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1、 N 14076 01 The fields marked with do not need to 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
2、 34 and 35 x Fields 1 3 shall be filled in in accordance with the data in the travel document 1 Surname Family name x 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 Nationality at birth
3、if different 8 Sex Male Female 9 Marital Status Single Married Separated Divorced Widow er Other please specify 10 In the case of minors Surname first name address if different from applicant s and nationality of parental authority legal guardian 11 National identity number where applicable 12 Type
4、of travel document Ordinary passport Diplomatic passport Service passport Official passport Special passport Other travel document please specify 13 Travel document number 14 Date of issue 15 Valid until 16 Issued by 17 Applicant s home address and e mail address Telephone number s 18 Residence in a
5、 country other than the country of current nationality No Yes Residence permit or equivalent N Valid until 19 Current occupation 20 Employer and employer s address and telephone number For students name and address of educational establishment 21 Main purpose s of the journey Tourism Business Visiti
6、ng family or friends Cultural Sports Official visit Study Medical reasons Transit Airport transit Other please specify 22 Member State s of destination 23 Member State of first entry 24 Number of entries requested Single entry Two entries Multiple entries 25 Duration of the intended stay or transit
7、Indicate number of days 26 Schengen visas issued during the past three years No Yes Date s of validity 27 Fingerprints collected previously for the purpose of applying for a Schengen visa No Yes Date if known 28 Entry permit for the final country of destination where applicable Issued by valid from
8、until For official use only Date of application Visa application number File handled by Application lodged at Embassy consulate CAC Service provider Commercial intermediary Border Name Other Supporting documents Travel document Means of subsistence Invitation Means of transport TMI Other Visa decisi
9、on Refused Issued A C LTV Valid From Until Number of entries 1 2 Multiple Number of days Application for Schengen visa This application form is free PHOTO ZHOU JIMIN 23 12 1993 HENAN UNITED KINGDOM CHINA CHINA X X X E4374764915 02 201514 02 2025 CHINA 495 505 BRISTOL ROAD BIRMINGHAM B29 6AU ZYS0831
10、163 COM 447843821694 XRD756100419 01 2018 STUDENT UNIVERSITY OF BIRMINGHAM EDGBASTON BIRMINGHAM B15 2TT 441214143344 X FRANCEFRANCE X 6 X X 29 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
11、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 organisati
12、on 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 by the applicant himself herself Means of support Cash Traveller s cheques Credit card Pre paid accommodation Pre paid
13、transport Other please specify by a sponsor host company organisation Please specify referred to in field 31or 32 other please specify Means of support Cash Accomodation provided All expenses covered during the stay Pre paid transport Other please specify 34 Personal data of the family member who is
14、 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 child grandchild dependent ascendant 36 Place and date 37 Signature for minors signature of parental authority legal guardian I am a
15、ware 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 con
16、sent to the following the collection of the 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 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 of the Member States and processed by those authorities for the purposes of a decision on my visa application Such
