CONSULAT GÉNÉRAL DE FRANCE
ALONDRES SERVICES DE VISAS
Je soussingé, _____________________________________, déclare avoir pris
connaissance de l’obligation d’être en possession d’une assurance couvrant, pour un montant minimum de 30.000 Euros, les dépenses médicales et hospitalières y compris d’aide sociale résultant de soins que je pourrais engager lors de séjours ultérieures dans l’espace Schengen ainsi que les frais de repatriement qui pourraient en résulter.
Londres, le ________________,
Signature:
___________________________________________________________________
I, the undersigned ____________________________________, hereby declare that I
have taken note of the requirement to contract a full travel insurance, covering – for a minimum of 30.000 Euros – any medical, hospitalisation and repatriation costs, as well as associated care expenses which I could incur during my future trips into the Schengen states.
London, the ________________,
Signature:
P.O. BOX 57, 6A CROMWELL PLACE, LONDON, SW7 2EW – TEL: (020)70 73 12 50
http:\\ www.consulfrance-londres.org
Application for Schengen Visa
This application form is free
Stamp embassy
Or consulate
N° 12225*01
1. Surname(s) family name(s)) |
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FOR EMBASSY / |
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CONSULATE USE ONLY |
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2. Surname(s) at birth (earlier family name(s)) |
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Date application : |
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3. First names (given names) |
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4. Date of birth (year-month-day) |
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5. ID-number (optional) |
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File handled by : |
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6. Place and country of birth |
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Supporting documents: |
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Valid passport |
7. Current nationality/ies |
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8. Original nationality (nationality at birth) |
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Financial means |
9. Sex |
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10. Marital status : |
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Invitation |
Male |
Female |
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Single |
Married Separated |
Divorced |
Widow(er) |
Other |
Means of transport |
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Health insurance |
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Other : |
11. |
Father’s name |
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12. Mother’s name |
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13. |
Type of passport: |
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National passport |
Diplomatic passport |
Service passport |
Travel document (1951 Convention) |
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Alien’s passport |
Seaman’s passport |
Other travel document (please specify): |
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………………………………………………………………………… ………….… |
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14. |
Number of passport |
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15. Issued by |
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16. |
Date of issue |
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17. Valid until |
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18. |
If you reside in a country other than your country of origin, have you permission to return to that country? |
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No |
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Yes, (number and validity) |
……………….…………………………………………………… |
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* 19. Current occupation |
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Visa : |
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Refused |
* 20. Employer and employer’s address and telephone number. For students, name and address of school. |
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Granted |
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Characteristics of Visa : |
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LTV |
21. |
Main destination |
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22. Type of Visa : |
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23. Visa : |
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Airport transit Transit Short stay |
Individual |
Collective |
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A |
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Long stay |
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B |
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C |
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D |
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D + C |
24. |
Number of entries requested |
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25. Duration of stay |
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Number of entries : |
Single entry Two entries Multiple entries |
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Visa is requested for: ______ days |
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26. |
Other visas (issued during the past three years) and their period of validity |
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1 2 Multiple |
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Valid from ……………….. |
27. |
In the case of transit, have you an entry permit for the final country of destination? |
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No |
Yes , valid until: |
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Issuing authority: |
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To ………………………… |
* 28. Previous stays in this or other Schengen states |
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Valid for : |
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…………………………… . |
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*The questions marked with * do not have to be answered by family members of EU or EEA citizens (spouse, child or dependent ascendant). Family members of EU or EEA citizens have to present documents to prove this relationship.
First Name
Telephone and telefax
e-mail address
29. Purpose of travel |
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Tourism Business Visit to Family or Friends |
Cultural/Sports Official Medical reasons |
Other (please specify): ….…………………………………………………….. |
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* 30. Date of arrival |
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* 31. Date of departure |
* 32. Border of first entry or transit route |
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33. Means of transport |
*34. Name of host or company in the Schengen states and contact person in host company. If not applicable, give name of hotel or temporary address in the Schengen states
Name
Full address
*35. Who is paying for your cost of travelling and for your costs of living during your stay?
