PHOTO
Application for Schengen Visa
This application form is free
1. Surname (Family name) (x)
FOR OFFICIAL USE ONLY
2. Surname at birth (Former family name(s)) (x) Date of application:
3. First name(s) (Given name(s)) (x)
Visa application number:
4. Date of birth (day -month -year)
5. Place of birth
6. Country of birth
7. Current nationality
Nationality at birth, if different:
Application lodged at □ Embassy/consulate □ CAC □ Service provider □ Commercial intermediary □ Border
Name:
□ Other
8. Sex
□ Male □ Female
9. Marital status
□ Single □ Married □ Separated □ Divorced
□ Widow(er) □ Other (please specify)
10. In the case of minors: Surname, first name, address (if different from applicant’s) and nationality of parental
authority/legal guardian
File handled by:
11. National identity number, where applicable Supporting documents: □ Travel document □ Means of subsistence □ Invitation □ Means of transport □ TMI □ Other:
Visa decision: □ Refused □ Issued : □ A □ C □ LTV
□ Valid:
12. Type of travel document
□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport □ Special pa ssport
□ Other travel document (please specify)
13. Number of travel document
14. Date of issue
15. Valid until
16. Issued by
17. Applicant’s home address and e -mail address
Telephone number(s)
18. Residence in a country other than the cou ntry of current nationality
□ No □ Yes □ Residence permit or equivalent ……………………..…………………………..
No. ……………….………………… Valid until….………………………….
From …………………………….
Until …………………………….
Number of entries:
□ 1 □ 2 □ Multiple
* 19. Current occupation
* 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) Number of days:
22. Member State(s) of destination
23. Member State of first entry
24. Number of entries requested
□ Single entry □ Two entri es □ Multiple entries
25. Duration of the intended stay or transit
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 ascen dant) 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 fie lds No 34 and
35.
(x) Fields 1 -3 shall be filled in in accordance with the data in the travel document.
26. Schengen visas issued d uring the past three years
□ No
□ Yes □ Date(s) of validity from …………………………….. to …………………..………………….…..
27. Fingerprints co llected 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
accommodation(s)
Telephone and telefax
* 32. Name and address of inviting company/organisatio n
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
Means of support
□ Cash
□ Traveller’s cheques
□ Credit card
□ Prepaid accommodation
□ Prepaid transport
□ Other (please specify)
.……………………… □ by a sponsor (host, company, organisation), please sp ecify
□ referred to in field 31 or 32 ……………………………………
□ other (please specify) ………………………………….………
Means of support
□ Cash
□ Accommodation provided
□ All expenses covered during the stay
□ Prepaid transport
□ 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)
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 territ ory 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 conc erning 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 tak en on my application or a decision whether to annul, revoke or extend a visa issued will be
entered into, and stored in the Visa Information System (VIS) (1) 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 re sidence 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 asyl um 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 serio us criminal offences. The
authority of the Member State respon sible for processing the data: Ministry of Foreign Affairs, Loretánské náměstí 5, CZ -118 00 Praha 1; Directorate
of Alien Police, Olšanská 2, P.O. BOX 78, CZ -130 51 Praha 3 and Ministry of the Interior, Nad Štolou 3, CZ -170 34 Praha 7.
I am aware that I ha ve the right to obtain in any of the Member States notification of the data relating to me recorded in the VIS and of the Mem ber
State which transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data rel ating 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 th e 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 person al data: Office for
Personal Data Protection, Pplk. Sochora 727/27, CZ -170 00 Praha 7.
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 rend er 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 m e does not mean
that I will be entitled to compensation if I fail to comply with the relevant provisions of Article 5(1) of Regula tion (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.