VURN: LPVLLMRDPM

Harmonised application form

Application for Schengen Visa
Photo
This application form is free

(1)
Family members of EU, EEA or CH citizens or of UK nationals who are Withdrawal Agreement beneficiaries shall not fill in
fields no. 21, 22, 30, 31 and 32 (marked with*).
Fields 1-3 shall be filled in in accordance with the data in the travel document.

1. Surname (Family name): FOR OFFICIAL USE ONLY

STAHI
Date of application:
2. Surname at birth (Former family name(s)):
STAHI Application number:

3. First name(s) (Given name(s)):

Application lodged at:
NOUREDDINE ☐ Embassy/consulate
4. Date of birth 5. Place of birth: 6. Country of birth: ☐ Service Provider
(day-month-year): TOUISSITE MOROCCO ☐ Commercial intermediary
12-07-1987 ☐ Border (Name):
____________
7. Current nationality: Nationality at birth, if different:
____________
MOROCCO ☐ Other:
Other nationalities:
File handled by:

8. Sex: 9. Civil status: Supporting documents:

☒ Male ☐ Single ☐ Divorced ☐ Travel document
☐ Female ☒ Married ☐ Widow Or Widower ☐ Means of subsistence
☐ Invitation
☐ Registered Partnership ☐ Other (please specify):
☐ TMI
☐ Separated
☐ Means of transport
10. Parental authority (in case of minors) / legal guardian (surname, first name, address, if different from applicant’s, ☐ Other:
telephone no., e-mail address, and nationality):
Visa decision:
11. National identity number, where applicable: ☐ Refused
V240021 ☐ Issued
12. Type of travel document: ☐ A
☒ Ordinary passport ☐ Diplomatic passport ☐ Service passport ☐ Official passport ☐ Special passport ☐ C
☐ LTV
☐ Other travel document (please specify):
☐ Valid:
13. Number of travel 14. Date of issue: 15. Valid until: 16. Issued by (country):
document: 18-04-2022 18-04-2027 MOROCCO From:
KJ0357327
Until:
17. Personal data of the family member who is an EU, EEA or CH citizen or a UK national who is a Withdrawal
Agreement beneficiary, if applicable
Number of entries:
Surname (Family name): First name(s) (Given name(s)): ☐ 1 ☐ 2 ☐ Multiple

Date of birth Nationality: Number of travel document or ID card: Number of days:

(day-month-year):

18. Family relationship with an EU, EEA or CH citizen or a UK national who is a Withdrawal Agreement beneficiary, if
applicable:
☐ Spouse ☐ Child ☐ Grandchild ☐ Dependent ascendant ☐ Registered partnership
☐ Other:

19. Applicant’s home address and e-mail address: Telephone no.:

HAY SOUARETE RES EL BARAKA 4 APT 432 A.B, 20300 CASABLANCA, MOROCCO +212661366741

NOUREDDINE.STAHI@GMAIL.COM

(1) No logo is required for Norway, Iceland, Liechtenstein and Switzerland. 1/3
20. Residence in a country other than the country of current nationality:
☒ No No. Valid until
☐ Yes. Residence permit or equivalent

*21. Current occupation:

Chemist/Chemical engineer
*22. Employer and employer’s address and telephone number. For students, name and address of educational establishment:
MANAGEM GROUP TWIN CENTER TOUR A ANGLE BD ZERKTOUNI ET BD AL
+212522956565 MASSIRA AL KHADRA
20250 CASABLANCA
MOROCCO
23. Purpose(s) of the journey:
☐ Tourism ☒ Business ☐ Visiting family or friends ☐ Cultural ☐ Official visit ☐ Medical reasons ☐ Sports ☐ Study ☐ Airport transit
☐ Other (please specify):

24. Additional information on purpose of stay:

25. Member State of main destination (and other Member States of destination, if applicable): 26. Member State of first entry:
Finland Finland
27. Number of entries requested:
☐ Single entry ☐ Two entries ☒ Multiple entries

Intended date of arrival of the first intended stay in the Schengen area: Intended date of departure from the Schengen area after the first intended
17-04-2023 stay:
23-04-2023
28. Fingerprints collected previously for the purpose of applying for a Schengen visa:
☒ No ☐ Yes Date, if known Visa sticker number, if known

29. Entry permit for the final country of destination, where applicable:
Issued by Valid from until

*30. Surname and first name of the inviting person(s) in the Member State(s). If not applicable, name of hotel(s) or temporary accommodation(s) in the
Member State(s):