Myself Host person/s Host company. (State who and how and present corresponding documentation):………………………………………………
…………………………………………………………………………………………………………………………
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*36. Means of support during your stay
Cash Travellers' cheques Credit cards Accommodation Other:
Travel and/or health insurance. Valid until: ………………………………………………..
37. Spouse’s family name |
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38. Spouse’s family name at birth |
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39. Spouse’s first name |
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40. Spouse’s date of birth |
41. Spouse’s place of birth |
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42. Children (Applications |
must be submitted separately for each passport) |
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Name |
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First name |
Date of birth |
1 |
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2 |
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3 |
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43.Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens.
Name
Date of Birth |
Nationality |
Number of passport |
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Family relationship :
of an EU or EEA citizen
44. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in the Schengen states and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states.
At my express request, the consular authority processing 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 altered or deleted, in particular, should they be inaccurate, in accordance with the national law of the state concerned.
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 Schengen state which deals with the application.
I undertake to leave the territory of the Schengen states upon 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 Schengen 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 the Schengen Implementing Convention and am thus refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Schengen states.
45. |
Applicant’s home address |
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46. Telephone number |
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47. |
Place and date |
48. Signature (for minors, signature of |
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custodian/guardian) |
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FOR EMBASSY /
CONSULATE USE ONLY
GUIDE TO COMPLETING THE SCHENGEN APPLICATION FORM:
Q.1. Your surname (family name) as it appears in the passport you are using to apply for your visa.
Q.2. If you have changed your surname since birth (e.g. through marriage) please write your previous surname here. If your surname has not changed since birth please leave this blank.
Q.3. Your first name(s) (Christian names).
Q.5. If your country of origin has issued you with an ID number please write it here. If you do not have an ID number or do not know what it is then leave this question blank.
Q.6. The town and country in which you were born.
Q.7. The nationality of the passport that you currently hold. For example if you hold a South African passport then write “South African”.
Q.8. If you use to hold a different nationality than you hold now then write this nationality here. If your nationality has never changed then leave this blank.
Q.9. Please indicate your sex by circling the correct option.
Q.10. Please indicate your marital status by circling the correct option.
Q.11. Write the full name of your father. If you are unaware of your father’s name please write ‘Unknown’.
Q.12. Write the full name of your mother. If you are unaware of your mother’s name please write ‘Unknown’.
Q.13. Circle the type of passport that you hold. Most applicants hold a “National Passport”. Only circle one of the other options if you are sure that you have that type of passport.
Q.14. Write your “passport number”, this usually appears on the photo page at either the front or back of your passport.
Q.15. Circle the name of the Authority that issued your passport (e.g. UK Passport Office or Department of home Affairs). This information should be written on the photo page of your passport.
Q.16. Write the date on which your passport was issued. This information can usually be found on the photo page of your passport.
Q.17. Write the date on which your passport will expire. This information can usually be found on the photo page of your passport.
Q.18. If you are applying for a Schengen visa in the UK then you should have UK residency (e.g. working holiday / work permit / indefinite leave). Please circle “yes” and write the ID number and expiry date on your residency stamp. The ID number can usually be found on the top right corner of the visa. If you have Indefinite Leave please write “Indefinite Leave”. If you don’t have a reference number, then please leave this blank.
Q.19. Write your current occupation (e.g. Nurse / Journalist / Teacher).
Q.20. Write the full address and telephone number of your employer in the UK. If you are unemployed please write “currently unemployed” and give details of your last employer.
Q.21. The “main destination” is the Schengen state in which you are spending the most time during your trip to the Schengen area. You must write the name of the country whose consulate you are applying through: e.g. if you are applying through the French Consulate you must write “France”.
