Application for Schengen Visa
This application is free
FOTO
1
. Surname (Family name) (x)
F
OR OFFICIAL USE ONLY
Date
of application:
Vi
sa application number:
A
pplication lodge at
Embassy/consulate
CAC
□ em
Prestadores de serviços
□ em
Intermediários
c
omerciais
na fronteira
Na
me:
Other
F
ile handled by:
S
upporting documents:
Travel document
Means of subsistence
□ I
nvitation
Means of transport
TMI
□ Ot
her
:
Vi
sa decision:
□ Re
fused
□ Issue
d:
□ A
□ C
LVT
Valid
:
F
rom
U
ntil
N
umber of entries:
□ 1
2 Multiple
N
umber of days:
2
. Surname at birth (Former family name(s)) (x)
3
. First name(s) (Given name(s)) (x)
4
. Date of birth (day-month-
year)
5
. Place of birth
6
. Country of birth
7
. Current nationality
Na
tionality at birth, if different:
8
. Sex
Male
Female
9
. Marital status
Single
Married
Separated
Divorced
Widow(er)
Other (please specify)
1
0. In the case of minors: Surname,
first name, address (if different from applicant’s) and nationality of
p
arental authority/legal guardian
1
1. National identify number, where applicable
1
2. Type of travel document:
Ordinary passport
Diplomatic passport
Service passport
Official passport
Special
passport
Other travel document (please specify):
13
. Number of travel
d
ocument
4. Date of issue
15
. Valid until
16
. Issued by
1
7.
Applican’ts home address and
e
-mail address
Tel
ephone number(s)
1
8. Residence in a country other than the country of current nationality
Não
Yes.
Residence permit or equivalent……………
..................................No ...................... Valid until
*
19. Current ocupation
*
20.
Employer and employer’s address and telephone number.
For students, name and address of
e
ducational establishment.
2
1. Main purpose(s) of the journey:
Tourism
Business
Visiting family or friends
Cultural
Sports
Official visit
Medical reasons
Study
Transit
Airport transit
Other (please specify)
2
2. Member State(s) of destination
23
. Member State of first entry
2
4. Number of entries requested
Single entry
Two entries
Multiple
entries
25
. Duration of the intended stay or transit
I
ndicate 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 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 in accordance with the data in the travel document.
2
6. Schengen visas issued during the past three years
No
Yes. Date of validity from ...................... a
2
7. Fingerprints collected previously for the purpose of applying for a Schengen visa
No
Yes.
................................................ Date, if known
2
8. Entry permit for the final country of destination, where applicable
Issued by
...........................
.............................valid from ....................
to …………………….
2
9. Intended date of arrival in the Schengen area
30
. 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
temporary accommodation(s) in the Member State(s)
A
ddress and e-mail address of inviting
p
erson(s)/hotel(s)/temporary accommodation(s)
T
elephone and telefax
*
32. Name and address of inviting company/organization
T
elephone and telefax of comp./organization
S
urname, first name, address, telephone, telefax, and e-mail address of contact person in company/organization
*
33. Cost of travelling and living
during the applicant’s stay is covered
by the applicant himself/herself
M
eans of support
Cash
Traveller’s cheques
Credit card
Prepaid accommodation
Prepaid transport
Other (pls. specify):
by a sponsor (host, company, organization),
p
lease specify
referred to in field 31 or 32
others (please specify):
Me
ans of support
Cash
Accommodation provided
All expenses covered during the stay
Prepaid transport
Other (pls. specify):
Place and date
34. Personal data of the family member who is an EU, EEA or CH citizen
S
urname
F
irst name(s)
D
ate of birth
N
ationality
Nu
mber of travel document or ID card
3
5. Family relationship with na EU, EEA or CH citizen
Spouse
Child
Grandchild
Dependent ascendant
3
6. Place and date
3
7. Signature
(f
or 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 the 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 my personal data concerning me which
appear on the visa 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 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 be
entered 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
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 State 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 fulfill 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 prevention, detection and investigation of terrorist offence
s and
of other serious criminal offences. The authority of the Member State responsible for processing the data is the Directorate General for the
Consular Affairs and the Portuguese Communities (DGACCP).
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 State concerned. The national supervisory authority [Portuguese Data Protection Commission (CNPD) – Rua de São Bento
nº. 148 3º, 1200-821 Lisboa – www.cnpd.pt ] 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 5(1) of Regulation (EC) No 562/2006
(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.
Signature
(for minors, signature of parental authority/legal guardian):
.
1
In so far as the VIS is operational.