Address and e-mail address of inviting person(s)/hotel(s)/temporary accommodation(s): Telephone no.:

*31. Name and address of inviting company/organisation:

METSO OUTOTEC OYJ RAUHALANPUISTO 9, 02230 ESPOO, FINLAND
Surname, first name, address, telephone no., and e-mail address of contact person in company/organisation:
SAARINEN ANITA ESPOO
ANITA.SAARINEN@MOGROUP.COM FINLAND
+358400479006
Telephone no. of company/organisation:
+358400479006
*32. Cost of travelling and living during the applicant’s stay is covered:

☐ by the applicant himself/herself ☒ by a sponsor (host, company, organisation), please specify:

☐ referred to in field 30 or 31
Means of support:
☒ other (please specify):
☐ Cash
☐ Traveller's cheques MANAGEM GROUP
Means of support:
☐ Credit card
☐ Cash
☐ Prepaid accommodation
☐ Accommodation provided
☐ Prepaid transport
☒ All expenses covered during the stay
☐ Other (please specify):
☐ Prepaid transport
☐ Other (please specify):

2/3
I am aware that the visa fee is not refunded if the visa is refused.

Applicable in case a multiple-entry visa is applied for:

I am aware of the need to have an adequate travel medical insurance for my first stay and any subsequent visits to the territory of Member States.

I am aware of and consent to the following: the collection of the data required by this application form and the taking of my photograph and, if
applicable, the taking of fingerprints, are mandatory for the examination of the application; and any personal data concerning me which appear on the
application form, as well as my fingerprints and my photograph will be supplied to the relevant authorities of the Member States and processed by
those authorities, for the purposes of a decision on my application.

Such data as well as data concerning the decision taken on my application or a decision whether to annul, revoke or extend a visa issued will be
entered into, and stored in the Visa Information System (VIS) for a maximum period of five years, during which it will be accessible to the visa
authorities and the authorities competent for carrying out checks on visas at external borders and within the Member States, immigration and asylum
authorities in the Member States for the purposes of verifying whether the conditions for the legal entry into, stay and residence on the territory of the
Member States are fulfilled, of identifying persons who do not or who no longer fulfil these conditions, of examining an asylum application and of
determining responsibility for such examination. Under certain conditions the data will be also available to designated authorities of the Member
States and to Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other serious criminal offences. The
authority of the Member State responsible for processing the data is: The Ministry for Foreign Affairs of Finland.

I am aware that I have the right to obtain, in any of the Member States, notification of the data relating to me recorded in the VIS and of the Member
State which transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data relating to me processed
unlawfully be deleted. At my express request, the authority examining my application will inform me of the manner in which I may exercise my right to
check the personal data concerning me and have them corrected or deleted, including the related remedies according to the national law of the
Member State concerned. The national supervisory authority of that Member State [contact details: The Office of the Data Protection Ombudsman in
Finland (www.tietosuoja.fi/en)] will hear claims concerning the protection of personal data.

I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that any false statements will lead to
my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under the law of the
Member State which deals with the application.

I undertake to leave the territory of the Member States before the expiry of the visa, if granted. I have been informed that possession of a visa is only
one of the prerequisites for entry into the European territory of the Member States. The mere fact that a visa has been granted to me does not mean
that I will be entitled to compensation if I fail to comply with the relevant provisions of Article 6(1) of Regulation (EU) No 2016/399 (Schengen Borders
Code) and I am therefore refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Member States.

Place and date: Signature:

(signature of parental authority/legal guardian, if applicable):

3/3
Business/Official visit - Affaires / Visite officielle

⚠ Missing documents may negatively affect the visa decision. For official use only
☒ Yes ☐ No Visa application form with a photograph ☐ Pending
Schengen visa application form shall be duly completed, dated and signed by the applicant. Please check the visa application photo
requirements on the website https://www.icao.int/Security/mrtd/Downloads/Technical%20Reports/Annex_A-Photograph_Guidelines.pdf.

Formulaire de demande de visa avec photo

Formulaire de demande de visa dûment rempli, daté et signé par le demandeur. Pour voir les specifications concernant la photo, merci de
cliquer sur le lien suivant: https://www.icao.int/Security/mrtd/Downloads/Technical%20Reports/Annex_A-Photograph_Guidelines.pdf.
☒ Yes ☐ No Travel document ☐ Pending
The travel document must be valid for a minimum of three (3) months after the planned journey, issued within the previous 10 years and
have at least two (2) blank pages.