Q.22. All applicants for tourist or business trips must circle “Short stay”. If you wish to apply for an “Airport transit” or “Transit” visa please circle the appropriate option.
Q.23. Circle “Individual”.
Q.24. If you would like a visa that allows you to return to the Schengen area after your first trip is over please circle “Multiple entries”. If you only need to enter the Schengen area on one occasion then please circle “Single entry”.
Q.25. Please state the total number of days you intend to stay in Austria (e.g. 90/180/365/2 years)
Q.26. This question refers to any visas, apart from Schengen visas and your visa for the UK that you have been granted in the past three years. You should write the name of the country and then the valid from date and valid to date e.g. US 13/01/2003 – 13/01/2004, Russia 27/06/2002 – 02/07/2002.
Q.27. ONLY answer this question if you are applying for a Transit Visa and you have circled that option in Question 22. If you are applying for a Transit Visa you must already have a visa or visas in your passport for your final destination(s) (if appropriate). Please write the validity of the visa(s) and the name of the authority that issued the visa(s). If you are applying for a transit visa but you do not require a visa for your onward destination please write ‘visa not needed’ in the box.
Q.28. This question refers to any Schengen visas that you have been granted in the past. For each visa issued write the name of the country whose Embassy granted your visa. Also write the dates from which the visa was valid e.g. France 13/01/2003 – 13/07/2003, Italy 20/06/2002 – 30/06/2002. Only mark as many visas as you have space for, it doesn’t matter if you leave out visas that you have been granted in the past.
Q.29. Please circle the word that best describes the reason for the trip that you intend to take. If the purpose of your trip is not covered by any options listed then please circle “other” and write a brief description of the purpose of your trip.
Q.30. Write the date on which you will first enter the Schengen area on the trip you intend to take.
Q.31. Write the date on which you will finally depart the Schengen area on the trip you intend to take.
Q.32. Write the name of the Airport, Sea Port or Train Station that you will use to enter the Schengen area on the trip you intend to take.
Q.33. Please write the method of transport that you will use on your trip. For example: Aeroplane / Eurostar / Ferry.
Q.34.
TOURIST TRAVELLERS
If you are travelling as a tourist and you have booked a hotel or hostel then write the name and address of the hotel you will be staying in. If you are booked into several hotels then write the details of the first hotel you are staying in. If you are going on a day trip leave this question blank.
BUSINESS TRAVELLERS
If you are travelling on business purposes please write the name and address of the company you will be visiting.
TRANSIT VISA APPLICANTS
Leave this section blank.
Q.35. Please indicate who will be financially responsible for you during your trip by circling the appropriate option. If you are supporting yourself please circle “Myself”. If you will be supported by your host then please write their full name and circle the appropriate option. If you will be supported by somebody other than yourself or your host then please write their full name and give details of your relationship to them.
Q.36. Please indicate what financial means you will use to support yourself whilst on your trip. If you will use your bank account to support yourself during your trip and have supplied a bank statement with your application then circle “Cash”. If you have purchased Traveller’s Cheques to use on your trip and have supplied them with your application please circle “Traveller’s Cheques”. Once you have circled the correct option you must write the expiry date of your Travel Insurance in the field below.
Q.37 – 42. If you are travelling with your spouse and or children please write their details in the answers to these questions. If this does not apply to you please leave these questions blank.
Q.43. Only fill out this section if you are financially dependent upon a family member who is an EU national. If the person you depend upon is not an EU national then leave this blank. If the person you depend upon financially is not a family member then leave this section blank.
Q.45 & 46. Write your home address and contact telephone number.
Q.47. Write the name of the place where you were are when you complete this application form and the date on which you filled it out. For example “London 18/04/05”.
Q.48. The applicant for the visa must sign the form here. In the case of children unable to write their signature the form may be signed by a parent or legal guardian and “(Parent)” or “(Legal Guardian)” written after the signature.
