申根签证申请表-短期签证申请表原件

This application form shouldbe filledout inEnglish此表格必须以英文填写PHOTO表头请自行删除照片★★★★★Schengen VisaApplication form★★申根签证申请表★★This applicationform isfree★★★此表格免费提供

1.Surname Familyname x姓签证机关For officialuse only专用

2.Surname atbirth Formerfamily name s x出生时姓氏Date ofapplication:

3.First names Givennamesx名Visa applicationnumber:

4.Date ofbirth day-month-year出生日

5.Place ofbirth/出生地

7.Current nationality/现国籍Application lodgedat期日-月一年□Embassy/ConsulateNationality atbirth,if different:出生□CAC

6.Country ofbirth/出生国时国籍，如与现国籍不同□Service providerCommercialintermediary

8.Sex/性别

10.In thecase ofminors:Surname,first name,address ifdifferent fromapplicants andnationality ofparental authority/legalguardian/未成年申请人须填上合法监护人的姓名、住址如与亩请人不同、及国籍File handledby:

11.National identitynumber,where applicable身份证号码，如适用Supporting documents:□Travel document

13.Number oftravel document

14.Date ofissue签发日期

15.Valid until有效期至

16.Issued by签发机关旅行证件编号

17.Applicants homeaddress and e-mail address申请人住址及电子邮件Telephone numbers电话号码Visa decision:□Refused□Issued□A

19.Current occupation现职业*

21.Main purposes of thejourney:旅程主要目的Number ofentries:□Tourism/旅游□Business/商务口Visiting Familyor Friends/探亲访友□1□2□Multiples□Cultural/文化□Sports/体育□Official visit/官方访问Number ofdays:□Medical reasons/医疗口Study/学习□Transit/过境□Airport transit/机场过境□Other pleasespecify/其它请注明x Fields1-3shall be filled inaccordance withthe datain thetravel document字段1-3须依据旅行证件填上相关资料

22.Member State sof destination/申根目的地

23.Member Stateof firstentry/首入申根国

24.Number ofentries requested申请入境次数

25.Duration of the intendedstay ortransit Indicatenumber ofdays□Single entry/一次口Multiple entries/多次预计逗留或过境日数□Two entries/两次The fieldsmarked with*shall notbefilledby family members of EU,EEA orCH citizensspouse,child ordependent ascendantwhile exercisingtheir right to freemovement.Family membersofEU,EEA orCH citizensshall presentdocuments toprove thisrelationship andfill in fields No34and

35.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

29.Intended dateof arrivalin theSchengen area预定入境申

30.Intended dateof departurefrom theSchengen area预定离开申根根国日期国日期*

31.Surname andfirst name of theinviting person s in the Member States.If notapplicable,name ofhotel sor temporaryaccommodation s in the Member States s申雇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Address ande-mail address of invitingpersons/hotel s/temporary Telephone and telefax电话及传真号码accommodations邀请人/酒店/暂住属所的地址及电字邮件*

32.Name andaddressofinviting company/organization邀请公司或机构名称及地Telephoneandtelefax ofcompany/址organisation邀请方电话及传真号码Surname,first name,address,telephone,telefax,ande-mail addressof contactperson incompany/organisation邀请公司/机构的联系人姓名、地址、电话、传真及电子邮件*

33.Cost oftraveling andliving duringthe applicantsstay iscovered旅费以及在国外停留期间的生活费用□by theapplicant himself/herself/由申请人支付by asponsor host,company,organisation,pleaseSpecify/由赞助人邀请人、公司或机构支付，请注明Means ofsupport/支付方式□referred toinfield31or32/参照字段31及32□Cash/现金L otherpleasespecify/其它请注明□Travellers cheques/旅行支票Means ofsupport/支付方式□Credit card/信用卡□Cash/现金Prepaid accommodation/预缴住宿Accommodation provided/提供住宿□Prepaid transport/预缴交通All expensescovered duringthe stay/支付旅程期间□Other pleasespecify/其它请注明所有开支□Prepaid transport/预缴交通□Other pleasespecify/其它请注明

34.Personal dataof thefamilymemberwho isan EU,EEA orCH citizen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 Firstnames姓名Date ofbirth/出生日期Nationality/国籍Number oftravel documentor IDcard旅行证件或身分证编号

36.Place anddate/地区及日期

37.Signature forminors,signature ofparental authority/legal guardian签字未成年人由其监护人代签I amaware thatthe visafee isnot refundedif the visa isrefused/本人知道即使签证被拒也不能退还签证费Applicable incase amultiple-entry visais叩plied forcf.field No24:/适用于申请多次入境签证参照字段24I amaware of the needto havean adequatetravel medicalinsurance formy firststay and any subsequentvisits to the territory of MemberStatus.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I amaware ofand consentto thefollowing:the collectionof the data requiredby thisapplicationformand the taking of my photographand,if applicable,thetakingoffingerprints,are mandatoryfor theexamination of the visa application;andanypersonal dataconcerning mewhich appearon thevisaapplicationform,as wellas myfingerprintsand myphotograph will be suppliedto the relevant authoritiesof the Member States and processedby thoseauthorities,for thepurposes ofa decisionon myvisaapplication.Such dataas wellas dataconcerning thedecision takenon my application ora decisionwhether toannul,revoke orextend a visa issuedwill beentered into,and storedin theVisaInformation SystemVISfor amaximum periodof fiveyears,during whichit willbe accessibleto thevisa authoritiesand theauthorities competentfor carryingoutchecks onvisas atexternal bordersand withinthe Member States,immigration andasylum authoritiesinthe Member Statesfor thepuiposes ofverifying whethertheconditions for the legalentry into,stay andresidence onthe territory of the Member Statesare fulfilled,of identifyingpersons whodo notor whono longerfulfill theseconditions,of examiningan asylumapplication and of determiningresponsibility forsuch examination.Under certainconditions the data willbe alsoavailable todesignatedauthorities ofthe Member Statesand to Europolforthepurposeofthe prevention,detection andinvestigation ofterrorist offencesandofother seriouscriminal offences.Theauthority ofthe MemberState responsiblefor processingthedatais Urzgdds.Cudzioziemcow TheOffice forForeigners,address:16Koszykowa St.,00-564Warsaw.I amaware that I havethe rightto obtainin anyoftheMemberStatesnotification ofthedata relating to me recordedinthe VIS andoftheMemberState which transmittedthedata,andtorequest that datarelating tomewhich areinaccurate becorrected andthatdatarelatingtome processingunlawfully bedeleted.At myexpress request,theauthority examiningmy applicationwill informmeofthe mannerin whichI mayexercise myrighttocheck thepersonal dataconcerning meand havethem correctedordeleted,including therelated remediesaccording tothe nationallaw ofthe Stateconcerned.The nationalsupervisory authorityof thatMemberStatewill hearclaimsconcerning theprotection ofpersonal data:Inspector GeneralfortheProtection ofPersonal Data,2Stawki St.,00-193Warsaw.I declarethat tothe bestofmyknowledge allparticulars suppliedby meare correctedand completed.I amaware thatany falsestatements willlead tomyapplicationbeingrejected ortotheannulment ofa visaalready grantedand mayalso renderme liableto prosecutionunder thelaw oftheMemberStatewhichdeals withthe application.I undertaketo leavethe territoryoftheMemberStatesbefore theexpiry ofthevisa,if granted.1have beeninformed thatpossession ofa visais onlyone ofthe prerequisitesforentry intothe EuropeanterritoryoftheMemberStates.The merefact thatavisahas beengranted tome doesnot meanthatIwillbeentitled tocompensation ifI failtocomply withtherelevantprovisions ofArticle51of RegulationEC No562/2006Schengen BordersCode andI amtherefore refusedentry.The prerequisitesfor entrywillbe checkedagain onentry intothe EuropeanterritoryoftheMemberStates.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1VTS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Urzqd doSpraw Cudzoziemcow,ul.Koszykowa16,00-564Warszawa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Generalny InspektorOchorny DanychOsobowych,ul.Stawki2,00-193Warszawa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款中所述前提条件而被拒绝入境，本人不得要求赔偿在进入中根成员国的领土时，入境条件将被再次审核Place anddate/地区及日期Signature forminors,signature ofparental authority/legal guardian签字未成年人由其监护人代签IIn sofar astheVISis operational。