Formular Za Vizu

Cslo zdosri / Applicarion numLer Cslo zdosri / Applicarion numLer Cslo zdosri / Applicarion numLer Cslo zdosri / Applicarion
numLer
SCF c. 1/2010 SCF c. 1/2010 SCF c. 1/2010 SCF c. 1/2010
Fjmen / Surname(s) (Family name(s)) Fjmen / Surname(s) (Family name(s)) Fjmen / Surname(s) (Family name(s)) Fjmen / Surname(s) (Family name(s))

Msro narozen / Flace of Lirrh Msro narozen / Flace of Lirrh Msro narozen / Flace of Lirrh Msro narozen / Flace of Lirrh
Srrn oLcansrv pi narozen (kd) / Original narionaliry (narionaliry ar Lirrh) (code) Srrn oLcansrv pi narozen (kd) / Original narionaliry (narionaliry ar Lirrh) (code) Srrn oLcansrv pi narozen (kd) / Original narionaliry (narionaliry ar Lirrh) (code) Srrn oLcansrv pi narozen (kd) / Original narionaliry (narionaliry ar Lirrh) (code)
Fohlav / Sex Fohlav / Sex Fohlav / Sex Fohlav / Sex
Osrarn jmena (dve uzvane() pjmen) / Surname(s) ar Lirrh (earlier family name(s)) Osrarn jmena (dve uzvane() pjmen) / Surname(s) ar Lirrh (earlier family name(s)) Osrarn jmena (dve uzvane() pjmen) / Surname(s) ar Lirrh (earlier family name(s)) Osrarn jmena (dve uzvane() pjmen) / Surname(s) ar Lirrh (earlier family name(s))
8. 8. 8. 8.
5. 5. 5. 5.
6. 6. 6. 6.
7. 7. 7. 7.
1. 1. 1. 1.
2. 2. 2. 2.
3. 3. 3. 3.
4. 4. 4. 4. Darum narozen (ddmmrrrr) / Dare of Lirrh (ddmmyyyy) Darum narozen (ddmmrrrr) / Dare of Lirrh (ddmmyyyy) Darum narozen (ddmmrrrr) / Dare of Lirrh (ddmmyyyy) Darum narozen (ddmmrrrr) / Dare of Lirrh (ddmmyyyy)
Kesrn jmeno(a) / Firsr name(s) (given name(s)) Kesrn jmeno(a) / Firsr name(s) (given name(s)) Kesrn jmeno(a) / Firsr name(s) (given name(s)) Kesrn jmeno(a) / Firsr name(s) (given name(s))
Soucasne srrn oLcansrv (kd) / Currenr narionaliry(ies) (code)) Soucasne srrn oLcansrv (kd) / Currenr narionaliry(ies) (code)) Soucasne srrn oLcansrv (kd) / Currenr narionaliry(ies) (code)) Soucasne srrn oLcansrv (kd) / Currenr narionaliry(ies) (code))
Srr narozen (kd) / Counrry of Lirrh (code)
Fro edn cely Fro edn cely Fro edn cely Fro edn cely
For Official Use Only For Official Use Only For Official Use Only For Official Use Only
Zpracovno km: Zpracovno km: Zpracovno km: Zpracovno km:
Darum podn: Darum podn: Darum podn: Darum podn:
Zdosr o udlen dlouhodoLeho vza Zdosr o udlen dlouhodoLeho vza Zdosr o udlen dlouhodoLeho vza Zdosr o udlen dlouhodoLeho vza
Applicarion for long Applicarion for long Applicarion for long Applicarion for long- -- -sray visa sray visa sray visa sray visa
Tenro formul je zdarma Tenro formul je zdarma Tenro formul je zdarma Tenro formul je zdarma
This applicarion form is free of charge This applicarion form is free of charge This applicarion form is free of charge This applicarion form is free of charge
Razrko adu / Sramp of EmLassy or Consulare
FOTO FOTO FOTO FOTO
FHOTO FHOTO FHOTO FHOTO
3,5 x 4,5 cm 3,5 x 4,5 cm 3,5 x 4,5 cm 3,5 x 4,5 cm
Fohlav / Sex Fohlav / Sex Fohlav / Sex Fohlav / Sex
