申根国家签证申请表

申根国家签证申请 Stamp of authority issuing visa APPLICATION FOR SCHENGEN VISA Photo 申根国家签证申请表 (照片 This application form is free 此表格免费提供 1. Surname (s) (family name(s )) / 姓 For official use only: 用 仅供使馆使 Data z?o?enia 2. Surname(s) at birth (earlier family name(s)) / 出生时姓(原姓) wniosku: Przyjmuj?cy wniosek: 3. First name(s) / 名 4. Date of birth (year-month-day) / 出生日期 (年-月-5.Number of ID document (optional) / 身份证号码(如持有) Dodatkowe 日) dokumenty: 6. Place and country of birth / 出生地及国家 Wa?ny dokument podró?y 7. Current nationality/ies / 现属国籍 8. Original nationality (nationality at birth) / 原国籍 (出生所属国籍) ?rodki finansowe Zaproszenie ?rodek transportu 9. Sex / 性别 10. Marital status / 婚姻状况 Male / 男 Female / 女 Single / 未婚 Married / 已婚 Separated / 分居 Ubezpieczenie Divorced / 离异 Widow(er) / 丧偶 Other / 其它 zdrowotne Inne: 11. Father’s name / 父亲姓名 12. Mother’s name / 母亲姓名 Wiza: 13. Type of travel docum‎‎ent / 旅行证件类型 Odmowa National passport / 私人护照 Diplomatic passport / 外交护照 Service passport / 公务护照 Wydana Travel document (1951 Convention) / 旅行证件(1951年公约) Alien’s passport / 外国人护照 Seaman’s passport / 海员护照 Typ wizy: Other travel document (please specify)/ 其他旅行证件(请注明): .......................................................................................................................................... 14. Number of passport / 护照号码 15. Issued by / 颁发机关 LTV A 16. Date of issue / 颁发日期 17. Valid until / 有效期至 B C D 18. If you reside in a country other than your country of origin, do you have permission to return to that country? D+C 若您在非国,籍所属国家,居住～ 是否持有允,许返回该国,的许可证明,, No / 无 Yes (number and validity) / 有(号码及有效期) .................................................................. * 19. Current occupation / 现从事职业 * 20. Employer and employer’s address and phone number. For students, name and address of school / 工作单位的地址及电话, 或学生所在学校名称及地址 21. Destination country / 目的地国家 22. Type of visa / 签证类别 23. Visa / 签证 Ilo?? wjazdów: Airport / 机场过境 1 2 Individual / 个人签证 Transit / 过境 wiele Wa?na Short stay / 短期停留 Collective ........(how many persons) od ........................ /团体签证 …….(人数) Long stay / 长期停留 do .............................. ...... 24. Number of entries requested / 申请入境次数 25. Duration of stay / 停留时间 Single entry / 一次入境 Two entries /两次入境 Visa reque sted for / 申请签证__________ days / 天 Multiple entries / 多次入境 26. Other visas (issued within the past 3 years) and their period of validity / 其它签证 (最近三年內) 及有效期 Wa?na w: .................................... 27. If you are in transit, do you have an entry permit for the final country of destination / 如是过境,您是否有进入最终目的地国的入境许 可? No / 无 Yes, valid until / 有,有效期至: Issued by / 签发机关: * 28. Previous stays in the Republic of Poland or other Schengen states / 以前在波兰或其它申根国家逗留情况 * Questions marked with * may be omitted by family members of EU or EEA citizens (spouse, child, or dependent ascendant). Family members of EU or EEA citizens have to present documents proving this relationship. * 欧盟或欧洲经济区公民的家庭成员(配偶,子女或赡养的老人)不必回答带*问, 欧盟或欧洲经济区公民的家庭成员必须提交可证明其亲属关系的 文件. 29. Purpose of travel / 旅行目的 For official use only: Tourism / 旅行 Business / 商务 Visit to family or friends / 探亲访友 Cultural/Sports 文化/体育 仅供使馆使用 Official / 公务 Medical reasons / 医疗 Work /工作 Education / 教育 Other (please specify) / 其它(请注明): .................................................................................................................... * 30. Date of entry / 入境时间 * 31. Date of departure / 离境时间 * 32. Border of first entry or transit route / 首次入 * 33. Means of transport / 交通工具 境地或过境路线 * 34. Name of host person or company in the Schengen states and contact person in host company. If not applicable – name of hotel or temporary address in the Schengen states / 申根国家的邀请人或邀请公司名称及该公司联系人; 如不适用-请填写在申根国家居住的旅馆名称或暂住地址 : Name / 姓名或单位名称 Phone and fax/电话及传真 Full address / 详细地址 E-mail address / 电子邮件 * 35. Who is covering the costs of your travel and stay / 由谁承担您旅行及逗留的费用? Applicant / 申请人 Host person / 邀请人 Host company (Please specify who, how and enclose corresponding documentat‎‎ion) / 邀请公司 (请注明何人和如何支付,并出示相关材料).............................................................................................................................................. * 36. Means of support during your stay / 在国外逗留费用的支付方式 Cash / 现金 Travellers cheques / 旅行支票 Credit cards / 信用卡 Accommodation / 有住处 Other / 其它: Travel and/or health insurance. Valid unti / 旅行和/或医疗保险,有效期至l: ............................................................................... 37. Spouse’s family name / 配偶姓 38. Spouse’s family name at birth / 配偶原姓 41. Spouse’s place of birth / 配偶出生地 39. Spouse’s first name / 配偶名 40. Spouse’s date of birth / 配偶出生日 期 42. Children (application must be submitted separately for each passport) / 子女( 每本护照都须分别递交申请表) Surname / 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./ 凡涉及您依靠的欧盟或欧洲经济区公民的个人资料,就仅需与欧盟或欧洲经济区公民有亲属关系的申请人填写: Surname / 姓 First name / 名 Date of birth / 出生日期 Nationality / 国籍 Number of passport / 护照号码 Relationship of an EU or EEA citizen. / 与欧盟或欧洲经济区公民的亲属关系:……………………………………… 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. At my express request, the 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 Polish law. 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 Polish law. If a visa is granted, I undertake to leave the territory of the Schengen states not later than the last day of the visa’s validity. I am aware that possession of a visa is only one of the prerequisites for entry into the territory of the Schengen states. The 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 refused entry‎‎. The prerequisites for entry will be checked again on entry into the territory of the Schengen states. -我知道并同意以下条款:本签证申请表上关于我的任何个人资料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.此资料可以被输入并存储在申根国家的相关机构的数据库中,并由各申根国家的有关机构使用. 如我明确要求,对我的申请进行审理的使领馆应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的权利. 我声明,就我所知,我提供的一切资料都是正确和完整的. 我知道,任何虚假陈述都将导致拒绝签证或以颁发签证的废止,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, 我保证在签证到期时离开申根国家领土. 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.如果没有履行申根执行公约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,入境条件将再次受到审查. 45. Applicant’s home address / 申请人家庭住址 46. Telephone number / 电话号码 48. Signature (for minors, signature of custodian/guardian) 47. Place and date / 申请地点和日期 / 签名(未成年人须由其监护人代签)