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Embassy of Italy
Consolato Generale d'Italia
New Delhi
Mumbai
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
PAI PANANDIKER
Date of application:
2. Surname at birth (Former family name(s)):
HEDE
Application number:
3. First name(s) (Given name(s)):
NEENA SHEKHAR
4. Date of birth (day month year): 5. Place of birth: 7. Current nationality: Application lodged at:
CHICALIM, GOA INDIAN □ Embassy/consulate
22/02/1971 □ Service provider
6. Country of birth: 8. Nationality at birth, if different: □ Commercial intermediary

INDIA □ Border (Name):

…………………………………………
9. Other nationalities: □ Other:

8. Sex: 9. Civil status:

□ Male □ Female □ Single □ Married □ Registered Partnership □ Separated □ Divorced □
Widow(er) □ Other (please specify):

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

11. National identity number, where applicable: Supporting documents:

□ Travel document
12. Type of travel document: □ Means of subsistence
□ Ordinary passport □ Diploma c passport □ Service passport □ Official passport □ Special passport □ Invita on
□ Other travel document (please specify):
13. Number of travel document: 14. Date of issue: 15. Valid until: 16. Issued by □ TMI
P6831635 04/04/2017 03/04/2027 (country): INDIA □ Means of transport
□ Other:
17. Personal data of the family member who is an EU, EEA or CH citizen if applicable
Visa decision:
□ Refused
Surname (Family name): □ Issued:
□A
□C
Date of birth (day month year): Nationality: □ LTV

□ Valid:
18. Family relationship with an EU, EEA or CH citizen if applicable:
□ spouse □ child □ grandchild □ dependent ascendant From:
□ Registered Partnership □ other:
19. Applicant's home address and e mail address: Telephone no.: Until:
WING B, HIRA NIKETAN, 2 ND FLOOR NEAR LOYOLA HIGH SCHOOL, MARGAO, +91 9422057216
SOUTH GOA, GOA-INDIA, 403601, [email protected] Number of entries:
20. Residence in a country other than the country of current nationality: □ 1 □ 2 □ Mul ple
□ No
□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid un l………………………….. Number of days:
* 21. Current occupation:
PRINCIPAL / PROFESSOR
* 22. Employer and employer’s address and telephone number. For students, name and address of educational
establishment: DON BOSCO COLLEGE OF ENGINEERING,
FATORDA,MARGAO, GOA,403602
23. Purpose(s) of the journey:
□ Tourism □ Business □ Visi ng family or friends □ Cultural □ Sports □ Official visit □ Medical reasons □ Study □
Airport transit □ Other (please specify):

24. Additional information on purpose of stay:

I ALONG WITH MY HUSBAND MR.SHEKHAR WAMAN PAI PANANDIKER INTEND TO TRAVEL TO ITALY. THE MAIN
PURPOSE OF MY TRAVEL IS TO ACCOMPANY MY HUSBAND AS HE INTENDS TO TRAVEL TO ITALY FOR A BUSINESS
TRIP
25. Member State of main destination (and other Member States of 26. Member State of first entry:
destination, if applicable):
ITALY
ITALY

27. Number of entries requested:

□ Single entry □ Two entries □ Mul ple 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:
INTENDED DATE OF ARRIVAL : 23/07/2023
INTENTED DATE OF DEPARTURE: 28/07/2023
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):
SOMASCHI HOTEL

Address and e mail address of inviting person(s)/hotel(s)/temporary Telephone no.:

accommodation(s):
+39 0172488482
SOMASCHI HOTEL, VIA NOSTRA SIGNORA DEL POPOLO
9-12062, CHERASCO (CN)

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

EUROSTAMPA GLOBAL SERVICES SRL, BENE VAGIENNA PROV. CN IN VIALE RIMEMBRANZA N.20 C.A.P 12041, TEL:
+39 0172651811

Surname, first name, address, telephone no., and e mail Telephone no. of company/organisation:
address of contact person in company/organisation:
+39 0172651853
PAUL JOHN, CHERASCO PROV. CN IN VIA ORESTE
BADELLINO N.7, C.A.P 12062. EMAIL:
[email protected]

* 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
□ Credit card Means of support:
□ Pre paid accommoda on □ Cash
□ Pre paid transport □ Accommoda on provided
□ Other (please specify): □ All expenses covered during the stay
□ Pre paid transport
□ Other (please specify): OVERSEAS TRAVEL
INSURANCE
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
(controller) for processing the data is the Ministry of Foreign Affairs and International Cooperation (Piazzale della Farnesina 1, 00135 – Roma, website:
www.esteri.it – e-mail: [email protected]).

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
Italian national supervisory authority competent for the protection of personal data is the Guarantor for the Protection of Personal Data (Piazza di
Montecitorio 121, 00186 Roma, www.garanteprivacy.it, tel. +3906 696771) which 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)