Muz / Male Zena / Female
Rodinn srav / Mariral srarus Rodinn srav / Mariral srarus Rodinn srav / Mariral srarus Rodinn srav / Mariral srarus
SvoLodn() / Single Zenar-vdan / Married Jin / Orher
Zijc oddlen / Separared Rozveden () / Divorced
Ovdovl() / Widov(er) Regisrrovan () / Regisrered
Fjmen orce/ Farher's surname Fjmen orce/ Farher's surname Fjmen orce/ Farher's surname Fjmen orce/ Farher's surname
Jmeno orce / Farher's name
Fjmen marky/ Morher's surname Fjmen marky/ Morher's surname Fjmen marky/ Morher's surname Fjmen marky/ Morher's surname
Jmeno marky / Morher's name
Druh cesrovnho dokladu / Type of rravel documenr Druh cesrovnho dokladu / Type of rravel documenr Druh cesrovnho dokladu / Type of rravel documenr Druh cesrovnho dokladu / Type of rravel documenr
Bzn cesrovn pas / Ordinary passporr
Diplomarick pas / Diplomaric passporr
SluzeLn pas / Service passporr
Zvlsrn pas / Special passporr
Cesrovn doklad (Zenevsk konvence 1951) / Travel documenr (1951 Convenrion)
Cesrovn doklad (Zenevsk konvence 1954) / Travel documenr (1954 Convenrion)
Jin cesrovn doklad (prosm uvere) / Orher rravel documenr (please specify)
Cslo cesrovnho dokladu / NumLer of rravel documenr Cslo cesrovnho dokladu / NumLer of rravel documenr Cslo cesrovnho dokladu / NumLer of rravel documenr Cslo cesrovnho dokladu / NumLer of rravel documenr 14. 14. 14. 14.
11. 11. 11. 11.
8. 8. 8. 8.
9. 9. 9. 9.
10. 10. 10. 10.
Nmonick knzka / Seaman's passporr
Cizineck pas / Alien's passporr
12. 12. 12. 12.
13. 13. 13. 13. Vydal (kd) / Issued Ly Vydal (kd) / Issued Ly Vydal (kd) / Issued Ly Vydal (kd) / Issued Ly
(code) (code) (code) (code)
Srrana/Fage 1 Srrana/Fage 1
Doplujc Doplujc Doplujc Doplujc
dokumenry: dokumenry: dokumenry: dokumenry:
Flarn pas
Frosredky k poLyru
Vizum: Vizum:
18. 18.
Doklad o uLyrovn
Doklad o rresrn
zachovalosri
domovskeho srru (q
174 zkona
c.326/1999 SL.)
FOTO FOTO FOTO FOTO
3,5 x 4,5 cm 3,5 x 4,5 cm 3,5 x 4,5 cm 3,5 x 4,5 cm
Fozvn
Dopravn
prosredky
Zdravorn pojisrn
Dals:
Lekask zprva (q 31
odsr. 5 psm. L)
zkona c. 326/1999
Doklad porvrzujc
cel poLyru
Darum vysraven (ddmmrrrr) / Dare of issue (ddmmyyyy) Darum vysraven (ddmmrrrr) / Dare of issue (ddmmyyyy) Darum vysraven (ddmmrrrr) / Dare of issue (ddmmyyyy) Darum vysraven (ddmmrrrr) / Dare of issue (ddmmyyyy)
F FF Fl ll la aa ar rr rn nn n d dd do oo o ( (( (d dd dd dd dm mm mm mm mr rr rr rr rr rr rr rr r) )) ) / // / V VV Va aa al ll li ii id dd d u uu un nn nr rr ri ii il ll l ( (( (d dd dd dd dm mm mm mm my yy yy yy yy yy yy yy y) )) )
15. 15. 15. 15.
1 11 16 66 6. .. .
(code) (code) (code) (code)
Srrana/Fage 1 Srrana/Fage 1
Doplujc Doplujc Doplujc Doplujc
dokumenry: dokumenry: dokumenry: dokumenry:
Flarn pas
Frosredky k poLyru
Vizum: Vizum:
18. 18.
S SS Sr rr rr rr ra aa an nn na aa a / // / F FF Fa aa ag gg ge ee e 1 11 1
Doklad o uLyrovn
Doklad o rresrn
zachovalosri
domovskeho srru (q
174 zkona
c.326/1999 SL.)
