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Application Summary

https://www.visas.inis.gov.ie/AVATS/SummaryDetails.aspx

FOR OFFICIAL USE ONLY

Application Reference / Transaction Number: Type of Visa: Journey Type: Visa Category: Surname: Forename: Other names: Date of Birth: Gender: Nationality: Passport / Travel Document Number: Issue Date: Expiry Date: Dates of Travel From: Dates of Travel To:

13274322 Short Stay Multiple Journey Business Ghassen Kannou 03/06/1979 Male Tunisia W493655 29/06/2011 28/06/2016 13/07/2013 17/07/2013

You are from a country which is exempt from visa fees. However, the Embassy or Consulate may charge an administration fee. You should check the website address shown for further details. Please note the address/contact details of the Irish Embassy/Consulate/Visa Office to which your application has been sent. Embassy of Ireland 1 and 2 Khalifa Al Suwaidi Development, 19th Street (Off 32nd Street), Al Bateen, P.O. Box 61581, Abu Dhabi United Arab Emirates Phone No : +971 (0)2 4958200 Email : See Webiste for e-mail facility Website : http://www.embassyofireland.ae

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29/06/13 18:21

Application Summary

https://www.visas.inis.gov.ie/AVATS/SummaryDetails.aspx

Please check above website for details of where you should now submit the following documentation, together with the relevant visa fee. Documents must be submitted within 30 days of completing your online application. 1. Printed and signed application summary sheet 2. Original passport (See 'www.inis.gov.ie' under Visas in 'Documents Required' for minimum validity) 3. Passport sized colour photograph which meets the requirements set out on 'www.inis.gov.ie' 4. Supporting documents as outlined under the relevant visa category on 'www.inis.gov.ie' under Visas in 'Documents Required'. NOTE: If you are applying to the Visa Office in Abuja, Abu Dhabi, Beijing, London, Moscow or New Delhi, please check the website of the relevant office, as given above, for full details of their requirements, which may differ slightly to those contained on www.inis.gov.ie. 5. All supporting documentation must be in English or accompanied by a notorised translation 6. Visa Fee: Current details of the fee required for various visa types are available on the website of the Visa Office/Embassy/Consulate given above Please note that your application will be held online for 30 days and it can be retrieved and printed any time during this period. However, it will not be possible for you to make changes to any of the details you have provided. If you need to advise us of anything you have omitted or incorrectly entered, you should submit this information in writing to the Embassy/Consulate or Visa Office shown above, with your supporting documentation. DECLARATION BY APPLICANT You must now read the declaration below and sign it. This must be signed by the applicant personally. An application for a person under the age of 18 should be completed by the parent or legal guardian. DECLARATION
I hereby apply for a visa to Ireland. The information I have given is complete and is true to the best of my knowledge. I also declare that the photograph submitted with this form is a true likeness of me, the applicant. I confirm that if, before the application is decided, there is a material change in my circumstances or new information relevant to this application becomes available, I will inform the Embassy/Consulate/Visa Office at which I have applied. I understand that additional information and/or data, such as fingerprints, may be required before my application can be processed. I understand that failure to provide such data, if requested to do so by the Visa Office, may result in the refusal of my application. I also understand that any false or misleading information, or false supporting documentation, may result in the refusal of my application without the right of appeal, and that this may result in me being prevented from making further visa applications for a period of five years. The Irish Naturalisation and Immigration Service, Department of Justice, Equality and Law

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29/06/13 18:21

Application Summary

https://www.visas.inis.gov.ie/AVATS/SummaryDetails.aspx

Reform/Department of Foreign Affairs will process the personal data on this application and related data for the purposes of promoting the interests of Ireland and its citizens. I agree that the data in my application, and/or any further data supplied, including any fingerprints and the results of database searches, may be disclosed to other Irish Government Departments and/or Agencies, including An Garda Sochna (Irish Police), as well as to public authorities of the Member States of the European Union/EEA and/or other States, including for the purpose of confirming identity and/or immigration history. I agree also that the application form and supporting documentation, or copies thereof, may be conveyed to the Irish deciding authority by reasonable means as considered appropriate by the receiving office, including commercial courier (in sealed package) or other postal or electronic means. Applicant's Signature Date

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