Harmonised application form

APPLICATION FOR SCHENGEN VISA

This application form is free

(1)

Family members of EU, EEA, CH citizens or of UK nationals who are Withdrawal Agreement beneficiaries shall not fill in fields no. 21, 22, 30, 31 and 32 (marked with *). Fields 1-3 shall be filled in in accordance with the data in the travel document. 1. Surname (Family name):

FOR OFFICIAL USE

ONLY

Date of application:

Application

number:

2. Surname at birth (Former family name(s)):

3. First name(s) (Given name(s)):

4. Date of birth (day-

month-year):

5. Place of birth:

6. Country of birth:

7. Current nationality:

Nationality at birth, if

different:

Other nationalities:

Application lodged

at:

Embassy/consul

ate

Service provider

Commercial

intermediary

8. Sex:

Male

Female

9. Civil status:

Single Married Registered Partnership

Separated Divorced Widow(er) Other (please specify):

Border (Name):

…

…

Other:

10. Parental authority (in case of minors) /legal guardian (surname, first name, address, if different from applicant's, telephone no., e-mail address, and nationality):

File handled by:

11. National identity number, where applicable:

Supporting

documents:

12. Type of travel document: Travel document

Ordinary passport Diplomatic passport Service passport Official passport Special passport

Other travel document (please specify):

Means of

subsistence

Invitation

13. Number of travel

document:

14. Date of issue:

15. Valid

until:

16. Issued by (country): TMI

Means of

transport

Other:

Visa decision:

Refused

Issued:

A

C

LTV

Valid:

From:

Until:

17. Personal data of the family member who is an EU, EEA, CH citizen or an UK national who is a Withdrawal Agreement beneficiary, if applicable Surname (Family name): First name(s) (Given name(s)): Date of birth (day-

month-year):

Nationality: Number of travel

document or ID card:

18. Family relationship with an EU, EEA, CH citizen or an UK national who is a Withdrawal Agreement beneficiary, if applicable:

spouse child grandchild dependent ascendant

Registered Partnership other:

19. Applicant's home address and e-mail address:

Telephone no.:

20. Residence in a country other than the country of current nationality:

No

Yes. Residence permit or equivalent …No … Valid until …

*21. Current occupation:

Number of entries:

1 2 Multiple

*22. Employer and employer's address and telephone number. For students, name Number of days: and address of educational establishment:

23. Purpose(s) of the journey:

Tourism Business Visiting family or friends Cultural Sports Official visit Medical reasons Study Airport transit Other (please specify):

24. Additional information on purpose of stay:

25. Member State of main destination (and

other Member States of destination, if

applicable):

26. Member State of first entry:

27. Number of entries requested:

Single entry Two entries Multiple entries

Intended date of arrival of the first intended stay in the Schengen area: Intended date of departure from the Schengen area after the first intended stay: 28. Fingerprints collected previously for the purpose of applying for a Schengen visa: No Yes.

Date, if known … Visa sticker number, if known …

29. Entry permit for the final country of destination, where applicable: Issued by … Valid from … until …

*30. 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):

Telephone no.:

*31. Name and address of inviting company/organisation: Surname, first name, address, telephone

no., and e-mail address of contact person

in company/organisation:

Telephone no. of

company/organisation:

*32. Cost of travelling and living during the applicant's stay is covered:

by the applicant himself/herself

Means of support:

Cash

Traveller's cheques

Credit card

Pre-paid accommodation

by a sponsor (host, company,

organisation), please specify:

… referred to in field 30 or 31

… other (please specify):

Means of support:

Cash

Accommodation provided

Pre-paid transport

Other (please specify):

All expenses covered during the

stay

Pre-paid transport

Other (please specify):

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: 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 States

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 application; and any personal data concerning me which appear on the 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 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 purposes 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 fulfil 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 the Directorate General for Consular Affairs and the Portuguese Communities (DGACCP).

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 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 the national law of the Member State concerned. The national supervisory authority of that Member State [Portuguese Data Protection Commission (CNPD) – Rua de São Bento nº 148 – 3º, 1200 – 821 Lisboa - www.cnpd.pt] 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 statements 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 States 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 6(1) of Regulation (EU) No 2016/399 (Schengen Borders Code) and I am therefore refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Member States. Place and date: Signature:

(signature of parental authority/legal

guardian, if applicable):

’.

(1) No logo is required for Norway, Iceland, Liechtenstein and Switzerland.

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