FOTO FOTO FOTO FOTO
3,5 x 4,5 cm 3,5 x 4,5 cm 3,5 x 4,5 cm 3,5 x 4,5 cm
Fozvn
Dopravn
prosredky
Zdravorn pojisrn
Dals:
Lekask zprva (q 31
odsr. 5 psm. L)
zkona c. 326/1999
Doklad porvrzujc
cel poLyru

Ne / No Ano (cslo) / Yes (numLer)
DoLa plarnosri (ddmmrrrr) / Validiry dare (ddmmyyyy)
Soucasne zamsrnn / Currenr occuparion Soucasne zamsrnn / Currenr occuparion Soucasne zamsrnn / Currenr occuparion Soucasne zamsrnn / Currenr occuparion
Zamsrnavarel (nzev vzdlvac insriruce) / Employer (Name of school) Zamsrnavarel (nzev vzdlvac insriruce) / Employer (Name of school) Zamsrnavarel (nzev vzdlvac insriruce) / Employer (Name of school) Zamsrnavarel (nzev vzdlvac insriruce) / Employer (Name of school)
Telefon zamsrnavarele (vzdlvac insriruce) / Telephone numLer of employer
Zamsrnavarel (vzdlvac insriruce) na zem Ceske repuLliky Zamsrnavarel (vzdlvac insriruce) na zem Ceske repuLliky Zamsrnavarel (vzdlvac insriruce) na zem Ceske repuLliky Zamsrnavarel (vzdlvac insriruce) na zem Ceske repuLliky
Employer afrer rhe Czech RepuLlic enrry Employer afrer rhe Czech RepuLlic enrry Employer afrer rhe Czech RepuLlic enrry Employer afrer rhe Czech RepuLlic enrry
Msro rrvaleho(dlouhodoLeho) poLyru v cizin / Flace of residence (long-rerm) sray aLroad Msro rrvaleho(dlouhodoLeho) poLyru v cizin / Flace of residence (long-rerm) sray aLroad Msro rrvaleho(dlouhodoLeho) poLyru v cizin / Flace of residence (long-rerm) sray aLroad Msro rrvaleho(dlouhodoLeho) poLyru v cizin / Flace of residence (long-rerm) sray aLroad
Ulice / Srreer Cslo / NumLer
Msro / Tovn
FSC / ZIF Srr (kd) / Srare (code) Telefon / Telephone numLer
Fedchoz poLyr na zem Ceske repuLliky dels nez 3 msce Fedchoz poLyr na zem Ceske repuLliky dels nez 3 msce Fedchoz poLyr na zem Ceske repuLliky dels nez 3 msce Fedchoz poLyr na zem Ceske repuLliky dels nez 3 msce
Frevious sray in Czech RepuLlic longer rhan 3 monrhs Frevious sray in Czech RepuLlic longer rhan 3 monrhs Frevious sray in Czech RepuLlic longer rhan 3 monrhs Frevious sray in Czech RepuLlic longer rhan 3 monrhs
21. 21. 21. 21.
Jesrlize se zdrzujere v jine nez domovske zemi, uvere oprvnn k nvraru pro zemi Lydlisr. Jesrlize se zdrzujere v jine nez domovske zemi, uvere oprvnn k nvraru pro zemi Lydlisr. Jesrlize se zdrzujere v jine nez domovske zemi, uvere oprvnn k nvraru pro zemi Lydlisr. Jesrlize se zdrzujere v jine nez domovske zemi, uvere oprvnn k nvraru pro zemi Lydlisr.
If you reside in a counrry orher rhan your counrry of origin, have you permission ro rerurn ro rhar If you reside in a counrry orher rhan your counrry of origin, have you permission ro rerurn ro rhar If you reside in a counrry orher rhan your counrry of origin, have you permission ro rerurn ro rhar If you reside in a counrry orher rhan your counrry of origin, have you permission ro rerurn ro rhar
counrry! counrry! counrry! counrry!
Adresa zamsrnavarele (vzdlvac insriruce) / Address of employer (school)
17. 17. 17. 17.
20. 20. 20. 20.
22. 22. 22. 22.
18. 18. 18. 18.
19. 19. 19. 19.
