APPLICATION FOR SCHENGEN VISA

PHOTO THIS APPLICATION FORM IS FREE

1. Surname (Family name) (x) 2. Surname at birth (Former family name(s)) (x) /. First name(s) (0i%en name(s)) (x) 1. Date of birth (day2month2year) 3. 4lace of birth 5. $ountry of birth 6.$urrent nationality 'ationality at birth7 if different:

FOR OFFICIAL USE ONLY Date of application: Visa application number:

8. Sex ! *ale ! Female

9. *arital status ! Sin le ! *arried ! Separated ! Di%orced ! :ido;(er) ! (ther (please specify) 1<. +n the case of minors: Surname7 first name7 address (if different from applicant=s) and nationality of 'ame: parental authority#le al uardian ! (ther 11. 'ational identity number7 ;here applicable

Application lod ed at ! "mbassy#consulate ! $A$ ! Ser%ice pro%ider ! $ommercial intermediary ! &order

File handled by: Supportin documents: ! )ra%el document ! *eans of subsistence ! +n%itation ! *eans of transport ! )*+ ! (ther:

12. )ype of tra%el document ! (rdinary passport ! Diplomatic passport ! Ser%ice passport ! (fficial passport ! Special passport ! (ther tra%el document (please specify) 1/. 'umber of tra%el document 11. Date of issue 13. Valid until 15. +ssued by

16. Applicant>s home address and e2mail address

)elephone number(s)

18. ,esidence in a country other than the country of current nationality ! 'o ! ?es. ,esidence permit or e@ui%alent AAAAAAA 'o. AAAAAAAA.. Valid until 1 19. $urrent occupation B 2<. "mployer and employer>s address and telephone number. For students7 name and address of educational establishment. 21. *ain purpose(s) of the Courney: ! )ourismAA.! &usinessAA.! Visitin family or friends A.! $ultural AA! Sports AA..! (fficial %isit ! *edical reasons ! Study ..! )ransit ! Airport transit ! (ther (please specify) 22. *ember State(s) of destination 2/. *ember State of first entry

Visa decision: ! ,efused ! ! ! ! +ssued: A $ -)V

! Valid: From .ntil 'umber of entries: ! 1 ! 2 ! *ultiple 'umber of days:

21. 'umber of entries re@uested ! Sin le entryA.! );o entries A.! *ultiple entries

23. Duration of the intended stay or transit +ndicate number of days

25. Schen en %isas issued durin the past three years ! 'o ! ?es. Date(s) of %alidity from AAAAAAA . to 26.Fin erprints collected pre%iously for the purpose of applyin for a Schen en %isa ! 'o AAAAAAAAAAAA! ?es. AAAAAAAAAAAAAA. Date7 if Dno;n 28. "ntry permit for the final country of destination7 ;here applicable +ssued by AAAAAAAAAAAA..Valid from AAAAAAAAAAuntil AAAAAAAAAAAAAAAAAA.

x 1

Fields 1-3 shall be filled in in accordance with the data in the travel document

The fields marked with * shall not be filled in by family members of EU, EEA or ! citi"ens #s$ouse, child or de$endent ascendant% while e&ercisin' their ri'ht to free movement( Family members of EU, EEA or ! citi"ens shall $resent documents to $rove this relationshi$ and fill in fields no 3) and 3*(

29. +ntended date of arri%al in the Schen en area

/<. +ntended date of departure from the Schen en area B /1. Surname and first name of the in%itin person(s) in the *ember State(s). +f not applicable7 name of hotel(s) or temporary accommodation(s) in the *ember State(s) Address and e2mail address of in%itin person(s)#hotel(s)#temporary accommodation(s) )elephone and telefax

B/2. 'ame and address of in%itin company#or anisation

)elephone and telefax of company#or anisation

Surname7 first name7 address7 telephone7 telefax7 and e2mail address of contact person in company#or anisation

B//. $ost of tra%ellin and li%in durin the applicant>s stay is co%ered ! by the applicant himself#herself ! by a sponsor (host7 company7 or anisation)7 please specify AA.! referred to in field /1 or /2 AA.! other (please specify) *eans of support ! $ash ! Accommodation pro%ided ! All expenses co%ered durin the stay ! 4re2paid transport ! (ther (please specify)

