Application Form For Schengen Visa Page 2
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432.
33.
BORDER OF FIRST ENTRY OR TRANSIT
MEANS OF TRANSPORT
ROUTE
HOST’S NAME
*34.
(
company or other) in the Schengen state - If not applicable, name of hotel address in the
Schengen state.
Name:
Telephone:
Full address:
Fax:
e-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
Accommodation
□
Other :Travel and/or health insurance valid until:
SPOUSE’S FAMILY NAME
SPOUSE’S FAMILY NAME AT BIRTH
37.
38.
SPOUSE’S FIRST NAME
SPOUSE’S DATE OF BIRTH
SPOUSE’S PLACE OF BIRTH
39.
40.
41.
42.
CHILDREN (Applications must be submitted separately for each passport)
SURNAME
FIRST NAME
DATE OF BIRTH
PLACE OF BIRTH
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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.
SURNAME
FIRST NAME
DATE OF BIRTH
NATIONALITY
PASSPORT NO.
FAMILY RELATION TO 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.
APPLICANT’S RESIDENCE ADDRESS
45.
46.
TELEPHONE/MOBILE NUMBER
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.
The undersigned declares to be aware of his/her obligation to request a permit of stay (“Permesso di soggiorno”) at the nearest
main Police Office (“QUESTURA”) within 8 (eight) working days from his/her entry into Italy. He/She is also obliged, once the
permit of stay is granted and also for specific categories of Visas valid for Schengen, to obtain a standard insurance policy
covering accidents, medical visits and hospital admission of health problems and pregnancy through a private Insurance Company
or by registering with the National Health Service (“Servizio Sanitario Nazionale”) for him/herself and his/her dependent family
members.
……………………….
47.
Signature
MANAMA,
(date)
48.
(
for minors, signature of both parents/guardian)
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