Druh vza: Druh vza: Druh vza: Druh vza:
D
;
Flarne od: Flarne od: Flarne od: Flarne od:
Focer vsrup: Focer vsrup: Focer vsrup: Focer vsrup:
Vce
Msro / Tovn FSC / ZIF Srr (kd) / Srare (code)
cel poLyru / Furpose of sray
Adresa msra poLyru na zem Ceske repuLliky Adresa msra poLyru na zem Ceske repuLliky Adresa msra poLyru na zem Ceske repuLliky Adresa msra poLyru na zem Ceske repuLliky
Address for sray on rhe rerrirory of rhe Czech RepuLlic Address for sray on rhe rerrirory of rhe Czech RepuLlic Address for sray on rhe rerrirory of rhe Czech RepuLlic Address for sray on rhe rerrirory of rhe Czech RepuLlic
Adresa pro dorucovn na zem Ceske repuLliky, je-li odlisn od msra poLyru Adresa pro dorucovn na zem Ceske repuLliky, je-li odlisn od msra poLyru Adresa pro dorucovn na zem Ceske repuLliky, je-li odlisn od msra poLyru Adresa pro dorucovn na zem Ceske repuLliky, je-li odlisn od msra poLyru
Fosral address if differenr from rhe address of sray on rhe rerrirory of rhe Czech RepuLlic Fosral address if differenr from rhe address of sray on rhe rerrirory of rhe Czech RepuLlic Fosral address if differenr from rhe address of sray on rhe rerrirory of rhe Czech RepuLlic Fosral address if differenr from rhe address of sray on rhe rerrirory of rhe Czech RepuLlic
Fedpokldan doLa poLyru / Visa is requesred for Fedpokldan doLa poLyru / Visa is requesred for Fedpokldan doLa poLyru / Visa is requesred for Fedpokldan doLa poLyru / Visa is requesred for dn / days
Fedchoz vza (udlen Ceskou repuLlikou v poslednch rech lerech) a jejich plarnosr Fedchoz vza (udlen Ceskou repuLlikou v poslednch rech lerech) a jejich plarnosr Fedchoz vza (udlen Ceskou repuLlikou v poslednch rech lerech) a jejich plarnosr Fedchoz vza (udlen Ceskou repuLlikou v poslednch rech lerech) a jejich plarnosr
Orher visas (issued during rhe pasr rhree years) and rheir period of validiry Orher visas (issued during rhe pasr rhree years) and rheir period of validiry Orher visas (issued during rhe pasr rhree years) and rheir period of validiry Orher visas (issued during rhe pasr rhree years) and rheir period of validiry
Fedchoz poLyry v dalsch schengenskch srrech / Frevious sray in Schengen srares Fedchoz poLyry v dalsch schengenskch srrech / Frevious sray in Schengen srares Fedchoz poLyry v dalsch schengenskch srrech / Frevious sray in Schengen srares Fedchoz poLyry v dalsch schengenskch srrech / Frevious sray in Schengen srares
Od (ddmmrrrr) / From (ddmmyyyy) Do (ddmmrrrr) / Till (ddmmyyyy) Srr (kd) / Counrry (code)
23. 23. 23. 23.
27. 27. 27. 27.
26. 26. 26. 26.
24. 24. 24. 24.
25. 25. 25. 25.
D
;
Do: Do: Do: Do:
Flarne pro: Flarne pro: Flarne pro: Flarne pro:
Vce
'28. '28. '28. '28. '28. '28. '28. '28.
D
;
Do: Do: Do: Do:
Flarne pro: Flarne pro: Flarne pro: Flarne pro:
S SS Sr rr rr rr ra aa an nn na aa a / // / F FF Fa aa ag gg ge ee e 2 22 2
Vce
'28. '28. '28. '28. '28. '28. '28. '28.
cel poLyru / Furpose of sray cel poLyru / Furpose of sray cel poLyru / Furpose of sray cel poLyru / Furpose of sray
Zdravorn dvody / Medical reasons Vkonn manazer / Execurive manager
Zamsrnn / Employmenr
Kulrura / Culrural parriciparion in rhe company arising under rhe Acr 513/1991
Nvsrva rodiny / Family Sporr / Sporrs
Fozvn / Invirarion Oficiln (polirick) nvsrva / Official (polirical)
Fodnikn / Business Srudium / Srudy
28. 28. 28. 28.
casr v prvnicke osoL vznikle podle zkona c.513/1991
Fodnikn / Business Srudium / Srudy
Specifikujre / Specify
Darum zamsleneho pjezdu (ddmmrrrr) / Dare of arrival (ddmmyyyy) Darum zamsleneho pjezdu (ddmmrrrr) / Dare of arrival (ddmmyyyy) Darum zamsleneho pjezdu (ddmmrrrr) / Dare of arrival (ddmmyyyy) Darum zamsleneho pjezdu (ddmmrrrr) / Dare of arrival (ddmmyyyy)
Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy) Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy) Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy) Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy)
Osrarn / Orher
29. 29. 29. 29.
