Application for Schengen Visa cipatahrenbeen Sons ‘Schengen Vizesi Bagvuru Formu ~ ia THiS APPLICATION FORM IS FREE BUFORM UCRETSUOR fi. SURNAME(S) Family name(s) RT OSETIA Soyadinz . SURNAME(S) Family Names given at birth Dato of aplication: Kick soyadinz veya varse eski soyediniz FIRST NAME(S) File handled by ‘Adin, varsa Kini adie ff. DATE OF BIRTH (Year-Month-Day) 15-1 CARD NUMBER (optional Dogum tathiniz(YirAy-Gin) Kimlik No. (steitéiginde) PLACE AND COUNTRY OF BIRTH Dogum yeriniz (yer ve ike) ‘Supporting documents i7. NATIONALITY - Current NATIONALITY - Original (at birth) {vata passport TabiyetnziTabyetiriniz Varsa esk!tabiyettriniz (dogumla sahip olunan) rancainesre tation Clteansoftanspont iLSEX (0. MARITAL STATUS (sath insurance Cinsiyetinz eden! durumunuz other COMALE/erkek — OFEMALE/Kadin Lisinglotbekar Cl Separeteclayn yepevan Widower SMairediewi — CIDWerceatboganms 1 otnerdgens lit. FATHER'S NAME [fa MOTHER'S NAME abana act ‘Annenizin ad iS. TYPE OF PASSPORT: Vie PPasaportun tr ratuses INATIONALINormal OIPLOMATICDiplomatk —-CISERVICEIMiamet__COALIENS/Yabanclara Cieraned [CISEANAN'SDerizsi CITRAVEL DOCUMENT (1851 Convention/Seyanat pasaport (1951 tt nigra fz eden [CloTHER TRAVEL DOCUMENT (cease spect¥Digerseyahal beigeer (itn agklayna) CChoractratios of Visa: 4. PASSPORT NO. 11S. NAME OF ISSUING COUNTRY OR AUTHORITY uv Pasaport No. Veren makam Oa Os Oe WG, DATE OF ISSUE 7. VALID UNTIL ce ‘Ver tari Pasaport os tarhine kadar gegertdr Bo+e [i8 Ifyou reside in @ country other than your country of origin, have you permission to retum fo that | Number of entries county? - D1 D2 Dmutipe atandasiigna sahip oldugunuz dike sian diginda bir Ukede yasiyorsant, bu Ukeye dénme iininiz var mi? (No! Haye C1 YES! Evet- (Number and Vay) (nfhametbeigasinin numa: ve geperi tart) pea te 79. CURRENT OCCUPATION ‘Su anki giz Te: "20. EMPLOYER AND EMPLOYER'S ADDRESS AND TEL NO (For siudona name and address o Schoo) Ivereninizin adresi ve telefon numarasi (Universite Ogrencier cin: denim Kurumunun adl ve adres!) Vali for: 7 YI Ran ERUREOGD wor Apa BT vaya Ava Ehononik BRIGEH [EWR] vandals ae Breve (es Goouk veya Dasoyia bad ‘Hu arabs) cevapiamek yorunds degiay.Avrupa Bil vey Aviupa Exoramik SBiges! (EWR) vatancagarnn ale evi, akraalk ans boialr,kantamak zoundade.i. WAIN DESTINATION Gideoaginz Schengen Ukesi Vize tre Bz TYPE OF VISA Airport transit! Havaslan varie Trane Transit C short stey Kise ebre kag Cltong stay Uzun sel alg 23. VISA Vie Dinca Tek vice Ci collective! Tops vice a, NUMBER OF ENTRIES REQUESTED Talep eden gig says) 1 SINGLE ENTRY! Tek or D TWo ENTRIES ai (Cl MULTIPLE ENTRIES! Goku gig 3. DURATION OF STAY Kaligstresi v ls requested for: ays Vize __ i gin talep oats 16. OTHER VISAS (coved during tho past tires years) AND THEIR PERIOD OF VALIDITY ‘Alman diger vizeler (gegen Og yl inde) ve bunlann gegerlilk surelert {suing Authonty!Veren maka: [27 In the case of transit, have you an entry permit for the final country of destination? Transit geo yapacaksanz, gidecepiniz Uke icin gi izniniz var mi ? No! Haye YES! Eve ~ valid nt tains kadar gegen: "28. Previous stays in this or other Schengen States Gideceginiz