Copy of the information page of the passport and copies of any pages with markings on them, e.g. previous Schengen visas, arrival and
departure stamps, etc.

Passeport
Un passeport en cours de validité
Le passeport doit être valable au moins 3 mois après le voyage prévu. Le passeport doit avoir été délivré au cours des 10 dernières années et
doit avoir au moins deux feuillets vierges.

Copie de la première page du passeport et de toutes les autres pages marquées, par exemple les copies des éventuels visas Schengen
(valables et périmés) et cachets de départs et retours.
☒ Yes ☐ No Travel medical insurance ☐ Pending
Travel medical insurance must be valid for the duration of travel and cover the entire Schengen area. An applicant for a multiple-entry visa
may provide an insurance policy, which is valid during the first trip. The minimum coverage of the policy must be 30 000 (thirty thousand)
euros. The policy has to cover costs in case of sudden illness or accident and assistance on site, including the costs of medical repatriation to
the place of permanent residence of the insured person or the repatriation in case of death.

Assurance médicale de voyage

L'assurance médicale de voyage doit être valable pour la durée du voyage et couvrir l'ensemble de l'espace Schengen. Un demandeur de visa à
entrées multiples peut fournir une police d'assurance, qui est valable lors du premier voyage. La couverture minimale du contrat doit être de
30 000 (trente mille) euros. L´assurance doit couvrir les frais en cas de maladie soudaine ou d'accident et d'assistance sur place, y compris
les frais de rapatriement sanitaire jusqu'au lieu de résidence permanente de l'assuré ou le rapatriement en cas de décès.
☒ Yes ☐ No Transport reservations ☐ Pending
Flight reservation of a return ticket. Attention: the ticket should not be purchased before visa is granted.

Réservation de billet
Réservation de billet d’avion aller-retour. Attention : Le billet ne doit pas être acheté avant que le visa ne soit délivré.
☒ Yes ☐ No Proof of accommodation ☐ Pending
Hotel reservation or other proof of accommodation in Finland

Preuve d'hébergement
Réservation d’hôtel ou preuve d’autre type d’hébergement en Finlande
☒ Yes ☐ No Invitation letter ☐ Pending
Invitation letter by the hosting party written in English, Finnish, Swedish or French:
- dated and signed by the host
- specifying the purpose and duration of the visit
- including details of the inviting and invited person
- specifying the nature of business relation
- specifying the fees beared by the host

Lettre d'invitation en anglais, finnois, suédois ou français:

- datée et signée par l'hôte
- précisant l'objet de voyage et la durée de la visite
- noms et prénoms des personnes invitées et d'hôte
- précisant la nature de la relation commerciale
- précisant les frais pris en charge par l'inviteur
☒ Yes ☐ No Travel order or letter from sending organisation ☐ Pending
Mission order or note verbale, specifying the details of the applicant, the official job title, the purpose of the trip, the length and place of the
envisaged stay.

Ordre de mission
Ordre de mission ou note verbale, précisant le nom et le prénom du demandeur, l’intitulé officiel de sa fonction, l’objet du voyage, la durée et
le lieu du séjour envisagé.
☒ Yes ☐ No Documents for business travel ☐ Pending
Declaration of the party bearing the travel and living costs if not indicated in the mission order or in the invitation.

Prise en charge
Prise en charge de la société responsable des frais de voyage et de séjour si ce n’est pas indiqué dans l’ordre de mission ou dans l’invitation.

APPLICATION ID: LPVLLMRDPM APPLICANT: STAHI NOUREDDINE 1/6

☐ Yes ☒ No Documents for seamen (crew members) ☐ Pending
Seaman
- Seaman’s book
- Employment contract or letter of appointment, indicating the duration of employment and allowing embarkation on board of the vessel
- Invitation from by shipowner / maritime agency of the Member State where the seafarer will embark. The invitation must be signed, bear the
stamp of the shipowner / maritime agency and mention the following data: seafarer’s name and surname; place and date of birth, passport
number, seafarer's book number; date of issue, period of validity of passport and the seafarer’s book; the seafarer's position on the vessel;
name and flag of the vessel; port and date of boarding and disembarking; itinerary that the seafarer will follow to arrive in the Member State
of destination/ transit including date and entry point (airport) to the Schengen area. The shipowner / maritime agency based in the Member
State is also required to indicate that it will bear all responsibility for the seafarer upon his arrival in the Member Stateand ensure that he
boards the ship.

