DER THE SPECIFICATI APPLICATION FOR SCHENGEN VISA pe THIS APPLICATION FORM IS FREE i) fi. Surame Famiy rae) CY mae Fox orricrac use ony “Sarva o¥biet (Former Fai ramet= sa [bate of appleation Firs ranel a) (Given rar OD NTA, vise application number: Date of th flay month year) fs Pace of bth current aro DANGATORE NDIA pplication lodged at lo. country of birth Nationality ot birth. of [A Embossy/eonsulare ara: different [exc Sex owt ata [commercial intermesiory je Mole = Female fs Srgle = Married o Separated » Divorced sf: Border douler) 2 Other (plese specify) la fae cose of minors: Surnane, Frat rams, odsrese(f cifferent from applicants) and rafioralty of Name arenteleuthorty/logal guardian NA Toiner! Ii. Nona dent masber, where applicable le handles by: porting decuants Iz, Type of travel docament fs Travel document |e Orcinory passport » Diplomatic passport Service possport » Officlelpessport » Special possport fy Means of subsistence [2 Stier trav document (please speci) I revirarion 13 Numer of travel document [bate often fo Valea Fé Tamed by [2 Means of trancport s4so1ss ovoa/aoia | se/oafzoze | RPOU rm I7- Aeneas ome address oneal ae Ffclepone nanbere) fac Rexdenes ira eoutny other thon The couniry of current rtloralty rOtougtiSs SPELL [2 No me a ia decision a Ves. Residence pera or eutialeht as NG eens Vall fo Refused SEITE sh “MENTION DESIGNATION 25, Employes ord employer" GRP and telephone rurber For student, name and address oF -ducatoral establishment. COMPLETE OFFICE ADDRESS WHERE YOUR WORKING 1 Moin porpoela) of the journey: lumber of day= 1 The fen rhe wt hal no be files ny fom members of EA o CH ens (nous chlor dependent secendort) while oxercing tel iat4, Niner of entries requested 5. Duration of the intended stay 0° [Sing entry. n Two.enties Multiple entries ‘rons rice number of cays DAYS IN SCHENGEN AREA 7 Fingerorits collected previcualy forthe purpose of opplying fora Schengen visa [Ne 2 Yes, NA = bate, it ain Enc pert for the final country oF destirafon, where applicable Sere 2200 BY ener FFOM aren mont pacer on Tntenied date of arrival nthe Schengen area “Trtendod date of departure from the tofoa/2013 ‘Schengen fea 11/04/2015, “i, Sarmame ond Fest name ofthe Ting pron(e) nthe Member State(s). nef applienbe, rome of otek) or temporary acconmodation(s)in the Member State(2). HOTEL NAME Sareane First none, adress, telephore, felefax, and ermal adress of contact person i fompary/orgorisation INVITING COMAPNY ADDRESS [address ond e-mail adress af ring parson(synovelTenporary fpccommosation) HOTEL ADDRESS aes 32, Name and adress of wong company organisation [eipiocend htaa? ae Fompany/ergenisation |For BUSINESS PURPOSE 5, Coat oF trevelrg and rg during The applicants Say covered SPONSOR NAME by the applicant nse herselh [> By a aponsor (host eompony, Crganisat ion) please specify ae s refeered ton filé 3 or 32 YOU CAN CHOOSEANY oprion) tue other (lease specify) Pears of surrort [aways CHOOSE THIS [cash ns of suport jorrion P Srovelle'seques = [sn | crea cant |: Accommodation provided |: Prep accommodation [ail experes cored curing Te stay peel ronsport [resp report | Grner peo specify) [Other okease se) 4, Porsoral data of the Yanly menber who is an EU, GEA or Hazen =e First ramets) feof beth ioralty N [ir 17s APPLICABLE. MENTION THE DETAILS JOR MENTION NA. 5, Fam relationship with an EU, EEA or CH clan spovee a childs grordchild dependent excendant 6, Plage ard date 7. Signature (For Rinors signature oF parental ‘outhority/legel guardion) Sa/oe/zoig MENTION PLACE OF SUBMISSION AND DATE((Eiamenare That the vise fos erat refunded ths waa refused ‘ApaabTe cae Grple-Sy waa is oppiod for (ef Fiekd No 24) Tm awore of the need to hove. adequste travel medical inaurance