*eans of support ! $ash ! )ra%eller>s che@ues ! $redit card ! 4re2paid accommodation ! 4re2paid transport ! (ther (please specify)

/1. 4ersonal data of the family member ;ho is an ".7 ""A or $E citiFen Surname First name(s) Date of birth 'ationality 'umber of tra%el document or +D card

/3. Family relationship ;ith an ".7 ""A or $E citiFen ! spouse AAAAA..! child AA! randchild AAAAAA! dependent ascendant /5. 4lace and date /6. Si nature (for minors7 si nature of parental authority#le al uardian)

+ am a;are that the %isa fee is not refunded if the %isa is refused. Applicable in case a multiple2entry %isa is applied for (cf. field 'o 21): + am a;are of the need to ha%e an ade@uate tra%el medical insurance for my first stay and any subse@uent %isits to the territory of *ember States.

+ am a;are of and consent to the follo;in : the collection of the data re@uired by this application form and the taDin of my photo raph and7 if applicable7 the taDin of fin erprints7 are mandatory for the examination of the %isa applicationG and any personal data concernin me ;hich appear on the %isa application form7 as ;ell as my fin erprints and my photo raph ;ill be supplied to the rele%ant authorities of the *ember States and processed by those authorities7 for the purposes of a decision on my %isa application. Such data as ;ell as data concernin the decision taDen on my application or a decision ;hether to annul7 re%oDe or extend a %isa issued ;ill be entered into7 and stored in the Visa +nformation System (V+S) 2 for a maximum period of fi%e years7 durin ;hich it ;ill be accessible to the %isa authorities and the authorities competent for carryin out checDs on %isas at external borders and ;ithin the *ember States7 immi ration and asylum authorities in the *ember States for the purposes of %erifyin ;hether the conditions for the le al entry into7 stay and residence on the territory of the *ember States are fulfilled7 of identifyin persons ;ho do not or ;ho no lon er fulfil these conditions7 of examinin an asylum application and of determinin responsibility for such examination. .nder certain conditions the data ;ill be also a%ailable to desi nated authorities of the *ember States and to "uropol for the purpose of the pre%ention7 detection and in%esti ation of terrorist offences and of other serious criminal offences. )he authority of 0reece responsible for processin the data is: *inistry of $itiFen 4rotection7 0reeD 4olice7 +nternational 4olice $ooperation Di%ision7 /rd Di%ision S+,"'"7 Hanellopoulou 17 0,I 1<1 66 Athens7 )el.:J/<.21<.5966<<<7 Fax:J/<.21<.59296517 "mail: infoKsirene2 r.com + am a;are that + ha%e the ri ht to obtain in any of the *ember States notification of the data relatin to me recorded in the V+S and of the *ember State ;hich transmitted the data7 and to re@uest that data relatin to me ;hich are inaccurate be corrected and that data relatin to me processed unla;fully be deleted. At my express re@uest7 the authority examinin my application ;ill inform me of the manner in ;hich + may exercise my ri ht to checD the personal data concernin me and ha%e them corrected or deleted7 includin the related remedies accordin to the national la; of the State concerned. )he national super%isory authority of that *ember State LEellenic Data 4rotection Authority7 Hifisias str 12/7 1st floor7 0, I 113 2/ Athens7 )el.: J/<.21<.51635<<7 Fax:J/<.21<.51635287 "2 mail: contactKdpa. rM ;ill hear claims concernin the protection of personal data. + declare that to the best of my Dno;led e all particulars supplied by me are correct and complete. + am a;are that any false statements ;ill lead to my application bein reCected or to the annulment of a %isa already ranted and may also render me liable to prosecution under the la; of the *ember State ;hich deals ;ith the application. + undertaDe to lea%e the territory of the *ember States before the expiry of the %isa7 if ranted. + ha%e been informed that possession of a %isa is only one of the prere@uisites for entry into the "uropean territory of the *ember States. )he mere fact that a %isa has been ranted to me does not mean that + ;ill be entitled to compensation if + fail to comply ;ith the rele%ant pro%isions of Article 3(1) of ,e ulation ("$) 'o 352#2<<5 (Schen en &orders $ode) and + am therefore refused entry. )he prere@uisites for entry ;ill be checDed a ain on entry into the "uropean territory of the *ember States.

4lace and date

Si nature (for minors7 si nature of parental authority#le al uardian):

+n so far as the ,+- is o$erational(