Marin
- Livret de marin
- Contrat de travail ou lettre de nomination, mentionnant la durée d’emploi et permettant l’embarquement à bord du navire
- Invitation de l’armateur/agence maritime de l’État membre dans lequel le marin embarquera.
L'invitation doit être signée, porter le cachet de l'armateur/agence maritime et mentionner les données suivantes: nom et prénoms du marin,
lieu et date de naissance, numéro de passeport, numéro du livret de marin, date de délivrance et durée de validité du passeport et du livret de
marin, fonctions du marin à bord du navire, nom et pavillon du navire, port et date d'embarquement et de débarquement, itinéraire que le
marin empruntera pour parvenir à l'État membre de destination/transit précisant la date et le point d'entrée (aéroport) dans l'espace
Schengen. L'armateur/agence maritime établi(e) dans l'État membre est également tenu(e) de préciser qu'il/elle sera entièrement
responsable du marin dès son arrivée dans l'État membre et qu'il/elle veillera à ce que le marin embarque effectivement à bord du navire.
☐ Yes ☒ No Documents for study or training ☐ Pending
Recipient of a scholarship under the European programmes Erasmus+ and Horizon 2020, or other EU mobility programmes:
- Letter of acceptance from the host institution in the Member State of destination

Boursier
Bénéficiare d’une bourse dans le cadre des programmes européens Erasmus+ et Horizon 2020, ou d’autres programmes de mobilité de l’UE :
- Lettre d’acceptation de l’établissement d’accueil dans l’État-membre de destination
☒ Yes ☐ No National ID ☐ Pending
Copy of national identity card (both sides)

Copie de la carte d’identité nationale (recto-verso)

APPLICATION ID: LPVLLMRDPM APPLICANT: STAHI NOUREDDINE 2/6

☒ Yes ☐ No Proof of employment ☐ Pending
Employee:
- Certificate of employment
- Certificate of declaration of wages to the CNSS
- Pay slips for the last 3 months including the name of the applicant and the company
- Foreign employees (not applicable to Algerian, Senegalese and Tunisian citizens) : employment contract stamped by the Ministry of
Employment

Civil servant:
- Certificate of incumbency
- Copy of the CNOPS card (both sides)
- Pay slips for the last 3 months including the name of the applicant and the employer

Persons practicing a specific profession or occupation:

Member of the Royal Court, Government, Parliament, Superior Council of the Judiciary, Constitutional Court, Court of Accounts, Economic,
Social and Environmental Council, National Council of Human Rights:
- Note verbale, certificate of tenure or other official document

Senior officials of the Moroccan state:

- Certificate of tenure issued by the relevant body

University rector or dean:

- Certificate of tenure issued by the university concerned

Staff of a European Union delegation, embassy, consulate or official body of a Member State:
- Certificate of tenure issued by the employer

Professions governed by a professional order (doctors, surgeons, dentists, pharmacists, lawyers, architects):
- Professional identity card or certificate from a professional order
- Certificate of registration for the professional tax

Self-employed / Entrepreneur/ Tradesman:

- Recent extract from trade register (max. 3 months) issued by the Commercial Court or the Court of First Instance
- Company statute
- Financial statement of the company and tax clearance certificates for the past year and for the current year

Farmer:
- Professional certificate issued by the Ministry of Agriculture
- Ownership certificate of agricultural property

Preuve d'emploi
Salarié:
- Attestation d’emploi
- Attestation de déclaration de salaires à la CNSS
- 3 derniers bulletins de salaire indiquant le nom du demandeur et de l’entreprise
- Les salariés étrangers (non-applicable aux citoyens algériens, sénégalais et tunisiens) : contrat d’emploi portant le cachet du ministère de
travail

Fonctionnaire:
- Attestation de fonction
- Copie de la carte de la CNOPS (recto—verso)
- 3 derniers bulletins de salaire indiquant le nom du demandeur et de l’employeur

Personnes exerçant une profession/activité spécifique:

Membres de la Cour royale, du gouvernement, du Parlement, du Conseil supérieur du pouvoir judiciaire, de la Cour constitutionnelle, de la
Cour des comptes, du Conseil économique, social et environnemental ou du Conseil national des droits de l’homme :
- Note verbale, attestation de fonction ou autre document officiel

Hauts fonctionnaires de l’État marocain :

- Attestation de fonction délivrée par l’organisme compétent

Recteur d’université ou doyen :