for my firs ata ord ary subsequent visits tothe teritory of Tom avers of and consent fo the folloing: the collection of the data required by this aplication form ara the teking of my photograph cru if opplceble, the taking of Fingerprints, are mandatary for the examivtion af the viea epplication ord ony persorl data Concerning me which sppear on the vss application orm, oF wal ar my fingerprints and my photograph wil be supplied to The relevant SUihoriiee ofthe Member States and prosesred by shave authorities, forthe purposes ofa isin on my wen copication. Such dita as wellas de concerning the decision taken an my aplleation ora decision whether to annul revoke or extend 2 visa tsued tall be entered inte, ard stored in the Visa Enfermation Syetem (VIS) for a maximum period of five years, durirg which # will be Crcessbie 40 the vou ewthorities ae the autheritics competent for sarcying at check on vigaz at cicternal borders and within the Member States, migration and sayin authorities in the Metsber Staves forthe purposes of verifying whether the cand ions For the Spal cniry inte say dnd residence on the terttory of the Member Stotes are fulfilled, of iaentifying persone who do not or who ro lenges fulfil thece conditions of exiting an anykan aplication and of determiringresporsibility for such exanination Under certain Cowitions the dete mil be tice avaluble te detigrates authorities of the Menber Stoves and to Eurapel for the purpose of The provwntion, detection and inechigation of terrorist offences ond of ther serous eriminal offences. The authority of Greece Fesponsile for processing the dat lor Milcry af Citicen Pretuction, Greck Police, Intarvational Police Cooperation Division, 3d Dtaton SERENE Karclpoutg d Oke 101 77 Athens, Tel =90. 2106977000, Fax!230.210 8929764, Cmall nfe@sirene-ar com Teamaare thet Ehave the right te ebtain in ony af the Munber Stotes ratification of the deta relating Ye me recorded Inthe VES and bf the Mentor State which tronomitied the date, ard to request that dstareloting 0 Ne which ore Inaccurate be corrected ond that Gate relating fo me processed vnlowfully be deleted. At my express request. the authority excrnining my application wil inferm me of ‘he moner which’! ney exerciee my right fo check the personal dat conckrning me and have them corrected or deleted, inluding the related remedies eosxeding te the national hut of the State concerned, The national supervisory authority of that Menber Store Gieline Date Protection Authority, Kifists str 1, tet floor, GR ~ 115 23 Athens, Tele *3OGIOG97S600, PaXir30 2106479928, ‘Prmail sontact@cbaar) wil hear clans concerning the protection of personal dota, declre that to the best of my knowledge oll portculare supplied by me are correct and complete, Tam ware thot any felse Ziotements wil lead to my apelication being rejected or to the anrulment of a visa already grorted and may elzo render me lable to [Prosecution under the lw of the Member State whlch deal with the epplicaion T undertoke te leave the tervitory of the Member States before the expiry of the via, if granted. T hove been Infermed that possession af aviv oly one of ‘he prerequsites for sutry iso the Europech territory of the Member States. The mere foct that & (iso hes beon granted te me doce re! mean thot Twill be erfitied to compensation I I fail 10 camply with the relevant provisions of Urscks 5) of Regulation (EC) No 662/2006 (Schengen Borders Coda) and Tom therefore rafused sntry. The prerequisites Tor entry Sl be checked ogdin an entry ito the Earepean territory of the Member Stoves, ace ond date orate pret Tor miner, sigrature of porentolouthority/Iegal queria [SUARDIAN SIGNATURE Ts REQUIRED 2 in 30 far as the VIS is operational