欧洲申根签证申请表

ThisapplicationformshouldbefilledoutinEnglish此#格#必须以英文填写SchengenVisaApplicationform申根签证申请表Thisapplicationformisfree此表格免费提供PHOTO照片1.Surname(Familyname)(x)姓Forofficialuseonly签证机关专用Dateofapplication:Visaapplicationnumber:Applicationlodgedat—Embassy/Consulate-CAC—Serviceprovider—Commercialintermediary—BorderName:—OtherluthorityFilehandledby:Supportingdocuments:—Traveldocument—Meansofsubsistence—Invitation—Meansoftransport-TMI—Other:Visadecision:—Refused—Issued-A-C-LTV-ValidFromUntilNumberofentries:-1-2-MultiplesNumberofdays:2.Surnameatbirth(Formerfamilyname(s)(x)出生时姓氏3.Firstname(s)(Givenname(s)(x)~名4.Dateofbirth(day-month-year)出生日期(日-月-年)Placeofbirth/出生地Countryofbirth/出生国7.Currentnationality/现国籍Nationalityatbirth,ifdifferent:出生时国籍，如与现国籍不同8.Sex/性别—Male/男一Female/女9.Maritalstatus/婚姻状况—Single/未婚一Married/已婚—Separated/分居一Divorced/离异一Widow(er)/丧偶-Other/其它10.Inthecaseofminors:Surname,firlegalguardian/未成年申请人须填—sname,address(ifdifferentfromapplicant's)andnationalityofparentala二合法监护人的姓名、住址(如与申请人不同)、及国籍11.Nationalidentitynumber,whereapplicable身份证号码，如适用12.Typeoftraveldocument护照种类：一Ordinarypassport/普通护照一Diplomaticpassport/外交护照—Servicepassport公务护照一Officialpassport/因公护照一Specialpassport/特殊护照-Other(pleasespecify)/其它旅行证件(请注明):13.Numberoftraveldocument旅行证件编号14.Dateofissue签发日期15.Validuntil有效期至16.Issuedby签发机关17.Applicant'shomeaddressmadaddress申请人住址及eII子邮件Telephonenumber(s)电话号码18.Residenceinacountryotherthanthecountryofcurrentnationality!：否居住在现时国籍以夕卜的国家-No否—Yes.ResidencepermitorequivalentNoValid-until..是。居留证编号有效期至*19.Currentoccupation现职业*20.Employerandemployer'saddressandtelephonenumber.FsrBfeutienindaddressofeducationalestablishment.工作单位名称，遍址和电话，学生填写学校名称及地址21.Mainpurpose(s)ofthejourney:旅程主要目的—Tourism/旅游—Business/商务—VisitingFamilyorFriends/探亲访友—Cultural/文化一Sports/体育—Officialvisit/官方访问—Medicalreasons/医疗一Study/学习—Transit/过境—Airporttransit/机场过境—Other(pleasespecify)/其它(请注明)(x)Fields1-3shallbefilledinaccordancewiththedatainthetraveldocument字段1-3须依据旅行证件填上相关资料22.MemberState(s)ofdestination/申根日日勺地23.MemberStateoffirstentry/HT人申根国24.Numberofentriesrequested申请入境次数—Singleentry/一次—Multipleentries/多次—Twoentries/两次25.DurationoftheintendedstayortransitIndicatenumberofdays预计逗留或过境日数Thefieldsmarkedwith*shallnotbefilledbyfamilymembersofEU,EEAorCHcitizens(spouse,childordependentascendant)whileexercisingtheirrighttofreemovement.FamilymembersofEU,EEAorCHcitizensshallpresentdocumentstoprovethisrelationshipandfillinfieldsNo34and35.欧盟、欧洲经济区或瑞士公民的家庭成员(配偶、子女或赡养的老人)行使其自由往来的权利，不必回答带(*)号的问题。欧盟、欧洲经济区或瑞士公民的家庭成员必须填写第34条及35条的问题并提交证明其亲属关系的文件。26.Schengenvisasissuedduringthepastthreeyearsit去三年获批的申根签证-No/没有—Yes.Date(s)ofvalidityfrom有。有效期由■■■■.to至27.FingerprintscollectedpreviouslyforthepurposeofapplyingforaSchengenvis/任申请申根签证是否有指纹纪录-No/没有-Yes有Date,ifknown/如有，请写明日期28.Entrypermitforthefinalcountryofdestination,whereapplicable最后目的地之入境许可Issuedby签发机关Validfrom有效期由until29.IntendeddateofarrivalintheSchengenarea预定入境申根国日期30.IntendeddateoTdeparturefromtheSchengenarea预定离开申根国日期*31.Surnameandfirstnameottheinvitingperson(s)intheMemberState(s).temporaryaccommodation(s)intheMemberStates(s)申根国的邀请人姓名。