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Consulate General of Italy

Photo

Boston

A pplication for National V isa (D)

T his application form is free

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

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

1. Surname (s) (family name(s) ) (x)

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

Y O U R L AST N A M E E X A C T L Y AS I T A PP E A RS O N Y O U R P ASSPO R T

F O R E M B ASSY

2. Surname(s) at birth (former family name(s)) (x)

/C O NSU L A T E USE O N L Y

M A I D E N N A M E I F A PP L I C A B L E O T H E R W ISE L E A V E B L A N K

3. F irst names (given names) (x)

Date of application:

F I RST A N D M I D D L E N A M E E X A C T L Y AS I T A PPE A RS O N Y O U R P ASSP O R T

4. Date of birth (day-month-year)

5. Place of birth/.................

7. C u r r ent nationality

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

C I T Y A N D ST A T E O F

V isa application number :

E X A M PL E : M A R C H 24, 1991

BIR T H

U.S. A N D/ O R O T H E R N A T I O N A L I T Y

SH O U L D APPE A R 24 03 - 1991

Nationality at bi rth, if different:

6. C ount r y of bi r th/........................

A pplication lodged at:

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

C O U N T R Y O F B I R T H

D O N O T

U .S. A N D/ O R O T H E R N A T I O N A L I T Y

E mbassy/Consulate

A B B R E V I A T E

C ity hall C A C

8. Sex

9. M arital status

Service provider

C H E C K A PP R O P R I A T E B O X

Commercial Intermediary

M ale

Single

M a r r ied

O ther

F em ale

Sep a r ated

D ivor ced

W idow/er

Name:

C H E C K A PP R O P R I A T E B O X

O the r (please specify)

10. In the case of minors: Surname, fi rst name, addr ess (if different from applicant ) and nationality of pa rent al authority/

legal gua rdian/......................................... ...............................

F ile handled by:

I F A PPL I C A B L E , C O M P L E T E AS I NST R U C T E D

Name of person who received

11. N ational I dentity number , whe re applicable/......................................................................

L E A V E T H IS B L A N K

file at window:

12. T ype of t r avel documen t/................................................

You can find this

O r din a r y p asspor t

D iplom atic p asspor t

in your passport

Supporting documents:

stated under

Se r vice p asspor t

O fficial p asspor t

T ravel document

A uthority

Special passport.

Means of substance

O ther t r avel document (please specify)

C H E C K O R D I N A R Y P ASSP O R T

I nvitation

16. Issued by

13. N umbe r of t r avel

14. D ate of issue

15. V alid until

Means of transport

L IST T H E PL A C E

document

D A Y-M O N T H-Y E A R

(COUNTRY)

T ravel H ealth insurance

Y O U R P ASSP O R T W AS

Y O U R P ASSP O R T IS

W H E R E Y O U R

O ther

P ASSP O R T N U M B E R

P ASSP O R T W AS ISSU E D

ISSU E D

V A L I D U N T I L

T elephone number (s)

17.

-m ail ad d r ess

V isa decision:

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

Refused

B EST C O N T A C T N U M B E R I N C L.

Y O U R C O M P L E T E H O M E A D D R ESS A N D E M A I L A D D R ESS

Refused for SIS non

A R E A C O D E

cancellable.

18. R esidence in a count r y othe r than the count r y of cu r r ent nationality /.....................................

Suspended F ile

N o

Issued

C H E C K

N O

U N L E S S Y O U A R E L I V I N G I N A C O U N T R Y O T H E R T H A N Y O U R H O M E C O U N T R Y

Y es. R esidence pe r m it or eq u ivalen t / ................................ N o

V alid until

T ype of visa:

19. C ur rent occupation

W R I T E ST U D E N T

V alid:

. F or students, n ame and ad d r ess of ed ucation al

20.

establish m en t.

L I S T T H E U .S. S C H O O L Y O U A R E A T T E N D I N G W I T H C O M P L E T E A D D R E SS

from

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

until

21. M ain Purpose(s) of the journey/.........................................................

C H E C K ST U D Y

Number of entries:

F amily reunion/V isiting F amily

Religious

Sports

B usiness

D iplomatic

M ultiplie

M edical treatment

Study

A doption

E mployment

Self employment

O ther (please specify)

(x) In fields from 1 to 3 information must be inserted as it appears on travel documents.

Numero di giorni:

Application For National Visa (D) Filing Sample - Consulate General Of Italy, Boston, Massachusetts, Usa

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