1.Surname(s) (family name(s))
2.Surname(s) at birth (earlier family name(s))
  
3.First names
4.Date of birth (year/month/day)
5.ID-number (optional)
6.Place and country of birth
7. Current nationality/ies
8.Original nationality (nationality at birth)
9.Sex
Male

Female
11.Father’s name
10.Marital status :
Single
Married
  
Divorced
Widow(er)
  
Separated
Other
12.Mother’s name
13.Type of passport:
National passport
Diplomatic passport
Service passport
Alien’s passport
Seaman’s passport
 
Travel document (1951 Convention)
Other travel document (please specify):
14.Number of passport
15.Issued by
16.Date of issue
17.Valid until
18.If you reside in a country other than your country of origin, have you permission to return to that country?
No
Yes
 
Number
 
Validity
*19.Current occupation
* 20.Employer and employer’s address and telephone number. For students, name and address of school.
21.Main destination
22.Type of Visa :
Airport transit
Transit
Short stay
Long stay
23.Visa :
Individual
Collective
24.Number of entries requested
Single entry
Two entries
Multiple entries
25.Duration of stay
Visa is requested for:
days
26.Other visas (issued during the past three years) and their period of validity
27.In the case of transit, have you an entry permit for the final country of destination?
No
Yes , valid until:
Issuing authority:
* 28.Previous stays in this or other Schengen states
* The questions marked with * do not have to be answered by family members of EU or EEA citizens (spouse, child or dependent ascendant). Family members of EU or EEA citizens have to present documents to prove this relationship.
29.Purpose of travel
Tourism
Visit to Family or Friends
Cultural/Sports
Official
Medical reasons
 
Business
Other (please specify):
*30.Date of arrival
*31.Date of departure
* 32.Border of first entry or transit route
*33.Means of transport
* 34.Name of host or company in the Schengen states and contact person in host company. If not applicable, give name of hotel or temporary address in the Schengen states
Name
Telephone and telefax
Full address
E-mail address
* 35.Who is paying for your cost of travelling and for your costs of living during your stay?
Myself
Host person/s
Host company. (State who and how and present corresponding documentation
* 36.Means of support during your stay
Cash
Accommodation
Travellers' cheques
Other
Credit cards
Travel and/or health insurance. Valid until:
37.Spouse’s family name
38. Spouse’s family name at birth
39. Spouse’s first name
40. Spouse’s date of birth
41. Spouse’s place of birth
42.Children (Applications must be submitted separately for each passport)
First Name(s)
Date of birth
1
2
3
43.Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens.
Name
First Name
Date of Birth
Nationality
Number of passport
Family relationship :
of an EU or EEA citizen
44. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in the Scheng en states and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states. At my express r equest, the consular authority processing 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 altered or deleted, in particular, should they be inaccurate, in accordance with the national law of the state concerned. I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will lead to my application being rejected or to the annulment of a visa alread y granted and may also render me liable to prosecution under the law of the Schengen state which deals with the application. I undertake to leave the territory of the Schengen states upon the expiry of the visa, if granted. I have been informed that posses sion of a visa is only one of the prerequisites for entry into the European territory of the Schengen 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 provi sions of Article 5.1 of the Schengen Implementing Convention and am thus refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Schengen states.
45.Applicant’s home address
46.Telephone number
47.Place and date