- Attestation de fonction délivrée par l’université concernée Personnel d’une délégation de l’Union européenne, d’une ambassade, d’un
consulat ou d’un organisme officiel d´un État-membre :
- Attestation de fonction délivrée par l’employeur

Professions réglementées par un ordre professionnel: (médecins, chirurgiens, dentistes, pharmaciens, avocats, architectes)
- Carte professionnelle ou attestation délivrée par l’ordre professionnel
- Attestation d’inscription à la taxe professionnelle

Profession libérale / Entrepreneur / Commerçant:

- Extrait du registre de commerce récent (max. 3 mois) délivré par le tribunal de commerce ou de première instance
- Statuts de la société
- Etat financier de la société et quittance d’impôts de l’année précédente et de l’année en cours (Recettes de Finance)

Agriculteur:
- Attestation professionnelle du Ministère de l’Agriculture
- Certificat de titre de propriété agricole

APPLICATION ID: LPVLLMRDPM APPLICANT: STAHI NOUREDDINE 3/6

☒ Yes ☐ No Proof of financial means ☐ Pending
Employee:
- Bank statements for the last 3 months
- Other proof of assets or other means of subsistence, as applicable

Civil servant:
- Bank statements for the last 3 months
- Other proof of assets or other means of subsistence, as applicable

Professions governed by a professional order (doctors, surgeons, dentists, pharmacists, lawyers, architects):
- Bank statements for the last 3 months
- Other proof of assets or other means of subsistence, as applicable

Self-employed / Entrepreneur/ Tradesman:

- Company’s bank statements covering the last 3 months
- Personal bank statements covering the last 3 months
- Other proof of assets or other means of subsistence, as applicable

Pensioner:
- Bank statements for the last 3 months of the account where the pension is paid into
- Other proof of assets or other means of subsistence, as applicable

Farmer:
- Bank statement of the farm or personal account covering the last 3 months
- Other proof of assets or other means of subsistence, as applicable

Student:
- A signed and legalised financial means document accompanied with supporting documents concerning the socio-economic situation of
parent(s) or legal guardian(s), based on the categories above, and bank statements for the last three months
- Proof of own financial means (if applicable), as per the abovementioned solvency requirements of the relevant profession

Unemployed:
- A signed and legalised financial means document accompanied with supporting documents concerning the socio-economic situation of the
person covering the costs in Morocco, as per the abovementioned solvency requirements of the relevant profession
- “Proof of own financial means (if applicable), as per the abovementioned solvency requirements of the relevant profession

Preuve de moyens financiers

Salarié:
- Relevés bancaires des 3 derniers mois
- Autre preuve de la propriété de biens ou d’autres moyens de subsistance, selon le cas

Fonctionnaire:
- Relevés bancaires des 3 derniers mois
- Autre preuve de la propriété de biens ou d’autres moyens de subsistance, selon le cas

Professions réglementées par un ordre professionnel: (médecins, chirurgiens, dentistes, pharmaciens, avocats, architectes)
- Relevés bancaires des 3 derniers mois
- Autre preuve de la propriété de biens ou d’autres moyens de subsistance, selon le cas

Profession libérale / Entrepreneur / Commerçant:

- Relevés bancaires de la société des 3 derniers mois
- Relevés bancaires personnels des 3 derniers mois
- Autre preuve de la propriété de biens ou d’autres moyens de subsistance, selon le cas

Retraité(e):
- Relevés bancaires des 3 derniers mois du compte où la pension est versée
- Autre preuve de la propriété de biens ou d’autres moyens de subsistance, selon le cas

Agriculteur:
- Relevés bancaires de la ferme ou compte personnel des 3 derniers mois
- Autre preuve de la propriété de biens ou d’autres moyens de subsistance, selon le cas

Etudiant(e):
- Document de prise en charge, signé et légalisé, accompagné par les justificatifs de la situation socioprofessionnelle du ou des parents ou
des tuteurs légaux, selon les exigences de solvabilité susmentionnées de la profession concernée
- Preuve de propres moyens de subsistance (le cas échéant), selon les exigences de solvabilité susmentionnées de la profession concernée

Sans emploi:
- Document de prise en charge, signé et légalisé, accompagné par les justificatifs de la situation socioprofessionnelle de la personne assurant
la prise en charge au Maroc, selon les exigences de solvabilité susmentionnées de la profession concernée
- Preuve de propres moyens de subsistance (le cas échéant), selon les exigences de solvabilité susmentionnées de la profession concernée

