N° 14076*01
Application for Schengen visa
PHOTO
This application form is free
For official use only
1. Surname (Family name) (x)
Date of application :
2. Surname at birth (Former family name(s)) (x)
Visa application number :
3. First name(s) (Given name(s)) (x)
File handled by :
4. Date of birth
5. Place of birth :
7. Current nationality :
(day-month-year)
6. Country of birth :
Nationality at birth, if different: :
Application lodged at :
□ Embassy/consulate
8. Sex
9. Marital Status
□ CAC
□ Service provider
Single
Married
Separated
Divorced
Widow(er)
□ Commercial intermediary
Male
Female
Other (please specify)
□ Border
10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parental
Name :
authority/legal guardian
□ Other
11. National identity number, where applicable :
Supporting documents :
12. Type of travel document
Ordinary passport
Diplomatic passport
Service passport
Official passport
Special passport
□ Travel document
□ Means of subsistence
Other travel document (please specify) :
□ Invitation
13. Travel document number
14. Date of issue
15. Valid until
16. Issued by
□ Means of transport
□ TMI
□ Other:
17. Applicant's home address and e-mail address
Telephone number(s)
Visa decision :
□ Refused
□ Issued :
□ A
18. Residence in a country other than the country of current nationality
□ C
No
Yes : Residence permit or equivalent N°………………….…….……Valid until………………..….
□ LTV
* 19. Current occupation
□ Valid :
From…………………………
* 20. Employer and employer's address and telephone number. For students, name and address of educational
establishment.
Until………………………….
Number of entries :
□ 1 □ 2 □ Multiple
21. Main purpose(s) of the journey :
Number of days : …………….
Tourism
Business
Visiting family or friends
Cultural
Sports
Official visit
Study
Medical reasons
Transit
Airport transit
Other (please specify ) :
22. Member State(s) of destination
23. Member State of first entry
24. Number of entries requested
25. . Duration of the intended stay or transit
Single entry
Two entries
Multiple entries
Indicate number of days :
26. Schengen visas issued during the past three years
No
Yes. Date(s) of validity ………………/…………….., …….…….…/………………, …..………../……………
27. Fingerprints collected previously for the purpose of applying for a Schengen visa
No
Yes. Date, if known : ……………………………………………………………….
28. Entry permit for the final country of destination, where applicable
Issued by……………………………….………, valid from……………………………..until……………………………
filled
* The fields marked with * do not need to be
in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) while exercising their right to free
movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields no 34 and 35.
(x) Fields 1-3 shall be filled in in accordance with the data in the travel document.