Harmonised Application form

Consolato Generale d'Italia

Bangalore
Application for Schengen Visa

This application form is free

Family members of EU, EEA or CH citizens or of UK nationals who are beneficiaries of the EU-UK Withdrawal Agreement shall not fill in
fields No 21, 22, 31, 32 and 33 (marked with*).
Fields 1–3 shall be filled in in accordance with the data in the travel document.

1. Surname (Family name): For official use only

Date of application:
2. Surname at birth (Former family name (s)):

Application number:
3. First name (s) (Given name (s)):

4. Date of birth (day-month-year) 5. Place of birth: 7. Current nationality:

Application lodged at:
☐ Commercial
8. Nationality at birth if intermediary
different: ☐ Embassy/ consulate
☐ Service provider
6. Country of birth: 9. Other nationalities:

10. Sex: 11. Civil status: ☐ Border (Name):

☐ Male ☐ Single ☐ Married ☐ Registered partnership ☐ Separated ..................
☐ Female ☐ Divorced ☐ Widow (er) ☐ Other (please specify) ☐ Other:
☐ Other

12. Parental authority (in case of minors) / legal guardian (surname, first name, address, if File handled by:
different from applicant’s, telephone No, email address, and nationality):

13. Nationality identity number, where applicable: Supporting documents:

☐ Travel document
☐ Means of subsistence
☐ Invitation
12. Type of travel document:
☐ Ordinary passport ☐Diplomatic passport ☐ Service passport ☐ Official passport ☐ Special
passport ☐ Other travel document (please specify):

13. Number of travel 14. Date of issue: 15. Valid until: 16. Issued by ☐ TMI
documents: (country): ☐ Means of transport
☐ Other:

17. Personal data of the family member who is an EU, EEA or CH citizen or a UK national who is a Visa decision:
beneficiary of the EU-UK Withdrawal Agreement, if applicable ☐ Refused
☐ Issued:
☐ A
☐ C
Surname (Family Name): First name (s) (Given name (s)): ☐ LTV

☐ Valid: From:
Date of birth (day- Nationality: Number of travel Until:
month-year): document or ID card:

18. Family relationship with an EU, EEA or CH citizen or a UK national who is a beneficiary of the EU-
UK Withdrawal Agreement, if applicable:
☐ Spouse ☐ Child ☐ Grandchild ☐ Dependent ascendant ☐ Registered partnership ☐ Other
(please specify):

19. Applicant’s home address and email address: Telephone no.:

20. Residence in a country other than the country of current nationality:

☐ No
☐ Yes. Residence permit or equivalent . . . . . . . . . . . . . No. . . . . . . . . . . . . . Valid until. . . . . . . . . . . . .

21. * Current occupation: Number of entries:

☐ 1 ☐ 2 ☐ Multiple

22. *Employer and employer’s address and telephone number. For students, name and address Number of days:
of educational establishment:

23. Purpose (s)of the journey

☐ Tourism ☐ Business ☐ Visiting family friends or others Cultural ☐ Sports ☐ Official visit
☐ Medical reasons Study ☐ Airport transit ☐ Other (please specify):

24. Additional information on purpose of stay:

25. Member State of main destination (and other 26. Member State of first entry:
Member States of destination, if applicable):

27. Number of entries requested

☐ Single entry ☐ Two entries ☐ Multiple entries
28. Intended date of arrival of the first intended stay in the Schengen area:
Intended date of departure from Schengen area after the first intended stay:

29. Fingerprints collected previously for the purpose of applying for a Schengen visa:
☐ No ☐ Yes.
Date, if known . . . . . . . . . . . . . . . . . . . . . . . . . . Number of the visa, if known . . . . . . . . . . . . . . . . . . . . . . . . .

30. Entry permit for the final country of destination, where applicable:

Issued by . . . . . . . . . . . . . . . . . . . . . . . . Valid from . . . . . . . . . . . . . . . . . . . . . . . until . . . . . . . . . . . . . . . . . . . . . . .

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):

Address and email address of inviting person Telephone No.:

(s)/ hotel(s)/temporary accommodation(s):

32. *Name and address of inviting company/ organization:

Surname, first name, address, Telephone No., Telephone No. of company/organisation:

and email address of contact person in
company/ organisation:

33. *Cost of travelling and living during the applicant’s stay is covered:

☐ by the applicant ☐ by a sponsor (host, company, organisation),

please specify:
Means of support: ☐ referred to in field 30 or 31
☐ Cash ☐ Other (please specify)
☐ Traveller’s cheques
☐ Credit card
☐ Credit Card Means of support:
☐ Pre-paid accommodation ☐ Cash
☐ Pre-paid transport ☐ Accommodation provided
☐ Other (please specify) ☐ All expenses covered during the stay
☐ Pre-paid transport
☐ Other (please specify)

34. Surname and first name of the person filling in the application form, if different from the
applicant:

Address and email address of the person Telephone no.:

filling in the application form:
I am aware that the visa fee is not refunded if the visa is refused.
Applicable in case a multiple-entry visa is issued:
I am aware of the need to have 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 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 application; and any personal
data concerning me which appear on the application form, as well as my fingerprints and my photograph will be supplied to the
relevant authorities of the Member State and processed by those authorities, for the purpose of a decision on my 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) for a maximum period of five years, during which it
will be accessible to the visa 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 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
the prevention, detection and investigation of terrorist offences and of other serious criminal offences. The authority of the Member State
responsible for processing the data is the Ministry of Foreign Affairs and International Cooperation (Piazzale della Farnesina 1,
00135 – Roma, website:
www.esteri.it – e-mail: dgit6@esteri.it).

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 which
transmitted the data, and to request the 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 Member State concerned. The Italian national supervisory authority competent for the protection of
personal data is the Guarantor for the Protection of Personal Data (Piazza di Montecitorio 121, 00186 Roma,
www.garanteprivacy.it, tel. +3906 696771) which will hear claims concerning the protection of personal data. The national
supervisory authority of that Member State 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 6(1) of Regulation
(EU) 2016/399 (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.

Place and date: Signature of applicant:

(signature of parental authority/ legal guardian, if applicable)