如无邀请人，请填写申根国的酒店或暂住居所名称itnotapplicable,nameothotel(s)orAddressande-mailaddressofinvitingperson(s)/hotel(s)/temporaryaccommodation(s)邀请人酒店/暂住居所的地址及电字邮件Telephoneandtelefax电话及传真号码*32.Nameandaddressofinvitingcompany/organization邀请公司或机构名称及地址Telephoneandtelefaxofcompany/organisation邀请方电话及传真号码Surname,firstname,address,telephone,telefax,ande-mailaddressofcontac邀请公司/机构的联系人姓名、地址、电话、传真及电子邮件personincompany/organisation*33.Costoftravelingandlivingduringtheapplicant旅费以及在国外停留期间的生活费用'sstayiscovered—bytheapplicanthimself/herself/由申请人支付Meansofsupport/支付方式—Cash/现金—Traveller'schequ/e旅行支票—Creditcard/信用卡—Prepaidaccommodation/预缴住宿—Prepaidtransport/预缴交通—Other(pleasespecify)/其它(请注明)—byasponsor(host,company,organisation),pleaseSpecify/由赞助人(邀请人、公司或机构)支付，请注明—referredtoinfield31or32/参照字段31及32—other(pleasespecify)/其它(请注明)Meansofsupport/支付方式—Cash/现金—Accommodationprovided/提供住宿—Allexpensescoveredduringthestay反付旅程期间所有开支—Prepaidtransport/预缴交通—Other(pleasespecify)/其它(请注明)34.PersonaldataofthefamilymemberwhoisanEU,EEAorCHcitizen家庭成员为欧盟、欧洲经济区或瑞士公民，请填写其个人信息Surname姓Firstname(s)名Dateofbirth/出生日期Nationality/国籍NumberoftraveldocumentorIDcard旅行证件或身分证编号35.FamilyrelationshipwithanEU,—spouse—child配偶子女EEAorCHcitizen申请人与欧盟、欧洲经济区或瑞士公民的关系—grandchild—dependentascendant孙儿女受养人36.Placeanddate地区及日期37.Signature(forminors,signatureofparentalauthority/legalguardian)签字(未成年人由其监护人代签)Iamawarethatthevisafeeisnotrefundedifthevisaisrefused本人知道即使签证被拒也不能退还签证费Applicableincaseamultiple-entryvisaisappliedfor(cf.fieldNo24):/适用于申请多次入境签证(参照字段24)IamawareoftheneedtohaveanadequatetravelmedicalinsuranceformyfirststayandanysubsequentvisitstotheterritoryofMemberStatus.本人知道须预备有足够保额的旅游医疗保险作为首次及其后各次出发到申根国家领域之用Iamawareofandconsenttothefollowing:thecollectionofthedatarequiredbythisapplicationformandthetakingofmyphotographand,ifapplicable,thetakingoffingerprints,aremandatoryfortheexaminationofthevisaapplication;andanypersonaldataconcerningmewhichappearonthevisaapplicationform,aswellasmyfingerprintsandmyphotographwillbesuppliedtotherelevantauthoritiesoftheMemberStatesandprocessedbythoseauthorities,forthepurposesofadecisiononmyvisaapplication.Suchdataaswellasdataconcerningthedecisiontakenonmyapplicationoradecisionwhethertoannul,revokeorextendavisaissuedwillbeenteredinto,andstoredintheVisaInformationSystem(VIS)(1)foramaximumperiodoffiveyears,duringwhichitwillbeaccessibletothevisaauthoritiesandtheauthoritiescompetentforcarryingoutchecksonvisasatexternalbordersandwithintheMemberStates,immigrationandasylumauthoritiesintheMemberStatesforthepurposesofverifyingwhethertheconditionsforthelegalentryinto,stayandresidenceontheterritoryoftheMemberStatesarefulfilled,ofidentifyingpersonswhodonotorwhonolongerfulfilltheseconditions,ofexamininganasylumapplicationandofdeterminingresponsibilityforsuchexamination.UndercertainconditionsthedatawillbealsoavailabletodesignatedauthoritiesoftheMemberStatesandtoEuropolforthepurposeoftheprevention,detectionandinvestigationofterroristoffencesandofotherseriouscriminaloffences.TheauthorityoftheMemberStateresponsibleforprocessingthedataisUrz?dds.Cudzioziemcw(TheOfficeforForeigners),address:16KoszykowaSt.,00-564Warsaw.IamawarethatIhavetherighttoobtaininanyoftheMemberStatesnotificationofthedatarelatingtomerecordedintheVISandoftheMemberStatewhichtransmittedthedata,andtorequestthatdatarelatingtomewhichareinaccuratebecorrectedandthatdatarelatingtomeprocessingunlawfullybedeleted.Atmyexpressrequest,theauthorityexaminingmyapplicationwillinformmeofthemannerinwhichImayexercisemyrighttocheckthepersonaldataconcerningmeandhavethemcorrectedordeleted,includingtherelatedremediesaccordingtothenationallawoftheStateconcerned.ThenationalsupervisoryauthorityofthatMemberStatewillhearclaimsconcerningtheprotectionofpersonaldata:InspectorGeneralfortheProtectionofPersonalData,2StawkiSt.,00-193Warsaw.Ideclarethattothebestofmyknowledgeallparticularssuppliedbymearecorrectedandcompleted.IamawarethatanyfalsestatementswillleadtomyapplicationbeingrejectedortotheannulmentofavisaalreadygrantedandmayalsorendermeliabletoprosecutionunderthelawoftheMemberStatewhichdealswiththeapplication.IundertaketoleavetheterritoryoftheMemberStatesbeforetheexpiryofthevisa,ifgranted.IhavebeeninformedthatpossessionofavisaisonlyoneoftheprerequisitesforentryintotheEuropeanterritoryoftheMemberStates.ThemerefactthatavisahasbeengrantedtomedoesnotmeanthatIwillbeentitledtocompensationifIfailtocomplywiththerelevantprovisionsofArticle5(1)ofRegulation(EC)No562/2006(SchengenBordersCode)andIamthereforerefusedentry.TheprerequisitesforentrywillbecheckedagainonentryintotheEuropeanterritoryoftheMemberStates.本人知悉并同意以下条款：该申请表中所有关于本人的个人信息、照片或采集的指纹样本均为审核本人的签证所需。本人在该申请表中所填写的所有个人信息、指纹样本和照片均可提供给申根国家的相关主管部门，以便其受理本人的签证申请并对申请作出决定。该信息以及签证结果甚或签证注销、撤消或延期的决定将一并收录到签证信息系统(1)(VIS系统)并最长保存五年，在此期间，所有申根成员国的相关签证部门、边境及境内的签证检查部门以及移民局和难民局均有权登入VIS系统，核查签证申请人是否已满足入申根国境并在境内逗留的相应前提条件；核实不满足或不再满足该前提条件的签证申请人；审核难民申请并确定出该申请的主管部门。必要时，各申根成员国的特定部门以及欧盟刑警组织均有权参考该信息，用于预防、侦察和调查恐怖活动及其它严重犯罪行为。波兰负责管理该类信息的部门是外国人管理局。(地址：Urz?ddoSprawCudzoziemcw,ul.Koszykowa16,00-564Warszaw^。本人知悉本人有权要求任何一个申根成员国告知VIS系统中都收录了本人哪些个人信息，是由哪个申根成员国收录进去的。除此之外，本人亦有权申请更正系统中收录的错误信息并删除不合法信息。审核本人签证申请的领事机构会应本人要求提供相关说明性信息，如签证申请人应如何行使审核个人信息的权力,依据相关申根成员国的法律规定要求更正甚或删除不正确的个人信息的权力以及如何行使向相关申根成员国的主管部门就个人信息保护事宜依法申诉的权力。波兰负责此项事宜的部门是人信息保护局总蓝察员(地址：GeneralnyInspektorOchornyDanychOsobowych,ul.Stawki2,00-193Warszaw®。本人确保以上信息均系本人如实提供，确保信息正确而完整。本人知悉提供虚假信息可导致本人签证申请被拒签或已得到的签证被注销甚或受理本人签证的申根国会因此而对本人追究刑事责任。如本人的签证申请被批准，本人有义务在在签证到期前离开申根国境。本人亦获悉得到签证仅是具备了进入申根国境的前提条件之一，如果本人因未满足编号为EC562/2006的欧洲共同体协定中第5条第1款中所述前提条件向被拒绝入境，本人小得要求赔偿。在进入申根成员国的领土时，入境条件将被再次审核Placeanddate她区及日期Signature(forminors,signatureofparentalauthority/legalguardian)签字(未成年人由其监护人代签)is(1)Insofaras