National Visa (D)application Form - Italian Embassy, Manila, Philippines (Page 4 of 4) in pdf

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 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 the

Member State responsible for processing the data is:

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 processing 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 [contact detail] will hear claims concerning the protection of personal data.

I declare that to the best of my knowledge all particulars supplied by me are corrected and completed. 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.

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Luogo e data / Place and date

Firma (per i minori, firma del titolare della potestà genitoriale/

tutore legale) / Signature (for minors, signature of parental authority/legal

guardian)