This document has no legal effect and cannot be basis for a visa application in any accredited Embassy or Consulate
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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.