30. 30. 30. 30.
Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy) Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy) Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy) Darum zamsleneho odjezdu (ddmmrrrr) / Dare of deparrure (ddmmyyyy)
Msro vsrupu na zem Ceske repuLliky / Flace of enrry in rhe Czech RepuLlic Msro vsrupu na zem Ceske repuLliky / Flace of enrry in rhe Czech RepuLlic Msro vsrupu na zem Ceske repuLliky / Flace of enrry in rhe Czech RepuLlic Msro vsrupu na zem Ceske repuLliky / Flace of enrry in rhe Czech RepuLlic
Dopravn prosredek / Means of rransporr Dopravn prosredek / Means of rransporr Dopravn prosredek / Means of rransporr Dopravn prosredek / Means of rransporr
Zvouc prvnick neLo fyzick osoLa / Inviring legal or narural person Zvouc prvnick neLo fyzick osoLa / Inviring legal or narural person Zvouc prvnick neLo fyzick osoLa / Inviring legal or narural person Zvouc prvnick neLo fyzick osoLa / Inviring legal or narural person
Jmeno a pjmen osoLy / Name and surname of rhe person
31. 31. 31. 31.
30. 30. 30. 30.
32. 32. 32. 32.
33. 33. 33. 33.
Jmeno a pjmen osoLy / Name and surname of rhe person
Nzev / Name
Ulice / Srreer
Cslo / NumLer
Msro / Tovn
FSC / ZIF Srr (kd) / Srare (code) Telefon / Telephone
FAX / FAX
E-mailov adresa / E-mail address
ZpsoL zajisrn hrady nklad spojench s poLyrem ZpsoL zajisrn hrady nklad spojench s poLyrem ZpsoL zajisrn hrady nklad spojench s poLyrem ZpsoL zajisrn hrady nklad spojench s poLyrem
Manner of funding rhe sray Manner of funding rhe sray Manner of funding rhe sray Manner of funding rhe sray
Zadarel sm / Myself Zvouc fyzick osoLa(y) / Hosr person(s)
Zvouc prvnick osoLa / Hosr company
Uvere odpovdajc doklady / Fresenr corresponding documenrarion
34. 34. 34. 34.
Financn prosredky k zivoLyr po doLu poLyru / Means of supporr during your sray Financn prosredky k zivoLyr po doLu poLyru / Means of supporr during your sray Financn prosredky k zivoLyr po doLu poLyru / Means of supporr during your sray Financn prosredky k zivoLyr po doLu poLyru / Means of supporr during your sray
Financn horovosr / Cash
FlareLn karry / Credir cards
Seky (cesrovn) / Traveller's cheques
35. 35. 35. 35.
Uvere odpovdajc doklady / Fresenr corresponding documenrarion
Seky (cesrovn) / Traveller's cheques
Osrarn / Orher
Osrarn (Specifikujre nap. doklad o uLyrovn) / Orher (specify, e.g. cerrificare of accommodarion)
Cesrovn a/neLo zdravorn pojisrn / Travel and/or healrh insurance
Cesrovn a/neLo zdravorn pojisrn / Travel and/or healrh insurance
plarne do (ddmmrrrr) / valid unril (ddmmyyyy)
Srrana / Fage 3 Srrana / Fage 3 Srrana / Fage 3 Srrana / Fage 3
Fjmen / Spouse's family name
Osrarn jmena (dve uzvane() pjmen) / Surname(s) ar Lirrh (earlier family name(s))
Jmeno / Spouse's firsr name
Darum narozen (ddmmrrrr) / Spouse's dare of Lirrh (ddmmyyyy)
Msro narozen / Spouse's place of Lirrh
Srrn oLcansrv manzelky (kd) / Spouse's narionaliry (code)
a. a. a. a. Fjmen / Surname
Osrarn jmena / Orher names
Jmeno / Firsr name
Msro narozen / Flace of Lirrh
Darum narozen (ddmmrrrr) / Dare of Lirrh (ddmmyyyy)
36. 36. 36. 36.
37. 37. 37. 37.
