Application For Schengen Visa - Consolato Generale D'Italia, Ho Chi Minh City, Vietnam Page 4
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435. Family relationship with an EU, EEA or citizen
child …………………………………….
spouse
grandchild
dependent ascendant
36. Place of birth
37. Signature (for minors, signature of parental authority/
legal guardian)
I am aware that the visa free is not refunded if the visa refused.
Application 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 subsequent visits to the territory of Member
State.
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 person data concerning
me which appear on 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 taken on my application or a decision whether to annul revoke or extend a visa issued
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will be entered into, and store 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 purposes of verifying whether the conditions for the legal
entry into, stay and residence on the territory of the Member States are fulfilled 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 serious criminal offences. The authority of the Member States responsible for processing
the data is: Garante per la Protezione dei Dati Personali , Piazza Montecitorio n.121, Roma , Italia.
I am aware that I have the right to obtain in any of the Member States notification of the data relating to me recorded in the VIS and of
the Member State which transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data
relating to me processed unlawfully be deleted. At any 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 the
related remedies according to the national law of the State concerned. The national supervisory authority of that Member States [contact
details] will hear claims concerning the protection of personal data.
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 visa already granted. I have been informed that possession 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
visa 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 me does not mean that I will be entitled to compensation if I hail to comply with the relevant provisions of Article 5(1) of Regulation
(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):
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(
) In so far as the VIS is operational.
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