Consolato Generale d'Italia

Mumbai
 22 Schengen State of first entry (if applicable) OSSERVAZIONI
2l Your dcstination in Italy Des,r'dione iil ltottd
L,vcnllqle Slulu SLhcttgt'n ch primt it6resxt E ANNOTAZIONI

23 Numer of entries requested/NrDcrodi ittgrcssi ilchrcsti 24 Number ofdays ofintended stay (max.355)
lildicarc i Eiorni di t(Egiomo Prcvisli (ila\simo 365)
tr I E2 E Multiple enariesiMilltiplttilsressi
25 lntended date ofarrival in Schengen area
l)dlu di arrivo Jtrevtsla nell'area Schettgen

26 SurnameandnameofthepersoninltalywhoappliedforFamilyReunification'orsurnameandnameoftheEmployerinltaly.
Coptome e nome dcllu persona che ha richieslo tl Ricottgiililgimerilo l:amiliare o del Dabre di lororo

For Adoption, Religious Reasons, Medical Reasons, Sport, Study, Mission, please specify the address in ltaly
Nel coso di visn per Ailtziine, Motivi Religktri, Cwe Mediche, Sporl, Shtdio, Missiote, intlicare l'nilirizzo di recaPib itt Iloli4

Address and e-mail of the person(s) who apllied for Family Telephone and fax number of the person(s) who apllied for
Reunification or the Employer ln.hnzzo e tildtrizzo di posta elettnrrica Fa m ily Reunifi cation or the Em ployer, lvt mcru di Telelono e cli lu clel la e

dclkt c pertonoe che chretlc ono rl Ricottgitl4tilmenb f-umtliaru o .lcl Dubrc di llvoro pe*ona'a che chiedeitDo il Rrcongiupilmcnh l"@ilidre o dcl l).tlorc dt Lavont

27 Name and address of host Company/Organization Telephone and fax number of the Company /Organization
Nohe e iildirizzo lell'tmprefr orgdilEruiotv che ittvila Tclelono e lu dell'inptcsa orgailizzuioile

Surname, Iirst name, address, telephone, fax and email address otcontact person in Company/Organization
Cogtrtme, nomc, irtlirizzo, leleJub, JG c itiliriztu dt posta elellroilicq delld petsoilo d, coiltalb pret.\o I'imprcfi orgattt2:d.idP

28. Cost oftraveling and living during the applica nt's stay is covered by Lc
"-pese
& uaggio e soggiorno del nchiedcilc soto u canco
I

E the applican I delrtchicdente |! a sponsor (host, company, organization), please specify

I d"l 7r,,run'r" (o:filc. tmptcrd. t)rgutt::tt:ililtc, prect.\art

Means of suppo ll Mez;i tJt stssrtenza

A Ca.sh carari
referred to in box n,26 or 27 'di ili qlle cryetle 26 o 2?
E Trrveller's Cheques
E Credit Cards,' Cqre di crediro
E Other (pls. specify) i Atho (Fecis@e)
E Prepaid accomodation' Alloggio prepagato
E Prepaid transport i rropo rto prepagato
E Other (pls. specifyl / Attto (preciiile)
Means Of supporl 'Mezzi di \uisistenzd

THIS INFORMATION IS NOT NECESSARY tr Cash ,QDtailti

FOR THE FOLLOWING TYPES OF VISA: tr Provided accomodation' Alhggio prepqgok'
Fam ily Reunifi cation, Following Family tr All expenses covered during the stty I Trte le spese copcrtc dtrunte il toggiorilo
Member, Salaried Employment, Self tr Prepaid trtnsporl i Tr porto prepogato
Employment, Mission, Diplomatic, Adoption tr Other (pls. specify) / Ahto (preci$te)
INDlCAZIOND NON NIl;CI,;SSANA NEL CASO DI VlSTO I'DI:

Subotdirob, Imro A uloilono, Mi$ione, Dipktmtico, klozione

29 Personal data of the family member who is an EU, EEA or '.H CitiZen t Oati atrugrdlci .lel JMilile che i cittadino UE, SEE o CH

Surname, crrgmnc I First Name/s,',r,,.,r

Date of birth Datu di ttoscito Nationality ciltddinatEd Number of travel document or ID card
Ntmero lel drrnmettb di via[Eio o della carlo d'iletililo

