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Schengen Visa Application Form-Embassy of Italy

Application for Schengen Visa, the harmonised application form provided by the Embassy of Italy.Download

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Application for Schengen Visa	 	
 	
 	
This application form is free	 	
1. Surname (	Family name	) (x) 	 	FOR OFFICIAL USE ONLY	 	
2. Surname at birth (Former family name(s)) (x)	 	Date of application:	 	 Visa application number:	 	  Application lodged at	 	□ Embassy/consulate	 	□ CAC	 	□ Service provider	 	□ Commercial intermediary	 	□ Border	 	 Name	: 	 □ Other	 	 File handled by:	 	   Supporting documents:	 	□ Travel document	 	□ Means of subsistence	 	□ Invitation	 	□ Means of transport	 	□ TMI	 	□ Other:	 	   Visa decision:	 	□ Refused	 	 □ Issued:	 	□ A	 	□ C	 	□ LTV	 	 □ Valid:	 	From	 	Until	 	  Number of entries:	 	□ 1 □ 2 □ Multipl	e 	  Number of days:	 	  	
3. First name(s)	 (Given name(s)	) (x) 	 
4. Date of birth (day	-month	-year)	 	 	5. Place of birth	 	 6. Country of birth	 	 	
7.Current nationality	 	 Nationality at birth, if different:	 	 	8. Sex	 	□ Male □ Female	 	9. Marital status	 	□ Single □ Marr	ied □ Separated □ Divorced □ Widow(er) 	□ Other (please specify)	 	
10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parental authority/legal guardian	 	  11. National identity number, where applicabl	e 	  
12. Type of travel document	 	□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport □ Special passport	 	□ Other travel document (please specify)	 	
13. Number of travel document	 	 	14. Date of issue	 	15.	 Valid until	 	  	
16. Issued b	y 	  	
17.	 Applicant's home address and e	-mail address	 	 	Telephone number(s)	 	
18. Residence in a country other than the country of current nationality	 	□ No	 	□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid until	 	
* 19. Current occupation	 	  * 20. Employer and employer's address and telephone number. For students, name and address of educational establishment.	 	 	
 	
21. Main 	purpose(s)	 of the journey	W 	 □ Tourism…….□ Business…….□ Visiting family or friends ….□ Cultural ……□ Sports 	……..□ Official v	isit	 	□ Medical reasons	 	□ Study	 …..	□ Transit □ Airport transit	 ……	□ Other (please specify)	 	 22. Member State(s) of destination	 	 	23. Member State of first entry	 	 	
24. Number of entries requested	 	□ Single entry….□ Two entries ….□ Multiple 	entries	 	
25. Durati	on of the intended stay or transit	 	 Indicate number of days	 	 	 * The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent asc	endant) while 	exercising their right to free movement. Family mem	bers 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	. 	
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26. Schengen 	visas issued during the past three years	 	□ No	 	□ Yes. Date(s) of validity from …………………. to	 	  	
 	
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	 	……………………………………………….	 	
 	
 	 	29. Intended date of arrival 	in the Schengen area	 	 	30. Intended date of departure from 	the Schengen 	area	 	 	
* 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)	 	    	
 	
Address and e	-mail address of inviting person(s)/hotel(s)/temporary accommodation(s)	 	    *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 travelling and living during the applicant's stay is covered	 	 	
  	
□ by th	e applicant himself/herself	 	  Means of support	 	□ Cash	 	□ Traveller's cheques	 	□ Credit card	 	□ Pre	-paid accommodation	 	□ Pre	-paid transport	 	□ Other (please specify)	 	
□ by a sponsor (host, company, organisation), 	 	please specify	 	…….□ referred to in field 31 or 3	2 	…….□ other 	(please specify)	 	 Means of support	 	□ Cash	 	□ Accommodation provided	 	□ All expenses covered during the stay	 	□ Pre	-paid 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	 	Number of travel document or ID card

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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)	 	    	
 	 	 	
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 m	y first stay and any subsequent 	visits to the territory of Member 	States.	 	
 
INFORMATION ON THE PROCESSING OF PERSONAL DATA	 	The collection of the data required by this application form,  the taking of your	 photograph and, if applicable, the taking of your 	fingerprints, are mandatory for the examination of the visa application; and any personal data concerning you which appear on	 the visa 	application form, as well as your fingerprints and your photograph wil	l be supplied to the relevant authorities of the Member States and 	processed by those authorities, for the purposes of a decision on your visa application.	 	Such data as well as data concerning the decision taken on your 	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 wi	ll be 	accessible to the visa authorities and the authori	ties 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 purposes of verifying whether the conditions for the 	legal entry 	into, stay and residence on t	he territory of the Member States are fulfilled, of identifying persons who do not or who no longer fulfil these 	conditions, of examining an asylum application and of determining responsibility for such examination. Under certain conditio	ns the data 	will b	e also available to designated authorities o	f the Member States (for  Italy	:  the Ministry of Interior and the Police authority) and to 	Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious crimi	nal offences. The 	Ministry of Foreign Affairs and International Cooperation (Piazzale della Farnesina 1, 00135 Roma, 	www.esteri.it	, [email protected]	)  is the 	Ital	ian authority responsible (	controller	) for processing the data.	 	 You have the right to obtain in any of the Member States 	communication	 of the data relating to you recorded in the VIS and of the 	Member State which transmitted the data, and to request that the data relating to you which are inaccurate be corrected, and 	that the data 	relating to you processed unlawfully be deleted.	 For information on the exercise of your right to check your personal data and have them 	corrected or deleted, as well as on legal remedies according to the national law of the State concerned, 	see 	www.esteri.it	 and 	www.vistoperitalia.esteri.it	. 	 Further  information will be provided upon request by  the authority examining your application. The Italian natio	nal supervisory 	competent authority on the protection of personal data is the Italian Authority for Data Protection (Piazza di Montecitorio 1	21, 00186 	Roma, 	www.garanteprivacy.it	; tel.: +3906 696771)	.  	  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	s 	involve my application being rejected or to the annulment of a visa already granted and may  result in prosecution under the 	law	 of the 	Member State that process the application.	 	 I undertake to leave the territory of the Member States before the expiry of the visa, if granted. I am aware that possession	 of a visa is only 	one of the prerequisites for entry into the European territo	ry of the Member States. The mere 	granting of a visa does not entitle me to 	compensation if I fail to fulfil  the conditions of Article 5 , paragraph 1, of the Council Regulation n. 562/2006 (Schengen 	Borders Code) 	and I am thus refused entry. The prerequ	isites for entry will be checked again on entry into the European territory of the Member States.	 	   Place and date	 	 Signature	 	 (for minors, signature of parental authority/legal guardian):
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