National (D) Visa Application Form - Consulate General Of Italy, Los Angeles, California, Usa
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4Consulate General of Italy - Los Angeles
PHOTOGRAPH
National (D) visa application form
This form is free of charge
.................................................
1. Surname (Family name)/ (x)
...........................................
For official use only
2. Surname at birth (Former family name(s)) / (x)
Data della domanda:
3. First name(s) / (x)
4. Date of birth (day-month-year)
5. Place of birth
7. Current nationality
Numero della domanda di
visto:
6. Country of birth
Nationality at birth, if different
Domanda presentata presso:
Ambasciata/Consolato
Centro comune
8. Sex:
9. Marital status:
Fornitore di servizi
Intermediario commerciale
Male
Single
Married
Altro
Female.
Separated
Divorced
Widow(er)
Nome:
Other (please specify)
10. For minors: surname, first name, address (if different from the applicant’s) and nationality of parental authority/legal
guardian:
Responsabile della pratica:
Nome di chi ha ricevuto la
11. National identity number, where applicable:
pratica allo sportello:
12. Type of travel document:
Ordinary passport
Diplomatic passport
Documenti giustificativi:
Service passport.
Official passport
Documento di viaggio
Special passport
Mezzi di sussistenza
Other travel document (please specify):
Invito
15. Valid until (day-month-yr) 16. Issued by
13. Numer of travel
14. Date of issue.(day-month-
Mezzi di trasporto
document
yr)
Assicurazione sanitaria di
viaggio
Altro
17. Appplicant’s home address and e-mail address
Telephone number(s)
......................................
Decisione relativa al visto:
Rifiutato
Rifiutato per segnalazione
18. Are you residing in a country other than the country of your current nationality:
SIS non cancellabile.
N o
Pratica Sospesa
Yes. Residence permit or equivalent:.....................: ………………N.………………………. Valid until …………………..
Rilasciato
Tipo di visto:
19. Current occupation
D
20. Employer, employer’s address and telephone number. For students, name and address of educational institution.
Valido:
dal …………………………..
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