Sample Application For Schengen Visa (Page 2 of 2) in pdf

28. Entry permit for the final country of destination, where applicable

For official use only

Issued by ….……………………….…….. ...Valid from ……………….……Until…….…………………….

29. Intended date of arrival in the Schengen Area

30. Intended date of departure from the Schengen Area

21-06-2013

30-06-2013

* 31. Surname and first name of the inviting person(s) in the Member State(s). If not applicable, name of hotel(s) or

temporary accommodation(s) in the Member State(s)

SEE ATTACHED BOOKINGS FOR FULL HOTEL DETAILS

Address and e-mail address of inviting person(s)/hotel(s)

Telephone and telefax

temporary accommodation(s)

SEE ATTACHED BOOKINGS FOR FULL HOTEL DETAILS

* 32. Name and address of inviting company / organisation

Telephone and telefax of company / organisation

Surname, first name, address, telephone, telefax and e-mail address of contact person in company / organisation

* 33. Cost of traveling and living during the applicant’s stay is covered

by the applicant himself/herself

by the sponsor (host, company, organisation), please specify

.....................................

referred to in field 31 or 32

Means of support

................................................

other (please specify)

Cash

Means of support

Traveler’s cheques

Cash

Credit card

Accommodation provided

Prepaid accommodation

All expenses covered during the stay

Prepaid transport

Other (please specify)

34. Personal data of the family member who is an EU, EEA or CH citizen

Surname

First name(s)

Date of birth

Nationality

Number of travel document or ID card

35. Family relationship with an EU, EEA, or CH citizen

spouse

child ………………………………..……

grandchild

dependent ascendant

36. Place and date

37. Signature (for minors, signature of parental authority/legal guardian)

LONDON 15-05-2013

(YOUR SIGNATURE!)

I am aware that the visa fee is not refunded if the visa is refused.

Applicable in case a multiple-entry visa is applied for (cf. field No 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 State.

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

purpose 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: Ministry of Foreign Affairs, Piazzale della

Farnesina n.1, 00194 Roma

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 the 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 national law of the State concerned. The national supervisory authority of the Member State

(Garante per la protezione dei dati personali, Piazza Montecitorio n. 121, 00187 Roma) 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 statement 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 State 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 European territory of the Member States.

LONDON

Place and date

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

(YOUR SIGNATURE!)

15-05-2013

(

) In so far the VIS is operational.