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7/23/2019 Schengen Visa Form
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This application form is free PHOTO
Austrian EmbassyCanberra
1. Surname (Family name) (x) RESERVED FOR OFFICIALUSE
2. Surname at birth (Former family name(s)) (x) Datum des Antrags:
3. First name(s) (Given name(s)) (x) Nr. des Visumantrags
4. Date of birth (day-month-year) 5. Place of birth 7. Current nationality
6. Country of birth Nationality at birth, if different:
8. Sex:
male female
9. Marital status: Single Married Widow(er)
Antrag eingereicht bei Botschaft/Konsulat Gemeinsame Antragsbe-arbeitungsstelle Dienstleistungserbringer Kommerzieller Vermittler Grenze
Name:
Sonstige Stelle
Akte bearbeitet durch:
SeparatedDivorcedOther (please specify) ..
10. In the case of minors: Surname, first name, address (if different from applicants) and nationality of parental authority/legal guardian
11. National identity number, where applicable
12. Type of travel document
Ordinary passport Diplomatic passport Service passport Official passport Special passport Other travel document (please specify) ..
13. Number of travel document 14. Date of issue 15. Valid until 16. Issued by
Belege: Reisedokument Mittel zur Bestreitung desLebensunterhalts Einladung Befrderungsmittel Reisekrankenversiche-rung Sonstiges:
Visum:Abgelehnt
Erteilt:AC Visum mit rumlich be-schrnkter Gltigkeit
Gltig
vom ..
bis..
Anzahl der Einreisen: 1 2 mehrfach
17. Applicant's home address and e-mail address Telephone number(s)
18. Residence in a country other than the country of current nationality: No Yes
Residence permit or equivalent
No. ...Valid until ..
* 19. Current occupation*
* 20. Employer and employer's address and telephone number. For students, name and address of educational establishment.. Anzahl der Tage:
1
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RESERVED FOR OFFICIAL21. Main purpose(s) of the journey:
Tourism Cultural Official visit Study Business Sports Medical reasons Transit
Other lease s ecif : 22. Member State(s) of destination
USE Airport transit
Zulssigkeitsprfung d. An-rags:
23. Member State of first entrySachbearbeiter:
24. Number of entries requested:
Single entry Two entries Multiple entries
25. Duration of the intended stay or transit:Indicate number of days Datum:
26. Schengen visas issued during the past three years:No YesDate(s) of validity from ......to .........
27. Fingerprints collected previously for the purpose of applying for a Schengen visa? No YesDate, if known:..
28. Entry permit for the final country of destination, where applicable:
Issued by .valid from . until
29. Intended date of arrival in the Schengen area 30. Intended date of departure from the Schengen area
Zulssig Unzulssig
Art d. beantragten Visums Flughafentransit (A) Kurzfr. Aufenthalt (C)
Langfr. Aufenthalt (D)
3456 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)
Address and e-mail address of inviting person(s)/hotel(s)/temporary accommodation(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
himself/herself by a sponsor (host, company, organisation)please specify
Means of support referred to in field 31 or 32 Cash
Traveller's cheques other (please specify) Credit card Means of support Pre-paid accommodation Cash Accommodation provided Pre-paid transport All expenses covered during the stay Pre-paid transport
Other (please specify) Other (please specify) ..
34. Personal data of the family member who is an EU, EEA or CH citizen Surname: First name(s): .
Date of birth: .. Nationality: ...
Number of travel document or ID card: ..
35. Family relationship with an EU, EEA or CH citizen spouse grandchild child dependent ascendant
36. 7#&%/ &)8 8&'/ 37. -$0)&'9,/ (for minors, signature of parental authority/legal guardian)
2
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* 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 thisrelationship 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.
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 photographand, 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 visa application form, as well as my fingerprints and my photograph will be supplied to the relevant authorities ofthe 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 issuedwill be entered into, and stored in the Visa Information System (VIS) for a maximum period of five years, during which it will beaccessible 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 theseconditions, 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 andinvestigation of terrorist offences and of other serious criminal offences. The authority of the Member State responsible for processing the
data is the Bundesministerium fr Inneres, Herrengasse 7, A-1014 Wien, Tel.+43-(0)1-531 26-0,[email protected] 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 theMember State which transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data relating tome processed unlawfully be deleted. At my express request, the authority examining my application will inform me of the manner inwhich 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 of that Member State [ www.dsk.gv.at ]
will hear claim sconcerning 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 statementswill 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 relevantprovisions of Article 5(1) of Regulation (EC) No 562/2006 (Schengen Borders Code) and I am therefore refused entry. The prerequisitesfor entry will be checked again on entry into the European territory of the Member States.
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