Visa Form
Visa Form
Visa Form
Bhattacharjee
2. Surname at birth (Former family name(s)) (x)
Debanik
4. Date of birth (day-month-year)
Application lodged at Embassy/consulate CAC Service provider Commercial intermediary Border Name:
06-05-1991
8.Sex
Indian
India
9. Marital status
Male
Female
Single
Married
Separated
Divorced
Widow(er)
Diplomatic passport
14. Date of issue
Service passport
15. Valid until
Official passport
16. Issued by
30/03/2007
17. Applicants home address and e-mail address
B-507, Navin Apartments, Plot-13, Sector-5, Dwarka, New Delhi-110075 [email protected]
29/03/2017
Telephone number(s)
+919836264280
Supporting documents: Travel document Means of subsistence Invitation Means of transport TMI Other: Visa decision Refused Issued: A C LTV Valid From.... Until .
Student
* 20. Employer and employers address and telephone number. For students, name and address of educational establishment.
Future Institute of Engineering & Management, Sonarpur Station Road, Sonarpur, Kolkata, West Bengal, India- 700150
Business
Cultural
Sports
22. Member State(s) of destination 24. Number of entries requested MIGR_119031_ rev._1_201003
Two entries
No
27. Fingerprints collected previously for the purpose of applying for a Schengen Visa
No
The field marked with * shall not be filled in by family members of EU,EEA or CH citizens (spous, child or dependent ascendant) while exercising their right to free movement. Family members 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 accordance with the data in travel document.
28. Entry permit for the final country of destination, where applicable
18/08/2013
24/08/2013
* 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)
Alden Marcus
Address and e-mail address of inviting person(s)/hotel(s) temporary accommodation(s)
Professorsgatan 1 Lund [email protected]
+46 46-222 76 57
Telephone and telefax of company / organisation
+46 46-222 76 57
Surname, first name, address, telephone, telefax and e-mail address of contact person in company / organisation
by the applicant himself/herself Means of support Cash Travelers cheques Credit card Prepaid accommodation Prepaid transport Other (please specify)
CECOST .....................................
All expenses covered during the stay Prepaid transport Other (please specify)
Airfare
Surname
34. Personal data of the family member who is an EU, EEA or CH citizen First name(s)
Date of birth
Nationality
spouse
child ..
grandchild
dependent ascendant