Harmonised application form (1)

Application for Schengen VisaThis application form is free.

1 Surname (Family name) (x)2 Surname at birth (Former family name(s)) (x)3 First name(s) (Given name(s)) (x)

OR OFFICIAL USE ONLY

Date of application:Visa application number:

4 Date of birth (day-month-year)

5 Place of birth6 Country of birth

7 Current nationalityNationality at birth, if different:

Application lodged atEmbassy/consulateCACService provider

9 Marital statusSingleMarriedSeparatedDivorcedWidow(er)

Commercial intermediaryBorder

Other (please specify)Name:10 In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parental authority/legal guardianOtherFile handled by:11 National identity number, where applicable

12 Type of travel documentOrdinary passportDiplomatic passportService passportOfficial passportSpecial passport

Supporting documents:Travel documentMeans of subsistenceInvitationMeans of transport

Other travel document (please specify)

13 Number of travel document

16 Issued byTMIOther:

17 Applicant's home address and e-mail address

Telephone number(s)Visa decision:RefusedIssued:

18 Residence in a country other than the country of current nationalityNoYes. Residence permit or equivalent No.* 19 Current occupationValid until

* 20 Employer and employer's address and telephone number. For students, name and address of educational establishment.

21 Main purpose(s) of the journey:TourismOfficial visitMedical reasonsStudyTransitAirport transitOther (please specify)BusinessVisiting family or friendsCulturalSportsNumber of entries:12Multiple

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

22 Member State(s) of destination

23 Member State of first entry

24 Number of entries requestedSingle entryMultiple entriesTwo entries

25 Duration of the intended stay or transitIndicate 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 ascendant) while exercising their right tofree 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 in accordance with the data in the travel document.26 Schengen visas issued during the past three yearsNoYes. Date(s) of validity fromto

27 Fingerprints collected previously for the purpose of applying for a Schengen visaNoYesDate, if known28 Entry permit for the final country of destination, where applicableIssued by29 Intended date of arrival in the Schengen areaValid fromuntil30 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 temporaryaccommodation(s) in the Member State(s)

Address and e-mail address of inviting person(s)/hotel(s)/temporaryaccommodation(s)

Telephone and telefax

*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 the applicant himself/herself

by a sponsor (host, company, organisation), please specifyreferred to in field 31 or 32

Means of supportCashTraveller's chequesMeans of supportCredit cardPre-paid accommodationPre-paid transportOther (please specify)CashAccommodation providedAll expenses covered during the stayPre-paid transportOther (please specify)other (please specify)

34 Personal data of the family member who is an EU, EEA or CH citizen

Number of travel document or ID card

35 Family relationship with an EU, EEA or CH citizenspouse36 Place and datechildgrandchilddependent ascendant

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 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 visa application; and any personal data concerning me which appear on the visaapplication form, as well as my fingerprints and my photograph will be supplied to the relevant authorities of the Member States and processed by thoseauthorities, for the purposes of a decision on my visa 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 beentered into, and stored in the Visa Information System (VIS) (1) for a maximum period of five years, during which it will be accessible to the visaauthorities and the authorities competent for carrying out checks on visas at external borders and within the Member States, immigration and asylumauthorities in the Member States for the purposes of verifying whether the conditions for the legal entry into, stay and residence on the territory of theMember States are fulfilled, of identifying persons who do not or who no longer fulfil these conditions, of examining an asylum application and ofdetermining responsibility for such examination. Under certain conditions the data will be also available to designated authorities of the Member Statesand to Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious criminal offences. The authority ofthe Member State responsible for processing the data is the Danish Immigration Service, Ryesgade 53, DK-2100 Copenhagen Ø, Denmark, 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 Statewhich transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data relating to me processed unlawfullybe 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 thepersonal data concerning me and have them corrected or deleted, including the related remedies according to the national law of the State concerned.The national supervisory authority of that Member State (the Danish Data Protection Agency, Borgergade 28, 5, DK-1300 Copenhagen K, Denmark, e-mail: [email protected]) 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 myapplication being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the law of the MemberState 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 onlyone 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 meanthat I will be entitled to compensation if I fail to comply with the relevant provisions of Article 5(1) of Regulation (EC) No 562/2006 (Schengen BordersCode) and I am therefore refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Member States.

Signature (for minors, signature of parental authority/legal guardian):

(1) In so far as the VIS is operational