Fillable Application For Schengen Visa (Page 3 of 3) in pdf

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 territory of Member

States.

INFORMATION ON THE PROCESSING OF PERSONAL DATA

The collection of the data required by this application form, the taking of your photograph and, if applicable, the taking of your

fingerprints, are mandatory for the examination of the visa application; and any personal data concerning you which appear on the visa

application form, as well as your fingerprints and your photograph will be supplied to the relevant authorities of the Member States and

processed by those authorities, for the purposes of a decision on your visa application.

Such data as well as data concerning the decision taken on your 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) 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 (for Italy: the Ministry of Interior and the Police authority) and to

Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious criminal offences. The

Ministry of Foreign Affairs and International Cooperation (Piazzale della Farnesina 1, 00135 Roma, , dgit6@esteri.it) is the

Italian authority responsible (controller) for processing the data.

You have the right to obtain in any of the Member States communication of the data relating to you recorded in the VIS and of the

Member State which transmitted the data, and to request that the data relating to you which are inaccurate be corrected, and that the data

relating to you processed unlawfully be deleted. For information on the exercise of your right to check your personal data and have them

corrected or deleted, as well as on legal remedies according to the national law of the State concerned, see and

Further information will be provided upon request by the authority examining your application. The Italian national supervisory

competent authority on the protection of personal data is the Italian Authority for Data Protection (Piazza di Montecitorio 121, 00186

Roma, tel.: +3906 696771).

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

involve my application being rejected or to the annulment of a visa already granted and may result in prosecution under the law of the

Member State that process the application.

I undertake to leave the territory of the Member States before the expiry of the visa, if granted. I am aware that possession of a visa is only

one of the prerequisites for entry into the European territory of the Member States. The mere granting of a visa does not entitle me to

compensation if I fail to fulfil the conditions of Article 5 , paragraph 1, of the Council Regulation n. 562/2006 (Schengen Borders Code)

and I am thus 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):

Application For Schengen Visa Page 3