Application for Schengen Visa icon

Application for Schengen Visa



НазваниеApplication for Schengen Visa
Дата конвертации26.09.2012
Размер79.84 Kb.
ТипДокументы

Application for Schengen Visa




T


Photo

his application form is free







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


For embassy / consulate use only


^ 2. Surname(s) at birth (earlier family name(s)) девичья или другая, если менялась



Date application :

3. First names имя, отчество





^ 4. Date of birth (year-month-day) дата рождения


5. ID-number (optional)


File handled by :

6. Place and country of birth место рождения



Supporting documents:

^ 7. Current nationality/ies

гражданство

8. Original nationality (nationality at birth)

гражданство при рождении

 Valid passport

 Financial means

9. Sex пол

Male Female

10.
Marital status :
семейное положение

 Single  Married  Separated Divorced Widow(er) Other

: Invitation

 Means of transport

^ 11. Father’s name

имя, фамилия отца

12. Mother’s name

имя, фамилия матери

 Health insurance








^ 13. Type of passport: тип паспорта

 National passport  Diplomatic passport  Service passport

 Travel document (1951 Convention)  Alien’s passport  Seaman’s passport

 Other travel document (please specify):

 Other



^ 14. Number of passport

номер паспорта

15. Issued by

орган, выдавший паспорт




^ 16. Date of issue

дата выдачи

17. Valid until

срок действия




18. If you reside in a country other than your country of origin, have you permission to return to that country? номер и срок действия документа, позволяющего вернуться в РФ

 No  Yes, (number and validity) (для иностранных граждан)




* 19. Current occupation занимаемая должность




Visa :

* 20. Employer and employer’s address and telephone number. For students, name and address of school.

место работы: название организации, адрес и телефон.

для студентов и школьников: название и адрес учебного заведения

 Refused

 Granted




Characteristics of Visa :

^ 21. Main destination

страна основного назначения



22. Type of Visa : тип визы

 Airport transit  Transit


 Short stay  Long stay

23. Visa :

 Individual


 Collective

 LTV

 A

 B

 C

 D

 D + C

^ 24. Number of entries requested кол-во въездов

 Single entry  Two entries  Multiple entries

25. Duration of stay срок действия визы

Visa is requested for: days


Number of entries :

^ 26. Other visas (issued during the past three years) and their period of validity

предыдущие шенгенские визы (за последние 3 года)


 1  2  Multiple

^ 27. In the case of transit, have you an entry permit for the final country of destination? наличие визы

 No  Yes , valid until: в случае транзита Issuing authority: в страну основного назначения

Valid from

To

* ^ 28. Previous stays in this or other Schengen states

даты предыдущих въездов в страны шенгенского соглашения


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 EEA citizens have to present documents to prove this relationship.


^ 29. Purpose of travel цель визита

 Tourism  Business  Visit to Family or Friends  Cultural/Sports  Official

 Medical reasons  Other (please specify):


For embassy / consulate use only







* 30. Date of arrival дата въезда

* 31. Date of departure дата выезда







* 32. Border of first entry or transit route страна, через которую вы въезжаете в Шенген

^ 33. Means of transport вид транспорта










* 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 приглашающая сторона




Name

название организации и имя контактного лица в Бельгии

Telephone and telefax

телефон и факс




^ Full address

точный адрес в Бельгии

e-mail address

адрес эл. почты










* ^ 35. Who is paying for your cost of travelling and for your costs of living during your stay?

 Myself  Host person/s  Host company. (State who and how and present corresponding documentation

за чей счет финансируется поездка




* ^ 36. Means of support during your stay финансовые средства на период пребывания

 Cash  Travellers' cheques  Credit cards  Accommodation Other:

Travel and/or health insurance. Valid until:










^ 37. Spouse’s family name

фамилия мужа (жены)

38. Spouse’s family name at birth

девичья фамилия жены




^ 39. Spouse’s first name

имя мужа (жены)


40. Spouse’s date of birth

дата рождения мужа (жены)

41. Spouse’s place of birth

место рождения мужа (жены)




42. Children (Applications must be submitted separately for each passport)

Name First name Date of birth

1дети (если вписаны в паспорт и сопровождают): фамилия, имя, дата рождения, гражданство

2

3










^ 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. заполняется только членами семьи граждан ЕС




Name


First Name




^ Date of Birth

Nationality

Number of passport





Family relationship :

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 the 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 to the annulment of a visa already granted and may also render me liable to prosecution under the law of the Schengen state which deals with the application.

I undertake to leave the territory of the Schengen states upon 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 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 Article 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 address

домашний адрес лица, запрашивающего визу

46. Telephone number

номер телефона




47. Place and date

место и дата заполнения анкеты

48. Signature (for minors, signature of custodian/guardian) личная подпись







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