid until
Until
* 19. Current occupation
Number of entries:
□ 1 □ 2 □ Multiple
Number of days:
1
Embassy of Italy
Harmonised application form
PHOTO
Application for Schengen Visa
This application form is free
1. Surname (Family name) (x)
F
OR 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)
Application lodged at
□ Embassy/consulate
□ CAC
□ Service provider
4. Date of birth (day-month-year)
5. Place of birth
7.Current nationality
□ Commercial
intermediary
6. Country of birth
Nationality at birth, if different:
□ Border
8. Sex
9. Marital status
Name:
□ Male □ Female
□ Single □ Married □ Separated □ Divorced □ Widow(er)
□ Other (please specify)
□ Other
10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parental
File handled by:
authority/legal guardian
Supporting documents:
□ Travel document
11. National identity number, where applicable
□ Means of subsistence
□ Invitation
□ Means of transport
□ TMI
12. Type of travel document
□ Other:
□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport □ Special passport
□ Other travel document (please specify)
13. Number of travel document
14. Date of issue
15. Valid until
16. Issued by
Visa decision:
□ Refused
□ Issued:
17. Applicant's home address and e-mail address
Telephone number(s)
□ A
□ C
□ LTV
18. Residence in a country other than the country of current nationality
□ Valid:
□ No
From
□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid until
Until
* 19. Current occupation
Number of entries:
□ 1 □ 2 □ Multiple
Number of days:
1
* 20. Employer and employer's address and telephone number. For students, name and address of educational
establishment.
21. Main purpose(s) of the journey:
□ Tourism…….□ Business…….□ Visiting family or friends ….□ Cultural ……□ Sports ……..□ Official visit
□ Medical reasons
□ Study …..□ Transit □ Airport transit ……□ Other (please specify)
22. Member State(s) of destination
23. Member State of first entry
24. Number of entries requested
25. Duration of the intended stay or transit
□ Single entry….□ Two entries ….□ Multiple entries
Indicate number of days
* 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.
(x) Fields 1-3 shall be filled in accordance with the data in the travel document.
26. Schengen 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 known
28. Entry permit for the final country of destination, where applicable
Issued by ………………………………..Valid from …………………………until
……………………………………………….
29. Intended date of arrival in the Schengen area
30. Intended date of departure from the Schengen
area
* 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)
Address and e-mail address of inviting person(s)/hotel(s)/temporary
Telephone and telefax
accommodation(s)
2
*32. Name and address of inviting company/organisation
Telephone and telefax of
company/organisation
Surname, first name, address, telephone, telefax, and e-mail address of contact person in company/organisation
*33. Cost of travelling and living during the applicant's stay is covered
□ by the applicant himself/herself
□ by a sponsor (host, company, organisation),
please specify
…….□ referred to in field 31 or 32
…….□ other (please specify)
Means of support
□ Cash
Means of support
□ Traveller's cheques
□ Cash
□ Credit card
□ Accommodation provided
□ Pre-paid accommodation
□ All expenses covered during the stay
□ Pre-paid transport
□ Pre-paid transport
□ Other (please specify)
□ Other (please specify)
34. Personal data of the family member who is an EU, EEA or CH citizen
Surname
First name(s)
Date of birth
Nationality
Number of travel document or
ID card
35. Family relationship with an EU, EEA or CH citizen
□ spouse ……………..□ child ……□ grandchild ………………□ dependent ascendant
36. Place and date
37. Signature (for minors, signature of parental
authority/legal guardian)
3
I am aware that the visa fee is not refunded if the visa is refused.
Applicable in case a multiple-entry visa is applied for (cf. field no 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.
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
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will be entered into, and stored in 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 fulfil 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 the Member State responsible for processing the
data is the Authority for Data Protection.
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 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.
Place and date
Signature
(for minors, signature of parental authority/legal guardian):
1
In so far as the VIS is operational.
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