Manzel (-ka) / Spouse Manzel (-ka) / Spouse Manzel (-ka) / Spouse Manzel (-ka) / Spouse
Dri (pro kazdou osoLu mus Lr podna samosrarn zdosr) Dri (pro kazdou osoLu mus Lr podna samosrarn zdosr) Dri (pro kazdou osoLu mus Lr podna samosrarn zdosr) Dri (pro kazdou osoLu mus Lr podna samosrarn zdosr)
Children (Applicarions musr Le suLmirred separarely for each passporr) Children (Applicarions musr Le suLmirred separarely for each passporr) Children (Applicarions musr Le suLmirred separarely for each passporr) Children (Applicarions musr Le suLmirred separarely for each passporr)
Name der einladenden Ferson/des einladenden Unrernehmens in den Schengen Name der einladenden Ferson/des einladenden Unrernehmens in den Schengen- -Sraaren und Konrakrperson im einladenden Sraaren und Konrakrperson im einladenden
L. L. L. L. Fjmen / Surname
Osrarn jmena
Jmeno / Firsr name
Msro narozen
c. c. c. c. Fjmen / Surname
Osrarn jmena
Jmeno / Firsr name
Msro narozen
d. d. d. d. Fjmen / Surname
Osrarn jmena
Jmeno / Firsr name
Zvouc osoLa(y) / Hosr person(s) Zvouc firma / Hosr company '35. '35. '36. '36.
Msro narozen
Zvouc osoLa(y) / Hosr person(s) Zvouc firma / Hosr company
'35. '35. '36. '36.
Domovsk adresa zadarele / Applicanr's home address Domovsk adresa zadarele / Applicanr's home address Domovsk adresa zadarele / Applicanr's home address Domovsk adresa zadarele / Applicanr's home address
Telefonn cslo / Telephone numLer Telefonn cslo / Telephone numLer Telefonn cslo / Telephone numLer Telefonn cslo / Telephone numLer
E-mailov adresa / E-mail address E-mailov adresa / E-mail address E-mailov adresa / E-mail address E-mailov adresa / E-mail address
39. 39. 39. 39.
38. 38. 38. 38.
40. 40. 40. 40.
1. daje v zdosri mus Lr vyplnny srrojem neLo hlkovm psmem v ceskem jazyce. V ppad nedosrarku msra v pslusnch ruLrikch
uvere daje na zvlsrn plohu.
2. Frva a povinnosri cizinc, spojene s poLyrem na zem CR jsou upraven zkonem c. 326/1999 SL., o poLyru cizinc na zem Ceske
repuLliky a o zmn nkrerch zkon, ve znn pozdjsch pedpis.
3. OsoLn daje pro cely zen podle zkona c.326/1999 SL., jsou zpracovvny sluzLou cizinecke policie, a ve sranovench ppadech
Minisrersrvem vnirra v souladu se zkonem c. 101/2000 SL., o ochran osoLnch daj, ve znn pozdjsch pedpis.
4. V souvislosri s zdosr o dlouhodoLe vzum jsem povinen na pozdn srrpr sejmur orisk prsr a pozen oLrazoveho zznamu.
5. Zavazuji se opusrir zem Ceske repuLliky ped skoncenm doLy povoleneho poLyru na zem Ceske repuLliky.
6. Byl jsem informovn o skurecnosri, ze udlen vza je jen jednou z podmnek vsrupu na zem Ceske repuLliky. Fouh skurecnosr, ze mi Lylo
udleno vzum, neznamen, ze mm prvo na nhradu skody, pokud z dvod nesplnn podmnek vsrupu a poLyru na zem Ceske
repuLliky sranovench zkonem c. 326/1999 SL., mi Lude vsrup na zem Ceske repuLliky odepen.
7. Byl jsem informovn, ze jsem povinen do 3 pracovnch dn ode dne vsrupu na zem ohlsir na policii Ceske repuLliky msro poLyru na
zem Ceske repuLliky.
8. Frohlasuji, ze jsem vsechny vse uvedene daje poskyrl(a) podle sveho nejlepsho vdom a svdom a ze jsou sprvne a plne.
1. Derails in rhe Applicarion musr Le complered in Llock lerrers in rhe Czech language. If more space is needed, specify rhe derails in a special
enclosure.
2. Righrs and duries of aliens connecred virh rheir sray on rhe rerrirory of rhe Czech RepuLlic are governed Ly Acr no. 326/1999 Coll.,
regularing Residence of Alliens in rhe Terrirory of rhe Czech RepuLlic and on changes of some acrs, as amended.
