Italian embassy Harmonised application form Application for Schengen Visa This application form is free PHOTO Family members of EU, EEA or CH citizens shall not fillin fields no.21, 22, 30, 31 and 32 (marked with’) Fields 1 3 shall be filed in in accordance with the data in the travel document. 7, Suman BANZA MUKONGO FOR OFFICAL USE ONLY 7, Summame at birt Date of application a Name vise application number: OUR Date of bith & Pace ofbiah \appicaton Todged al 1976.09.17 KINSHASA i cinbessyiconsulate IDI service provicer &. Comty of birth 77 Current nationality 7. Nationality at bir, diferent [] Commercial intermedia COD. DEMOCRATIC REPUBLIC OF | COD - DEMOCRATIC REPUBLIC OF COD - DEMOCRATIC REPUBLIC OF IDI Barter ‘THE CONGO (FORM. ZAIRE) ‘THE CONGO (FORM ZAIRE) ‘THE CONGO (FORN. ZAIRE) ase 3 Marital stats ICD otner Male sing 70, Holder of parental responsibiliy in case of minors)/ Legal guardian 70, Surname 7D. Wane Fis handled by 70, dares (i aMTerent Wom Whe apHCAnTS| 7D, PRONE Supporng Gosumens 70 Ema 70, Nationaliy IC Travet documents ICameans of supcort [Ca ssvaton pi [itcans of tanspot Dorner iss decision: IL Retusea issued No logo is roquired for Norway, lealand, Lisehtonetein and Switzerland, 177, National Identity Number, where applicable os (Oc 42. Travel document type Ove ORDINARY PASSPORT (SSUED AFTER 01042009) vai 7s, Number of Travel] 15, Dats oss ENR aaa 7 once Tambor orenvies Becument 202140415, maei014 cop-pewocranic —|E1 ‘0083303 Repustie OF THE Conco|—]2 FORM ZalRe) ite 77 Personal data oF he Tamily member who Wan EU, EERor GW Gaon WF appTCTe 77 Surname [Fam name) 77 ame tiumberoraays 77 Date ofr 77, Rational atbinh,Faerent | 17, Wumber of Travel Document 7a Family constant wit an EU, EEA or CH ofan “Applicants home adarers 7e Rae [AVENUE LONGO 34A QKAUKA C/KALAMU 75 POSTAL CODE 75, Fone ere czas 2249815909997 Te County 75 Gy CoD. DEMOCRATICREPUBLICOF THE CONGO | KINSHASA on zARe) 48. Email ‘Tegrasemaria@g mail om 20, Residence in a counity other than the county of current nationaliy No 20, Residence pemnit or equivalent 20, Valid uni 2, Naber TH Other parpoae{ayoF the journey EMPLOYEES: "2p, Employer and eniployers adaress and telephones number. For stuGenis, name and adaress of eGUCaTOnaT establishments LASAGESE SARL TE RUGTESS 7S AVENUE KABAMBARE COMUNE DE KINSHASA 2, POSTAL CODE 2, County COD - DEMOCRATIC REPUBLIC OF THE CONGO (FORM. ZAIRE) 2a, Phone Drax 9044270781 Eman Lasagessesarl05@g mailc omBE Purpose(syoF he journey: Business Bi, Adaioral formation on purpose GF stay JE, Mawibar State ot main destination (and other 35, Member Sate ot ist ty Member States of destination, if applicable! rA-rmauy may By, Number oF enbies required one Zi WENGE Gate OT aT OT Whe TT 2028-05-15 | 27. Intended date of departure from the Schengen area after the Wat intended stay: 2023-06-15 Tended say mv the Schengen area 27, Duration of he intended stay or Fansit. Indicate The number of Gays 30 FE. Fingerprints Collected previously Tor the parnose ofappiving fora Schengen visa Ne FE Date inoue Ze. Visa sicker nuiiber, TOW 2 ERY peri Tor the Hal COUTTy OF TESETNATIGN, WHETE app Ze lesued By 75, Vand To BeTavonmadons about ie living person(s). Irnot applicable, namie OTHOTe|s) or emporary aCcOmOURTION{S) Mt Te Member States) 730, Summame of te iiviing person =30, Namie of the lnviing person | =40, Date of bith of the inviting] “30, Province of the inviting person person 730, Address ofthe inviting person "30. POSTAL CODE of the inviting person Tab, FRane ofthe inviting parson | 0, Fax ofthe inviting parson "a0, Cily oF the inviting pareon “30, Elna ofthe avg parson 30, Inviting company VILLA CARLOTTA =30, Province ofthe inviing company 730, Phone of the inviting company 735, City of he inviting company Tio, Fax ofthe inviting Company leer Tao, Address of the Tivitng company “30, POSTAL CODE of the inviting company 10 Vie Acqua Sottuea Isemnia Isernia tay 35170 30, Email oF the maviing Company Tavitation "3H, Namie Ta, Aaaress “Bi, POSTAL CODE "Hi Province "3H, PRONE, TH Far 731, Email Contact parson in company organization UF AppCADIEy Tar, Sumane =H Namie TH ACESS "3H, Phone "HH Far 73H, Email Taz, The applicant Wavel and subaiatence expenses are Charged “Gz, Means oF supportTam aware athe visa Tee fe nol refunded Ihe visa Is TeTISea Applicable in case a multiple-enty vsais appled for | am aware ofthe need tohave an adequate travel medical insurance for my frst stay and any subsequent visits to the terior of Member Sates. | am aware of and consent tothe folowing the collection of he data required by this application form and the ‘aking of my photograph ard, i applicable, ‘me taking of ingerprinis, are mandatory for ie examination ofthe application: and any personal data concerning me which appear onthe application form, 232 wel 3° my fingorprnte ane my photograph will bo eupplied fe tho relevant authortes othe Mambor States and processed by those authors, for he purposes of a decision on my apalicaticn. Such data as well as data concerning the decision taken on my appication ora decision whether fo annul, revoke of extend a visa issued will be entered into, and store inthe Vise Information Sysiem (VIS) fora maximum petiod of five years, Curing which itil be accessible t the visa authoriies andthe authoniies competent forcarying cut checks on visas at extemal borders and within fre Member States, immigraton and asylum authontes n the Member States for the purpases of venfyng whether the canations for he legal entry ino, stay and residence on the trntery ofthe Member States are fulfil, of dentfyng persons viha de net oF who ne longes ful these cancitions, of examinng an asylum pplication and of determining eespeneiiliy fer auch examination. Under eetain cendstione the cata wif be alzo avaiable te designated authariies of he Member States (for Italy the Ministry of Interior and the Police authori) and to Europa fr the purpese ofthe oreveniion. detection and investigation of terorst fences and of ofier serious ciimnal offences. The Minisity of Foreign Affairs and Inlernational Cooperaiion - MAECI (Piazzale dela Farresina 1 00135 Roma) wanwestrit tl, 0039 06 36911 (svitchbcard), through the Diglomatc Representation or Consulate where the visa appication has been lodged, isthe authority responsible or processing the data Tam aware hall have the ight fo Oblain,n any ci the Member Stiles naiicalon othe Gala Tealing to me Tecorded in he VIS and aT he Member SIS ‘hich tansnitted te data, and to request inal data telaing to me wich are inaccurate be corrected ard that data relating fo me processed unlaviuly be oloted. At my exprose roqueat, the authorty examining my application (for the Diplomatic Repreaortations of Conaulates ploase visit vawe cater ito hitp:vistopertaia ester) wll inform me ofthe manner in which Imay exercise my right lo check the personal data conceming me and nave them Ccorected or deleted, including the related remedies according io the national law othe Member State concerned The lilin national supervisory ‘competent authority onthe protection of personal data is the MAECI Data Protection Officer /DPO (emall:cpd@estet.t, certified ema: mpd@cert estet) ortne alan Data Protecton Aunorty (Piazza Venezia 11, 00187 ROMA, tel, 0159.06 696771 (swtendoara), mal: garante@gpao pec: protocolle@sec gpdp.8). Ideclare that fo the test of my knwledge all particulars suppliee by me are correct and complete. am aware that any false ‘Statements wil la fo my apalcstion bsing resciad orf the annulment ofa viea eady granted and may alsa rencer me liable fo proseewsion under the law ofthe Member State which ceals wih the application. | undertake to leave the ferrfory ofthe Member Slates before the expiry of he vie, ifgranted. | have been informed that possession of 2 vsais ony one ofthe prerequisites for entry nto the European terior ofthe Member States. The mere fact that a visa has been granted fo me does noi mean that wil De entilec to Compensation if Taf to comply win the elevant provsions cf tcl 61) of Regulation (EU) No 2010096 (Schengen Borders Code! and am therefore refused enty. The prerequisites for enry willbe checked again on eny into the European teitry of the Member Sites. SE PRE ane OSE ‘SE SGTAAE Tor HUTTE, SNSTUTE OT paTSTIAT AUNT TEGAN GUTETANTAppendix for Application for Schengen Visa Please do also bring this page when applying for a visa It contains your entries in a machine-readable format, Barcode 1