ikede veya diger Schengen Uikelerinde daha éncekl Kalislaninzin /kameternzin tanhler 9. PURPOSE OF TRAVEL ‘Seyahatinzin amacr 1 TOURISM) Turistkgezi Cl BUSINESS! geist VISIT TO FAMILY or FRIENDS) Ale vay arkadag yret 1D OTHER (pieasespeciyy Diper amare (ten acklayna CD CULTURAL-SPORTS) Kira Spor amagh OFFICIAL Reemi gexi 1D MEDICAL REASONS! Sadik nodenieri "30. DATE OF ARRIVAL Varig tarhinie “1. DATE OF DEPARTURE Danis tarhiniz *Yikizgarani (Bundy cord, Avass BG veya Avtups Exnonik Bagel (EWR) valanaaganinn aa Brava (E, co vaya Toy ‘ldo akrabalar) cevaplamatyorunsa del. AviUpa Bet veya Avrupa Exonomk Balge! [EWR] vtandaglrnin al Steve, akvablk hg beget, kantamak tonndadi bagi"32. BORDER OF FIRST ENTRY or transit route 3. INTENDED MEANS OF TRANSPORT GGirg yaplacak /vansit gegilecek ik sir Seyahat edecediniz arag "34, NAME OF HOST OR COMPANY] CONTACT PERSON IN SCHENGEN STATES AND CONTACT PERSON IN HOST COMPANY If not applicable, give name of Hotel or temporary address in the ‘Schengen States. Schengen tikesinde davet eden Kg! fima/ kurumun adi ve davet eden fima ! kuruméaki muhatabiniz. Sayet bu blgiler mevcut degise, kalinacak otelin adi veya Schengen Ukesindek’ gacicl adresiniz NAME Telephone and Fax lig kiginin a ve soyadt Telofon ve faks numarast FULL ADDRESS [e-mail address ‘Agik acres Je-posia adresi "35. WHO IS PAVING FOR YOUR COST OF TRAVELLING AND FOR YOUR COSTS OF LIVING DURING YOUR STAY? Seyahat ve yuri kalig masrafiannzi Kim Gstlenecek ? 1D mySeLe; Kenai 1D Host PERSON'S’ Davet econ kivgler 1D Host COMPANY! Davet eden frma kara Stat who and how and present corresponding dacumentation! Kin vane gekide Ustenge laten agkiaynz ve ger belgelen exten 36. MEANS OF SUPPORT during your stay ‘Yurtiginda keldiginz dénemde gogiminizi nasil temin edeceksinz cass Nakt pr (CI TRAVELLERS’ CHEQUES! ayahat gk Cl cREDI CARDS! Kiet kat Cl AccoMMODATION! Kaisatinz yer Comer: oer (CI TRAVEL andlor HEALTH INSURANGE:Seyahat ve / vey hastak igri (Walid unsvcoperit tari) 7. SPOUSE’S FAMILY NAME SPOUSE'S FAMILY NAME given at birth simian soyadl Esinlzn kzik soyedi 9. SPOUSE'S FIRST NAME fo. SPOUSE'S DATE OF J. SPOUSES PLACE OF Eginizin adi BIRTH BIRTH Esinizin dogum tain Eiaizin dogum yer }i2. CHILDREN (Applications must be submitied separately Tor each passport) ocular (Her pasaport icin ayn bir miracat formu doldurulmalir) NAME FIRST NAME DATE OF BIRTH NATIONALITY Soya a gum tah Tabet *Yidizpratnn 7) baundugu soar, Rurupa Bi veya raps Exenomik Bligeai (EWA) valandapiannn ale Weve (6 Oa veya Ussayda baal ‘ldo akrabalr) covaplomak yorunda deg Avupa Bl veya Avtupa Ekonomi Balge! (EWR) atandsglarn ale\Sreye,abvabali tte! begeel,kanitamak zorunaaai'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 cttzens. Begum oldugunuz Avrupa Birligi ve Avrupa Ekonomik Bélgest (EWR) vatandagi olan kigiye alt bill. ‘Bu bolim, sadece Avrupa Bill veya Avrupa Ekonomik Béigesi (EW) vatandaginmn aie bireytrafindan cceveplandinlacaktr WANE TRST NAME Soyedi i DATE OF BIRTH IATIONALITY PASSPORT NO. ogum tai rabiyet PPasaport numarast FAMILY RELATIONSHIP OF AN EU OR EEA CITIZEN; ‘Avrupa Bitigl veya Avrupa Exonomik Bblges! (EWR) vatandas: le