APPLICATION ID: LPVLLMRDPM APPLICANT: STAHI NOUREDDINE 4/6

☐ Yes ☒ No Proof of studies ☐ Pending
- School certificate or student card for the current year
- Legalised birth certificate (in Morocco with apostille certification)
- Copy of the family record book

Preuve d'études
- Certificat de scolarité ou carte d’étudiant pour l’année en cours
- Acte de naissance légalisé (au Maroc avec certification apostille)
- Copie du livret de famille
☐ Yes ☒ No Proof of pension ☐ Pending
- Proof of pension

Preuve de pension
- Attestation de pension
☐ Yes ☒ No Documents for third country citizens ☐ Pending
Copy of the permanent residence card (valid for at least 3 months after the visa expiry date) if you are not Moroccan or Mauritanian.

Carte de séjour
Copie de la carte de séjour permanent (valable au minimum 3 mois après l’expiration du visa) si vous n’êtes pas marocain ou mauritanien.
☐ Yes ☒ No Other additional documents ☐ Pending
Proof of family tie
Spouse and minor or dependent child of the below-mentioned persons:
- Persons practicing a specific profession or occupation
Member of the Royal Court, Government, Parliament, Superior Council of the Judiciary, Constitutional Court, Court of Accounts, Economic,
Social and Environmental Council, National Council of Human Rights
- Senior officials of the Moroccan state
- University rector or dean
- Staff of a European Union delegation, embassy, consulate or official body of a Member State

Documents supplémentaires
Preuve du lien de parenté
Conjoint et enfant mineur ou à charge des personnes mentionnées ci-dessous:
- Personnes exerçant une profession/activité spécifique
Membres de la Cour royale, du gouvernement, du Parlement, du Conseil supérieur du pouvoir judiciaire, de la Cour constitutionnelle, de la
Cour des comptes, du Conseil économique, social et environnemental ou du Conseil national des droits de l’homme
- Hauts fonctionnaires de l’État marocain :
- Recteur d’université ou doyen
- Personnel d’une délégation de l’Union européenne, d’une ambassade, d’un consulat ou d’un organisme officiel d´un État-membre
☐ Yes ☒ No Request for visa revocation ☐ Pending
Request for visa revocation is added at the Visa Application Centre, if needed.

La demande de révocation de visa est ajoutée au Centre de demande de visa, si nécessaire.

☐ Yes ☒ No Other submission documents ☐ Pending
Other submission documents are added at the Visa Application Centre, if needed.

D'autres documents sont ajoutés au centre de demande de visa, si nécessaire.

APPLICATION ID: LPVLLMRDPM APPLICANT: STAHI NOUREDDINE 5/6

Signatures
I have understood that I (or my authorised representative) have to submit the above-mentioned documents to the Visa Application Centre. By
signing this form, I hereby confirm that all the information stated in the documentation is true.
J'ai compris que moi (ou mon représentant autorisé) dois soumettre les documents susmentionnés au Centre de demande de visa. En signant
ce formulaire, je confirme par la présente que toutes les informations indiquées dans la documentation sont vraies.

Signature of the applicant / representative of the applicant

Signature du demandeur / représentant du demandeur

For official use only (at the Visa Application Centre)

Pour usage officiel uniquement (au Centre de demande de visa)

☐ I have understood that I have to submit the above-mentioned missing documents to the Visa Application Centre by the date mentioned
above. If I do not submit the documents by the date mentioned above, I accept by signing this form that the visa application will be
examined without the requested documents and that the decision may be to my disadvantage.
J'ai compris que je dois soumettre les documents manquants mentionnés ci-dessus au Centre de demande de visa avant la date
mentionnée. Si je ne soumets pas les documents à la date mentionnée ci-dessus, j'accepte en signant ce formulaire que la demande de
visa sera examinée sans les documents demandés et que la décision pourra être à mon désavantage.

☐ I do not intend to submit the above-mentioned missing documents to the Visa Application Centre.
I accept by signing this form that the visa application will be examined without the requested documents and that the decision may be
to my disadvantage.
Je n'ai pas l'intention de soumettre les documents manquants mentionnés ci-dessus au Centre de demande de visa. J'accepte en signant
ce formulaire que la demande de visa sera examinée sans les documents demandés et que la décision pourra être en ma défaveur.

Signature of the applicant / representative of the applicant Signature of the submission officer
Signature du demandeur / représentant du demandeur

APPLICATION ID: LPVLLMRDPM APPLICANT: STAHI NOUREDDINE 6/6