N°14076*01 ApplicationforSchengenvisaPHOTO This application form is free Forofficialuseonly1. Surname (Family name) (x) Date of application : 2. Surname at birth (Former family name(s)) (x) Visa application number : 3. First name(s) (Given name(s)) (x) File handled by : 4. Date of birth 5. Place of birth : 7. Current nationality : (day month year) 6. Country of birth : Nationality at birth, if different: : Application lodged at : □ Embassy/consulate 8. Sex 9. Marital Status □ CAC Single Married Separated Divorced Widow(er) □ Service provider Male Female □ Commercial intermediary Other (please specify) □ Border 10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parental authority/legal guardian Name : □ Other 11. National identity number, where applicable : 12. Type of travel document Supporting documents : Ordinary passport Diplomatic passport Service passport Official passport Special passport □ Travel document Other travel document (please specify) : □ Means of subsistence □ Invitation 13. Travel document number 14. Date of issue 15. Valid until 16. Issued by □ Means of transport □ TMI □ Other: 17. Applicant's home address and e mail address Telephone number(s) Visa decision : □ Refused □ Issued : 18. Residence in a country other than the country of current nationality □ A □ C No Yes : Residence permit or equivalent N°………………….…….……Valid until………………..…. □ LTV * 19. Current occupation □ Valid : From………………………… * 20. Employer and employer's address and telephone number. For students, name and address of educational establishment. Until…………………………. Number of entries : □ 1 □ 2 □ Multiple 21. Main purpose(s) of the journey : Tourism Business Visiting family or friends Cultural Sports Official visit Study N
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