This document has no legal effect and cannot be basis for a visa application in any accredited Embassy or Consulate — — PhotoApplication for Schengen VisaThis application form is freeStamp embassy or consulateNo 12225*01 1. Surname(s) (family name(s)) 2. Surname(s) at birth (earlier family name(s)) 3. First name(s) (given names) 4. Date of birth (year-month-day)5. ID-number (optional) 6. Place and country of birth 7. Current nationality/ies8. Original nationality (nationality at birth) 9. SexMale   Female   10. Marital statusSingle   Married   Separated   Divorced   Widow(er)   Other    11. Father's name12. Mother's name 13. Type of passportNational passport   Diplomatic passport   Service passport   Travel document (1951 Convention)   Alien's passport   Seaman's passport   Other travel document (please specify)    14. Number of passport15. Issued by 16. Date of issue17. Valid until 18. If you reside in a country other than your country of origin, have you permission to return to that country?No   Yes (number and validity)    * 19. Current occupation * 20. Employer and employer's address and telephone number. For students, name and address of school. 21. Main destination22. Type of visaAirport transit   Transit   Short stay   Long stay   23. VisaIndividual   Collective    24. Number of entries requestedSingle entry   Two entries   Multiple entries   25. Duration of stay (in days) 26. Other visas (issued during the past years) and their period of validity 27. In the case of transit, have you an entrie permit for the final country of destination?No   Yes , Valid until:                                       Issuing authority:     * 28. Previous stays in this or other Schengen states 29. Purpose of travelTourism   Business   Visit to family or friends   Cultural/sports   Official   Medical reasons   Other (please specify)    * 30. Date of arrival* 31. Date of departure * 32. Border of first entry or transit route33. Means of transport * 34.  Name of host or company in the Schengen states and contact person in host company. If not applicable, give name of hotel or temporary address in the Schengen states. NameTelephone and telefaxFull addressE-mail address * 35. Who is paying for your cost of travelling and for your costs of living during your stay?Myself   Host person/s   Host company    * 36. Means of support during your stay.Cash   Travellers' cheques   Credit cards   Accomodation   Other:   Travel and/or health insurance Valid until     37. Spouse's family name38. Spouse's family name at birth 39. Spouse's first name40. Spouse's date of birth41. Spouse's place of birth 42. Children (Applications must be submitted separately for each passport)NameFirst nameDate of birth123 43. Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens.NameFirst NameDate of birthNationalityNumber of passportFamily realationship of an EU or EEA citizen 44.  I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in the Schengen states and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states. At my express request, the consular authority processing 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 altered or deleted, in particular, should they be inaccurate, in accordance with national law of the state concerned. 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 the annullment of a visa already granted and may also render me liable to prosecution under the law of Schengen state which deals with this application. I undertake to leave the territory of the Schengen states upon 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 Schengen 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 Artice 5.1 of the Schengen Implementing Convention and am thus refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Schengen states. 45. Applicant's home address46. Telephone number 47. Place and date48. Signature (for minors, signature of custodian/guardian) FOR EMBASSY / CONSULATE USE ONLY Date application: File handled by: Supporting documents: Valid passport Financial means Invitation Means of transport Health insurance Other: Visa: Refused Granted Characteristics of Visa: LTV A B C D D+C Number of entries: 1   2   Multiple    Valid from:.................... To:................................ Valid for:....................... * The questions marked with * do not have to be answered by family members of EU or EEA citizens (spouse, child or dependent ascendant). Family members of EU or EAA citizens have to present documents to prove this relationship.