akrabalk dereceni: ws. {am aware of and consent to the following: any personal data concerning me which appest on this visa application form wil be supll tothe relevant authorles inthe Schengen States and processed by those athortles, necessary, for the purposes of deision on my visa aplication. Such data may be Input into, and stored in, databases aceeselbie to ‘the relovant authorities inthe various Schengen Siates. [Aimy express request, the consular authority processing my aplication wll inform me ofthe manner in which | may ‘exercise my right to check the parsoral data concerning me and have them altered or deleted, In particular, should toy be naceurate, in eccordance withthe national law ofthe State concerned. "octare that to th best of my knowiodge al particulars supplied by me are correct and compete {am aware that any fale statements wl lead to my applieation boing rected or tothe annuiment of vee already ‘ranted and may alco render mo Hable to prosecution under the law ofthe Schengen State which dais withthe pplication undertake to leave the trcitory ofthe Schengen States upon the exply ofthe vis, If granted {Ihave been Informed tht possession ofa visa te only ono ofthe prerequisite fr en into the European terror ofthe ‘Schongon Statas. The mere fact that a visa has bean granted to me does not mean that | wl be ented to compensation {i falte comply with the relevent provisions of Arle 54 ofthe Schengen implementing Convention an am th refused entry. The prerequisites for entry wil be checked again on enty ino the European tertory f the Schengen ‘States, u miracaatformunda gahsima ait 6ze bilglerin diger Schengen-Devieternin yeti makamlarina da etlocesinden ve gerokiginde bu makamlartarafindan mOracaatimia gil glem yapmak dzere uilamlablecaginden haberderm ve bunw kabul ediyorum. Sdz konusu bilgier, her Schengen-Devetin yet ‘akamlan tarafindan kullaiian veri bankasina igenip s2kianeblir. Moraceatim! Kabul eden Konsolosluk, gah igri inceleyebilmem ve yanls bile iil devltin kendi Kanunlarina gBre dedistiebmem veya sidietilmem cin, dzet talebim Ozerine kanun haklarim Konusunda bana gerekr blgiy verecektr. MUracaat formunda yaptigim jeyanlarn dogru ve eksiksiz o'dugunu taahhGt ederim. Yanilg beyanlarin, miracastimin reddine veya verimig olan 2eniniptaline ve miracaatinslemin yapan Schengen-Devietinin mevzvatina gore cazal takbata neden abllecegini bilyorum. Vize veri takdirde, Schengen-Devieller sinvlanny, ve stres! bikin sonra terk fbsecegin!teahnat ederim. Schengen-Devieernin sinvlarindan giig yapabimek iin verien vizenin, gerekl josuilardan yanizca bir okdugu konusunda bigjlendirdim. Vizeni verimesine ragmen, Schengen Uygulama iagmasiin 5. maddesinn 1. satnndak! On kogullan yerine getimemam nedeniye,giisime izn verimemesi zminat talep etme hakkint dogumaz. Schengen-Devitlernin Avrupa bélgesine girs kogullan Schengen siurinda fenien incelenmektedr. iS. APPLICANT'S HOME ADDRESS s TELEPHONE NO. ‘Moracaat sahibinn Torkiye'deki adrest Telefon numarast 7. PLACE AND DATE 8. APPLIGANT'S SIGNATURE (Tor minors, signature of ‘Yer ve tain ccustodianiguardian) Imza (eit olmayantarin yer vel | vasi imzalayacaktr)