3. Fersonal derails for rhe purpose of proceedings pursuanr ro Acr no. 326/1999 Coll. are processed Ly rhe foreign police service and Ly Minisrry
OsoLn daje rkajc se oLcana EU neLo EHF (Evropsk hospodsk prosror), krer Vs vyzivuje. OsoLn daje rkajc se oLcana EU neLo EHF (Evropsk hospodsk prosror), krer Vs vyzivuje. Taro orzka Ly mla
enclosure.
of Inrerior in specified cases pursuanr ro Acr no. 101/2000 Coll. regularing personal dara prorecrion as amended.
4. In relarion ro rhe Applicarion for a long-rerm visa, I am oLliged ro suffer fingerprinring and raking of visual image on requesr.
5. I hereLy underrake ro leave rhe Czech RepuLlic Lefore rhe rerminarion of my permirred sray on rhe rerrirory of rhe Czech RepuLlic.
6. I have Leen informed aLour rhe facr rhar granring a visa is only one of rhe condirions for enrering rhe Czech RepuLlic. The mere facr rhar I
have Leen granred a visa does nor mean rhar I am enrirled ro damages in case rhar I am prevenred from enrering rhe Czech RepuLlic Lased on
my failure ro meer condirions for enrry and sray in rhe Czech RepuLlic specified in Acr no. 326/1999 Coll.
7. I have Leen informed rhar I am oLliged ro reporr rhe place of sray in rhe Czech RepuLlic ro rhe Czech Folice virhin 3 Lusiness days folloving
my enrry.
8. I hereLy represenr rhar I have provided all rhe aLove specified derails according ro my rrue and free vill and rhar rhey are complere and
correcr.
Fodpis zadarele Fodpis zadarele Fodpis zadarele Fodpis zadarele ( u nezlerilch podpis zkonneho zsrupce): :: :
Applicanr's Signarure Applicanr's Signarure Applicanr's Signarure Applicanr's Signarure (for minors, signarure of cusrodian/guardian): :: :
Msro pro nalepen konrroln csri vzoveho srrku
........................
Fodpis pracovnka vydvajcho vzum
Msro a darum: Msro a darum: Msro a darum: Msro a darum:
Flace and dare: Flace and dare: Flace and dare: Flace and dare:
OsoLn daje rkajc se oLcana EU neLo EHF (Evropsk hospodsk prosror), krer Vs vyzivuje. OsoLn daje rkajc se oLcana EU neLo EHF (Evropsk hospodsk prosror), krer Vs vyzivuje. Taro orzka Ly mla
enclosure.
of Inrerior in specified cases pursuanr ro Acr no. 101/2000 Coll. regularing personal dara prorecrion as amended.
4. In relarion ro rhe Applicarion for a long-rerm visa, I am oLliged ro suffer fingerprinring and raking of visual image on requesr.
5. I hereLy underrake ro leave rhe Czech RepuLlic Lefore rhe rerminarion of my permirred sray on rhe rerrirory of rhe Czech RepuLlic.
6. I have Leen informed aLour rhe facr rhar granring a visa is only one of rhe condirions for enrering rhe Czech RepuLlic. The mere facr rhar I
have Leen granred a visa does nor mean rhar I am enrirled ro damages in case rhar I am prevenred from enrering rhe Czech RepuLlic Lased on
my failure ro meer condirions for enrry and sray in rhe Czech RepuLlic specified in Acr no. 326/1999 Coll.
7. I have Leen informed rhar I am oLliged ro reporr rhe place of sray in rhe Czech RepuLlic ro rhe Czech Folice virhin 3 Lusiness days folloving
my enrry.
8. I hereLy represenr rhar I have provided all rhe aLove specified derails according ro my rrue and free vill and rhar rhey are complere and
correcr.
Fodpis zadarele Fodpis zadarele Fodpis zadarele Fodpis zadarele ( u nezlerilch podpis zkonneho zsrupce): :: :
Applicanr's Signarure Applicanr's Signarure Applicanr's Signarure Applicanr's Signarure (for minors, signarure of cusrodian/guardian): :: :
Msro pro nalepen konrroln csri vzoveho srrku
........................
Fodpis pracovnka vydvajcho vzum
Msro a darum: Msro a darum: Msro a darum: Msro a darum:
Flace and dare: Flace and dare: Flace and dare: Flace and dare:

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