大溪地表格签署（此页不用打印,打印第二页签字就可以）

大溪地格签署（此页不用打印,打印第二页签字就可以） 大溪地表格签署(此页不用打印，打印第二页签字就可以) 请在第二页表格第37项和表格最后一行签名(需本人签名且尽量与护照上签名保持一致，不能代签，不能 涂改。) 34. Personal data of the family member who is an EU, EEA or CH citizen 家庭成员为欧盟、欧洲经济区或瑞士公民，请填上其个人资料 Surname First name(s) 姓氏 名字 Date of birth / 出生日期 Nationality / 国籍 Number of travel document or ID card 旅行证件或身分证编号 35. Family relationship with an EU, EEA or CH citizen 申请人与欧盟、欧洲经济区或瑞士公民的关系 spouse child …….………………………. grandchild dependent ascendant 配偶 子女 孙儿女 受养人 36. Place and date / 地区 及 日期 37. Signature (for minors, signature of parental authority/legal guardian) 签署(未成年人由其监护人代签) I am aware that the visa fee is not refunded if the visa is refused / 本人知道即使签证被拒也不能退还签证费 Applicable in case a multiple-entry visa is applied for (cf. field No24): / 适用于申请多次入境签证 (参照字段 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 Status. 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 am aware of and consent 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 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) (1) for a maximum period of five years, during which it will be accessible 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 fulfill 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: Commission Nationale de l'Informatique et des Libertés – 8, rue Vivienne – 75083 PARIS cedex 02 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 and of the Member State which transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data relating to me processing 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 State concerned. The national supervisory authority of that Member State (Commission Nationale de l'Informatique et des Libertés – 8, rue Vivienne – 75083 PARIS cedex 02) will hear claims concerning the protection of personal data. I declare that to the best of my knowledge all particulars supplied by me are corrected and completed. 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 5(1) of Regulation (EC) No 562/2006 (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. 我知道并同意以下条款:必须提供本签证申请表上所收集的数据，包括我的照片、以及指纹样本，用作核实我的签证申请。本签证申请表上关于 我的任何个人资料，包括我的照片、以及指纹样本，将被提交给有关申根国家的相应机构，以便用于审理我的签证申请。 此数据将会连同有关申请的批核决定以及废除、取消或延长已发签证的决定，一并输入在签证信息系统(VIS)(1)并储存最长五年，其间各签证部 门 、于各申根国边境及境内执行签证检查的法定部门、各申根国的移民局以及难民部门都有权使用有关数据，作为审查该人士是否符合资格合法 进入、逗留、或居住于申根国境，作为识别不符合或不再符合资格的人士，以及作为审查难民申请和决定负责机关谁属。于某些情况下，该数 据将被开放予各申根国的特定部门以及欧盟警察组织，作为预防、侦查和研究恐怖袭击及其它严重罪案。负责处理数据的申根国部门是:法国国 家信息和自主权委员会– 8, rue Vivienne – 75083 PARIS cedex 02。 当我的数据被错误更改以及该数据被不合法地删除，我知道自己有权向输入本人数据至签证信息系统、传输有关我的数据、或要求取得有关我的 资料的申根国取得通知。如我明确请求，对我的申请进行审理的使领馆会通知我，以何种方式可以行使核查有关我的个人资料并依据有关国家 法 律规定更改或消除错误数据、以及取得赔偿的权利。该申根国的国家监督部门(法国国家信息和自主权委员会– 8, rue Vivienne – 75083 PARIS cedex 02)将会听取保障个人资料的要求。 我声明，就我所知，我提供的一切数据都是正确和完整的。我知道，任何虚假陈述都将导致拒绝签证或已发签证的废止，也可以根据对我的申请 进行审理的申根国家的法律规定进行刑事追究。 如果签证申请被批准，我保证在签证到期前离开申根国家领土。我获悉，拥有签证只是进入欧洲申根国家领土其中的一个条件，如果没有履行 欧 洲共同体公约562/2006之第五条第一款规定的条件而被拒绝入境，那么仅仅拥有签证并不意味着我有权就此要求赔偿。在进入欧洲申根国家 的领 土时，入境条件将被再次审查。 Signature (for minors, signature of parental authority/legal guardian) Place and date / 地区 及 日期 签署(未成年人由其监护人代签) (1) In so far as the VIS is operational