Application Form For Schengen Visa (English/esperanto) Page 4
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437. Signature (for minors, signature of parental
36. Place and date / Sevsebis adgili
da TariRi
authority/legal guardian)
xelmowera (mcirewlovanis SemTxvevaSi
mSoblis/meurvis xelmowera)
I am aware that the visa fee is not refunded if the visa is refused
vici, rom vizaze uaris miRebis SemTxvevaSi savizo mosakrebelis dabruneba ar xdeba
Applicable in case a multiple-entry visa is applied for (cf. field No 24):
mravaljerad vizaze ganacxadis SemTxvevaSi (ix. grafa 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.
me vici, rom evrokavSiris qveynebSi pirveli da yoveli momdevno yofnisas unda mqondes
saTanado samedicino dazRveva.
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 concerning 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 taken on my application or a decision whether to annul, revoke or extend a visa issued will be entered into, and stored in
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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 fulfill 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 and to Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious criminal offences.
The authority of Greece responsible for processing the data is: Ministry of Citizen Protection, Greek Police, International Police Cooperation Division, 3rd Division
SIRENE, Kanellopoulou 4, GR– 101 77 Athens, Tel.:+30.210.6977000, Fax:+30.210.6929764, Email:
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 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 the related remedies according to the national law of the State concerned. The national supervisory authority of that Member State The national supervisory authority
of that Member State {Hellenic Data Protection Authority, Kifisias str 1-3, 1st floor, GR – 115 23 Athens, Tel.: +30.210.6475600, Fax:+30.210.6475628, E-mail:
contact@dpa.gr} 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 a visa already granted and may also render 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 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 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.
gavecani da veTanxmebi, rom am anketaSi miTiTebuli Cemi piradi monacemebis Segroveba da Cemi fotosuraTis gadaReba da, saWiroebis
SemTxvevaSi, TiTis anabeWdebis aReba, aris savaldebulo savizo ganacxadis Sesafaseblad; da rom savizo ganacxadSi mocemuli
CemTan dakavSirebuli nebismieri informacia, aseve Cemi foto da TiTis anabeWdebi gadaecema “Sengenis” qveynebis Sesabamis
kompetentur uwyebebs da Seswavlil iqneba maT mier Cemi vizis moTxovnis ganxilvis mizniT.
es monacemebi, aseve monacemebi Cem gancxadebasTan dakavSirebuli gadawyvetilebis an vizis gauqmebis, gawvevis an gagrZelebis
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Taobaze aRiricxeba da Seinaxeba savizo sainformacio sistemaSi (VIS) (
) maqsimum xuTi wliT, da am drois ganmavlobaSi es
informacia xelmisawvdomi iqneba vizebze pasuxismgebeli uwyebebisaTvis, agreTve uwyebebisaTvis romlebic uflebamosilni arian
Caataron
vizebis Semowmeba evrokavSiris sagareo sazRvrebze da mis wevr saxelmwifoebSi, evrokavSiris wevri saxelmwifoebis
saimigracio da TavSesafris miniWebaze pasuxismgebeli uwyebebisaTvis, raTa ganisazRvros, dakmayofilda Tu ara evrokavSiris wevri
saxelmwifos teritoriaze Sesvlis, gaCerebisa da cxovrebis pirobebi, gamovlindnen pirebi romlebic ar an aRar akmayofileben am
pirobebs, ganxilul iyos ganacxadi TavSesafris miRebis Taobaze da ganisazRvros am ganxilvaze pasuxismgebeli mxare. garkveul
SemTxvevebSi es monacemebi aseve
xelmisawvdomi iqneba evrokavSiris wevri saxelmwifoebisa da evropolis saTanado uwyebebisaTvis
teroristuli danaSaulisa da sxva seriozuli kriminaluri danaSaulis prevenciis, gamovlenisa da gamoZiebis mizniT. evrokavSiris
wevr saxelmwifoSi am monacemebis damuSavebaze pasuxismgebeli uwyeba aris saberZneTis adamianis uflebaTa dacvis saministro,
saberZneTis policiis xelmZRvaneli uwyeba, saerTaSoriso sapolicio TanamSromlobis ganyofileba, sirenes 3-e qveganyofileba,
kanelopulu 4, 101 77, aTeni. tel: +30.210.6977000 faqsi: +30.210.6929764. eleqtronuli misamarTi :
vici, rom maqvs ufleba evrokavSiris wevr nebismier saxelmwifoSi miviRo Setyobineba CemTan dakavSirebuli monacemebis VIS
monacemTa bazaSi da Tu evrokavSiris wevri romeli saxelmwifos mier moxvda am monacemebis gadagzavna, da moviTxovo CemTan
dakavSirebul monacemebSi arsebuli uzustobebis Sesworeba da CemTan dakavSirebuli ukanonod damuSavebuli informaciis waSla.
Cemi moTxovnis safuZvelze, uwyeba romelic ganixilavs Cem ganacxads ganmimartavs Tu rogor visargeblo uflebiT, Sevamowmo
Sevacvlevino
an
wavaSlevino
CemTan
dakavSirebuli
piradi
informacia,
agreTve
Sesabamis
saxelmwifos
kanonmdeblobiT
gaTvaliswinebuli dacvis saSualebebis Sesaxeb. erovnuli sazedamxedvelo organo (uwyeba, romelic icavs adamianis piradul
monacemebs ,l. kifisias 1-3, 115 23, aTeni tel: + 30 210. 6475600, faqsi: + 30.210.645628, el. misamarTi contact@dpa.gr) ganixilavs saCivrebs
piradi monacemebis dacvasTan dakavSirebiT.
vacxadeb, rom ramdenadac CemTvis cnobilia Cems mier warmodgenili monacemebi sruli da sworia. vici, rom yalbi informaciis
warmodgenam SeiZleba gamoiwvios vizis moTxovnis uaryofa, an ukve gacemuli vizis gauqmeba, aseve Cems winaaRmdeg SesaZlebeli
samarTlebrivi proceduris aRZvra Cemi ganacxadis ganxilviT dakavebuli evrokavSiris wevri qveynis kanonmdeblobis Tanaxmad.
viReb valdebulebas davtovo Sengenis qveynebis teritoria aRniSnuli vizis moqmedebis gasvlisTanave. vici, rom vizis qona Sengenis
qveynebis teritoriaze Sesvlis aucilebel pirobaTagan mxolod erTia. mxolod vizis qona ar maZlevs uflebas moviTxovo raime
saxis kompensacia Tu ver davakmayofileb evrokavSiris wesdeba 562/2006-is (Sengenis sasazRvro kodeqsi) muxli 5(1)-is moTxovnebs da
Sesabamisad qveyanaSi Sesvlisas sazRvarze miRebuli uaris SemTxvevaSi. QSengenis qveynebis evropul teritoriaze Sesvlisas kidev
erTxel iqneba Semowmebuli Tu ramdenadaa daculi qveyanaSi Sesvlis pirobebi.
Place and date /
Signature (for minors, signature of parental authority/legal guardian)
Sevsebis adgili da TariRi
xelmowera (mcirewlovanis SemTxvevaSi mSoblis/meurvis
xelmowera)
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(
) In so far as the VIS is operational im SemTxvevaSi Tu VIS sistema moqmedebs
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