Harmonised application form

Application for Schengen Visa

This application form is free

Family members of EU, EEA or CH citizens 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

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

Date of
application:
3. First name(s) (Given name(s)):
Application
number:

Date of birth (day-month-year): 5. Place of birth: 7.Current nationality: Application

lodged at:
6. Country of birth: Nationality at birth, if
different: □
Embassy/consul
ate
Other nationalities:
□ Service
8. Sex: 9. Civil status: provider

□ Male □ Female □ Single □ Married □ Registered Partnership □ Separated □ □ Commercial

Divorced □ Widow(er) □ Other (please specify): intermediary

□ Border
(Name):

………………

□ Other:

10. Parental authority (in case of minors) /legal guardian (surname, first name, address, if different File handled
from applicant’s, telephone no., e-mail address, and nationality): 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
□ Means of
□ Other travel document (please specify): subsistence

□ Invitation

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

1
13. Number of travel 14. Date of 15. Valid until: 16. Issued by □ TMI
document: issue: (country):
□ Means of
17. Personal data of the family member who is an EU, EEA or CH citizen if applicable transport

Surname (Family name): First name(s) (Given name(s)): □ Other:

Visa
Date of birth (day-month-year): Nationality: Number of travel document or ID card:
decision:

18. Family relationship with an EU, EEA or CH citizen if applicable: □ Refused

□ spouse □ child □ grandchild □ dependent ascendant □ Issued:
□ Registered Partnership □ other:
□A
19. Applicant's home address and e-mail address: Telephone no.:
□C
20. Residence in a country other than the country of current nationality:
□ LTV
□ No
□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid □ Valid:
until……………
From:

Until:

*21. Current occupation: Number of

entries:
* 22. Employer and employer’s address and telephone number. For students, name and address of
educational establishment: □1□2□
Multiple
23. Purpose(s) of the journey:
Number of
□ Tourism □ Business □ Visiting family or friends □ Cultural □ Sports □ Official visit □ Medical days:
reasons □ Study □ Airport transit □ Other (please specify):

24. Additional information on purpose of stay:

25. Member State of main destination (and other 26. Member State of first entry:
Member States of destination, if applicable):

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:

2
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 Telephone no.:

person(s)/hotel(s)/temporary accommodation(s):

*
31. Name and address of inviting company/organisation:

Surname, first name, address, telephone no., Telephone no. of company/organisation:

and e-mail address of contact person in
company/organisation:

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

□ by the applicant himself/herself □ by a sponsor (host, company, organisation),

please specify:
Means of support:
…….□ referred to in field 30 or 31 …….□
□ Cash other (please specify):

□ Traveller’s cheques Means of support:

□ Credit card □ Cash

□ Pre-paid accommodation □ Accommodation provided

□ Pre-paid transport □ All expenses covered during the stay

□ Other (please specify): □ Pre-paid transport

□ Other (please specify):

3
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: Ministry of Foreign Affairs, Loretánské náměstí 5, CZ-118 00 Praha 1; Directorate of Alien
Police, Olšanská 2, P.O. BOX 78, CZ-130 51 Praha 3 and Ministry of the Interior, Nad Štolou 3, CZ-170 34 Praha 7.

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 [Office for Personal Data Protection, Pplk. Sochora 727/27, CZ-170 00 Praha 7] 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):