30. Fa m ily relation with an EU, EEA or CH citizen ,' rin"ololhiliote con nD cittddino (JE, SEE o CH

E Spouse.t coaa,se E Son/Daughtet /Figtio/a E Other descendantr,ltrfl disceildentidircili

E Dependent ascendant , ,{rcc,
'dente
o carrco

3 I Place and date I.uogo e ,laro 32. Signature (for minors, signature of parental authority/legal guardian)
Firma (per t miil)ri,trnnt del lilolure della ltuler:ilA genbriale'lutore legalc)

I am aware of the fact that the refusal of a visa does not give rise to the reimbursement of fees paid
il rilinto del vi,tto iloil dd luoqo al rimhorso dci dirilli Ngdli per lo lrollqzhne dello proli

2
 INFORMATION ON THE PROCESSING OF PERSONAL DATA. tNt.oRMAlIrA
sLtt.lMTTAMEN!o DEt DAtt PEttSoNALI

the detection of your fingerprints, are mandatory for the

The collection of data required in this form, your photograph and, if applicable,
rpp.ri'on this visa application form, as.well as your fingerprints and your
examination ofthe visa epplicetion and your personal o.trirr'rrr,i.r, those authorities' for the adoption of a decision on your
photograph will be supplieJ t" it. conipeteni ttatian auilrorities ani processed by

mcrilo alla sta domondu.

is the
Affai n (piazzare delra Farnesina 1,00t35 Roma' www.esteri'it, dgit6@esteri'it)
The Ministry of Foreign
, Roma, www.cste.i.it) t t'atortti itatiutru respott,hite (itotorc) det trutt'menh dci dott'
l#,1i,:,:,:;lf,';#,;nn)),:t:,|| i,,u t 00 t 35

system and req-uest that inaccurate data relating to you

you have the right to obtain notification ofthe data relating to you registered. in thr informatic your
---^^-^^)..-r^..,G,rt, Ue Oeleiea. For information on the exercise of your right to check
rf ,pp.ri --^-irtcrt in rhis
^^-anr ptoriOed this reqrrd leqislation of the State
by the national legislation
regard hv
reilAcdi e chc qilellt relatiw llla sila
di chiedcrc che i d.tti itlesalli relalivi dlld rtu petsonq veilgano
ylle vii di ricorso Previslr 4 lale rigllarLlo
, ,,", ,1,,, o ,"ti,fi*,li o n,pprimcili, cosi coni.
',,i,.ii "

your application. The ltalian national supervisory authority competent

I be provided upon request by the authority examining (Piazza di Montecitorio r2r' 00186 Roma'
ror the protection or iersonal Dila
-{iiij".ll,}#'ii'."'d#"".r di lulela dei dali Persoilah a il Gafonte Per l.l
i.^ L, tua lonan]a- L,aillorili, di conlr(ilk' ilazi()nale iloliald comPcfenle n m.ilefia
ioirc"irunu I Z t' o0 1 86 Roma' ||*'w saronteDrirqc!'il' tel' 3906 69677 l)
'ti

comprete. I am aware that false statements will

lead to my application being rejected or
I declare that all information suppried by me are correct and iv fi,. under the law of the state (Article
result in the request ro. tt. pror..rtion Representation
to the annulment of a visa already granted and will
Jclla mia domando o l'unnilllameilh del vtlt giti cdtcc\s() e
Iolsc comPorleranilo il resPitryimeillu
iozionc dello Stato (arlicolo 33 I c.P P')'

to meet the conditions of Article 5, paragraph I of Regulation

(EU) No'
il
/98, and for these reasons my entry is refused'
po'ogo1o I il Regolanetu' (LtE) n 562'2006 (Culice l;toilherc
Schcilt'cn)
u p'""'l)uii'i'"ob1'

pet lalt molivi mt veilgo rututqto t il'trc'ru'

e dell'articolo 1 del D.Lgs. 286t98 e

egal guardian)
Place and dlle 'Luogo e,loto l4 gctti k,riole, hilorc lcgale)

a,XNOUZIONI (riservato all'Ufficio) r RLMARKS $t ofi ce te on tv)