申根签证申请表

申根签证申请表 BOT Application for Schengen Visa 申根簽證申請表格 ( 請用英文填寫) Photo 照片 This application form is free 1. Surname(s) (family name(s)) 姓 簽證機構專用欄 FOR EMBASSY / CONSULATE USE ONLY 2. Surname(s) at birth (earlier family name(s)) (原始姓: 冠夫姓前或被收養前等…) Date application : 3. First names (given names) 名 4. Date of birth (year-month-day) 出生日期 (年/月/日) 5. ID-number 身分證號碼 File handled by : 6. Place and country of birth 出生地及國家 Supporting documents: 7. Current nationality/ies 目前國籍 8. Original nationality (nationality at birth) 原始國籍 Valid passport Financial means 9. Sex 性別 10. Marital status 婚姻狀況 Invitation Means of transport Male 男性 Single 單身 Married 已婚 Separated分居 Health insurance Divorced 離婚 Widow(er) 鰥寡 Other 其他 Female 女性 Other : 11. Father’s name 父親姓名 12. Mother’s name 母親姓名 13. Type of passport 護照種類 National passport (普通護照) Diplomatic passport Service passport Travel document (1951 Convention) Alien’s passport Seaman’s passport Other travel document (please specify): …………………………………………………………………………………….… 14. Number of passport 護照號碼 15. Issued by 發照機構 16. Date of issue 發照日 17. Valid until 效期截止日 18. If you reside in a country other than your country of origin, have you permission to return to that country? 若你現居住在非原國籍地,你有再入境的許可嗎? (居住在台灣的國人免填) No Yes (number and validity) ……….……………………………………………………….. * 19. Current occupation 職稱 Visa : * 20. Employer and employer’s address and telephone number. For students, name and address of school. Refused 公司名稱,地址,電話 / 學校名稱和校址 Granted Characteristics of Visa : 21. Main destination 主要行程國家 22. Type of Visa 簽證種類 23. Validity of visa 簽證效期 LTV A , Airport transit機場轉機簽證(不入境) , One month 一個月 , Transit過境入境簽證 (轉機因素) , Three month 三個月 B , Short stay 短期簽證 , Six month 六個月 C , Long stay長期簽證 (半年內停留90天 , One year 一年 D 以上) , Individual 個人 D + C 24. Number of entries requested 入境次數 25. Duration of stay Number of entries : Visa is requested for: ______ days 申請停留天數 Single entry Two entries Multiple entries 26. Other visas (issued during the past three years) and their period of validity. 過去三年內曾有其他簽證及其效期. 1 2 Multiple Valid from ……………….. 27. In the case of transit, have you an entry permit for the final country of destination? 如在比利時轉機是否持有目的國之入境許可? To ………………………… No無 Yes有, valid until有效期限 Issuing authority發證機構 Valid for : * 28. Previous stays in this or other Schengen states 上一次停留在比利時或其他申根國家的時間 ……………………………. * The questions marked with * do not have to be answered by family members of EU or EEA citizens (spouse, child or dependent ascendant). Family members of EU or EEA citizens have to present documents to prove this relationship. *註記之問題,EU親屬或EEA居民不需要回答。(請另附親屬關係證明文件: 29. Purpose of travel 停留目的 簽證機構專用欄 Tourism旅遊 Business商務 Visit to Family or Friends探訪親戚,朋友 Cultural/Sports文化/運動 FOR EMBASSY / CONSULATE USE ONLY Official 公務 Medical reasons醫療 Other (please specify)其他(請說明) ……………………….………….. * 30. Date of arrival 入境日期 *31. Date of departure 出境日期 33. Means of transport 交通工具 * 32. Border of first entry or transit route 入境第一站或過境途徑 * 34. Name of host or company in the Schengen states and contact person in host company. If not applicable, give name of hotel or temporary address in the Schengen states 在申根國聯絡的公司及聯絡人/或居住的旅館/或臨時聯絡的地址 Name 名稱 Telephone and telefax電話/傳真 Full address 詳細地址 e-mail address 電子信箱 * 35. Who is paying for your cost of travelling and for your costs of living during your stay? 旅費來源 Myself 自備 Host person/s 受訪者 Host company. (State who and how and present corresponding documentation): 受訪公司(註明姓名及財力證明,另附公司邀請文件) ………………...……………………………. …………………………………………………………………………………………………………………… * 36. Means of support during your stay 停留期間費用 Cash 現金 Travellers' cheques旅行支票 Credit cards信用卡 Accommodation已有住宿證明 Other其他 Travel and/or health insurance旅行或健康保險 Valid until (效期) ….…..……………………… 37. Spouse’s family name 配偶姓氏 38. Spouse’s family name at birth配偶婚前的姓氏 39. Spouse’s first name 配偶名字 40. Spouse’s date of birth 41. Spouse’s place of birth 配偶出生日期 配偶出生地 42. Children (Applications must be submitted separately for each passport) 子女 (每本護照必須個別提出申請) Name 姓 First name 名 Date of birth出生日期 1 2 3 43. Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens. EU或EEA親友資料。 僅供EU或EEA居民之親屬填寫 Name 姓 First Name 名 Date of Birth 出生日期 Nationality 國籍 Number of passport 旅行社送件章蓋章處 護照號碼 Family relationship :申請者與EU或EEA居民之親屬關係 (稱謂) of an EU or EEA citizen 44. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in the Schengen states and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states. At my express request, the consular authority processing 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 altered or deleted, in particular, should they be inaccurate, in accordance with the national law of the state concerned. 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 Schengen state which deals with the application. I undertake to leave the territory of the Schengen states upon 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 Schengen 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 the Schengen Implementing Convention and am thus refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Schengen states. 本人同意申請表所列之個人資料,若有必要,得轉傳其他申根會員國家簽證機構,以核發簽證。 依比利時法規,簽證審核期間,申請者得要求簽證單位告知其權利,修正或刪除個人資料檔,尤以個人資料發生錯誤時。 本人保證在此申請表所填寫之資料真實無誤;本人瞭解若有任何不實資料將導致簽證申請被拒絶,已持有之簽證亦將被取消並擔負法律責任。本人保證在簽證效期期滿前離開簽證適用國。本人瞭解持有簽證只是入境之先決條件,若被拒絶入境,將不得要求賠償。 45. Applicant’s home address 申請者住家地址 46. Tel. No電話號碼 統一編號: 47. Place and date 申請地點及日期 聯絡人: 48. Signature (for minors, signature of custodian / guardian) 申請者親自簽名(需 與護照同) / 未成年者由監護人代簽 電話: *註記之問題,EU親屬或EEA居民不需要回答。(請另附親屬關係證明文件: *註記之問題,EU親屬或EEA居民不需要回答。(請另附親屬關係證明文件: