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Application for SchengenVisa
Td khai xin cap thi thwc Schengen
This application form is free
Td khai dvgc pht min ph
PHOTO
l. Surname (Family name) (x)l Hp 2. Surname at birth (Former fami|y names(s)) (x) l Hq khi sinh (Hq truc ddy)
For oficia| use only/ Muc ddnh ring cho cO qrcm chtrc nng
(Given name(s)) Tn (x) (Tn 3. First name(s) tm)
4. Date of birth (day-month-year)/ Ngoy thng nm sinh (nga-y".thng-nm) 5. Place of birth/ Noi sinh . Country of birtV Qu c gia sinh 7. Current nationality/ Qu c fich hrQnnay Nationa|ity at birth, i16i77g1g|1/ Quc ich khi sinh (nukhac quc tich hien noy):
Date of application:
Visa application number
Application lodged at: 8. Sex/ Gii tnh n Melel Nam 9. Marita| status/ Tinh trang hn nhan n Single/ DQc than n Married/ Dd tuil hon n.seprratedl t4,than n Divorced/ I.y hn l Widow(er\l Ga chngivo n other (please specify)/ Tinh trqng kluic (xin nur)
n Female/,V&
n Embassy/ Consulate n CAC n Serviceprovider n Commercial intermediary n Border Name: n Other File handled by:
l0. In the case of minors: Surname, irst name, address (if different,from app|icant's) and nationa|ity of parenta| authority/ lega| guardianl Trudng hqlp ngtdi chua thdnh nin: hQ, tn,dia chi (nukhng tr ng voi dia chi ngtdi xin ctip th1thrc) vd quc tlch cua ng i c quyn nui dtdng/ ngni gim hQ
l l. Nationa|ityidentity number,wherc app|icab|e/ CMND, nu S c,in
l2. Type of travel document/.Lo4igiy to thng hanh n ordinary passpor HQ chiiiu ph thng n Diplomatic passport/ H chiu ngoal 4ruo n Service passporV H chiu cng vu o oflicia| passpor H chiu cong (HQ chiu cong vu1 n Specia| passpor Hq chiudc bit n other trave| document (please specify)/ Giti1,td thong hdnh khc (xin nur) | 3. Number of travel document/ Sb hq chitlGi(b td thng hanh
l4. Date of issuel Ngdy cp
|5. Va|id until/ Agd;, h han
| 6. lssued by Co quan cdp Telephonenumberls)/ (Cc) s din thoqi
Supporting documents: n Traveldocument n Meansof subsistence n Invitation n Meansof transport n TMI n Other: Visa decision: n Refused r Issued: nA oC o LTV
Valid
l7. App|icant's home address and e.mai| address/ Dia chi nhd ring vd tfu diQn ttr cua ngrai xin cdp thi th|c
l8. Residence in a country other than the country of current nationality/ Quy vi hin c at trli tai mt quc gia khc voi qucgia md minh dang mang quc tich khng, r:Nol Khng n }.es./Cd. Residence permit or equivalen tl Gi$, php clr tr hoQc gi , 0 nrong dtrung N"./ ^ld. ...... ' Va|id unti|/ Cd gia tri ti ngay\
l9. Current occupation/ Ngh nghi?p hin tqt
20. Employer and employer's address and telephone number. For students, name and address of educational establishment./ Tn,dia chi vd s difu hoqi cua co quan. Di vdi hqc sinh, sinh vin: tnvd dia chi tnrdng'
2 l . Main purpose(s) of the journ eyl (C c) myc dch chnh cua chuyndi: nTourism/ Du lich o Business/ Thuong mqi nVisiting fami|y or friends/ Thm thn nh n hoc bqn b a Cu|tura|/ |,n ha n Sport Ththao n oficia| visit/ Thm chnh thtrc n Medica| reasons/ L.y- y t do n Study/ H7c tQp
D F
n Transi Qu cnh
o Airport transiQu canhsdn bay o Other (please specify)/ Muc dich khc (xinnu r) 23. MemberStateof first entry. Ntnc thdnhvin nhdpcanhddu tin s
IIntil
22. Member State(s) destination/ of (Cc) rurc dnthuc kh i Schengen 24' Number of entriesrequestes tdnnhdp 'canhyucdu n Sing|eentry/ Mpt ln n Two entry/ Hai ln n Mu|tiple entries/Nhiutdn
Numberof entries: nl a2 oMultiple
25. Duration of the intended stay or transit. lndicate number of days Thi gian dv dinh lw tni hoQc qwi canh, nu r s ngay
Numberof days:
The fields marked with * shall not be filled in by members of EU. EEA or CH citizens (spouse, child or dependentascendant)while exercising their right to free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields N' 34 and 35/ Tfujn nfuin cua cng d n Lin minh chu u' Khr kinh tch u u hoc Thuy S ftq, chng, con hoQc cha, m9, ng, bd s ng pha thuQc) khng phai di.ncc muc ddnh fuiu * khi thrc hin quyn tv do di lqi caa minh. Ttty nhin nhtngngvi nay phai trinh gi(iy td chtng minh quan hQ gia tlinh vd dinvdo muc 34, 35 (x) Fields l.3 sha|| be fi||ed in in accordance with the data in the trave I documen Myc l -3 phai dtgc din chnh xc nhu trong gitiy td thng hanh,
26. Sche ngen visas issued during the past three year Thi thq,cSchengen dtryc cp tong vdng ba nm tro lqi day aNol Khng '''..totdnn7dy 27. Fingcrprints collected previous|y for the purpose of app|ying for a Schengen visa/ Quy vi dd wng arqc t(b du vdn tay khi xin cdp thi thyc Schengen chua? oNolChm n Yes/Rri
Dqfpif |rnnwn/ Thi oinn n,, hit
28. Entry permit.for the fina| country of destination.,when app|icable/ Giy td cho php nhQp canh vdo ntc dncuiji citng trong hdnh trinh, nu cdn lssued by/ Cp boi .., . . .. .... Valid rom/C gi tr! ti, ngay . ... until/ tai ngdy' 29. Intended date ofarrival in the Schengen are Ngdy dr illnh nhdp canh vdo khoi Schengen 30. Intended date ofdeparture from the Schengen are Ngy dry dinh xut cnh khoi kh i Schengen
*3l. Surnameand irstnameof the invitingperson(s) the MemberState(s). not applicable' in If nameof hote|(s) temporary or accommodation(s) the Member State(s) Hq vd tn(nhtng) in l ngtvi ndi lai cc nuc thnhvin'Nukhng c, d nghi nu tn (cc) khach s7n hoc (nhmg) chtam tru tqi (cc) nrc thdnhvin' dia
Address and e-mail address inviting person(s)/hotel(s)/ temporary accommodation(s)/ Dia chi vd hdm tht din tt cua (nhrn ngti mdi, (cc) kfuchsqn, (cc) dia chi tqm tru Telephone and telefax/ S din thoqi vd fer Telephone and telefax of com pany'/orga nisation/ So dn thoai va.fax caa co (luan to chc mdi
*32.Nameand address invitingcompany/organisatio of Tn dla chi co quarut chttcmdi vd
Surname, first name, address, telephone,telefax and email address of contact person in companv/ organisation/ Hq vd tn,dia cht,, sii dien thoai, sfax. dia ch thu din tt cua ngtnli tinh trong-Co quan to cht?c mt *33. Cost of travel|ing and living during the app|icant's stay is covered/ Chi ph di tqi va n o cua ngudi xin cp thi th1tctrong thdi gian lnt tru s dto. c chi tr
n by the app|icant himse|f/ herse|f/ boi chinh ngttdt xin cp thi thrc Mesns of support/ Hinh th c thanh ton n Cash/ Tinn t n Trave||er's cheques/ Scdu lich o Credit card/ Thtin d4ng n Prepaid accommodationl Ch6 dd dwc thanh ton trttc o Prepaid trenspor Phwng ti(n di lqi dd dtrqc thanh ton trwlc o Other (please specify)/ Hinh thrc khac (xin nu r)
n by a sponsor (host, company, organisation). p|ease specifl/ bcti mt don v! bao ldnh (ngwdi mdi, co quan, t chtrc), xtn nu ri ... '. . f] referred to in field 3| or 32l dtryc nutrong muc 3l hoc 32 ...... D otber (p|easespecify//bnkhac (xin nurd) Means of support/ Hinh thuc thanh toan n Cash/ Tinmt n Accommodation provided/ Ch6 o dugc chu cp o' A|| expenses covered during the stayi Chu cp tdl ca chi ph trong thdi gian lru tru n Prepaid transpor Phtmng ti(n di lqt dd dtqc thanh ton truoc n other (p|ease speci$)/ Hinh thttc khac (xin nur)
34. Personal data of the.fami|y member who is an EU, EEA or CH citizerr/ Thng tin c nhn cua thdnh vingia dinh ld cng d n Lin minh ctuiu u,Khi kinh c|uiu u hoc Thuv Si Sumame/ Ho
First name(s)/ In
Date of birth/ Ngdy tfuing nm sinh
Nationaliw/ouc tich
Number of travel document or ID car Sa gi(b td th ng hdnh hoc CMND
35. Fami|y relationship with an EtI, EEA or CH citize Quanh( hq hangvi cng in Linminhch u u,Kkhikinh chduu _o hoqc ThuyS! n Spouse Vq/Chng a Chi|dl Con n Grandchi|dl Chtiu l Dependentascenden Cha, mg,ng, bd siing phtt tl thuQc
36. Pface and date/ Ngdy vd noi ldm don
(for minors, 37. Sigrature sigyrature parental of authority/ legal guardian)/ Ch b'. (Di vi ngtdi chra thdnhnin'. co chr cdn ky gin hQ) cua ngudi c quyn nui dudng/ngmJi
I am a aethat the visa fee is not 'efunded ifthe visa is efuse I i n,'d' th c r i)n?l ph thi thvc s khng duqc h@n l4i hia don xin aip thi th|.cbi td i' ch
Appli.|ble in c.c. r multip|e{nt.y viir i8 rpplicd for (cf. letdNo zy Tro,,g.ruvng hqp xln thi thrc ntulp cnh nhiu kin (xen m1c 24): | {m rwrr. of tbc n.cd !o hv r rdcqurte trrv | med|c.||ns lrc. ormy first st.y 'nd rny subs{quet vilitr to bct.rritory of Membcr strtc Tlit ,,tui |hk cdn lhilpfii c bao hi,n! t du lich phi hgp cho ln lf l| diu linv nht|1atdn luu hi rp Eo t?i lanh !h6 cdc qujc thr,hyicn' gn
I am &wee d oonsentto thc fol|o$ing: lhe collection ofthe data equied lhis applicationform and the t8king ofmy photogaph of by 8nd,ifapplicab|e' the tskinB ofingepints, mandaloryfothe examinalionofthe vis appliction; and any pesonaI arc data conceming me which appca the visa applicdion form, s wgl| as on my ingep.ints my photographwill be supplicd to the e|evtauthoritiesof the Member states and processcdby those 8uthoities' the purposeof a decision and fo on my visa application. rd nhdn .kic d ng ', ring: x, 'Tronqqui t'/l,1h hi sd xin aip thi thlrc' ec an. cp nhn{ thng |ih yu'cu trong t ktai xin ctip thi thrc, chup nh va tir ddu win tay a|i4 t6i .|o,8 lrvna hqp cdn ,hi,ld b, bu,ac:nQi thng tin c nfuin ghi |ronq |d khai cang nhl. du in tay v hh aati dtpc chuyn cc co dn q&n clnic nnqa]a aic nKic tl.rh vin\0 a,qc cc co q,ah ny x1rLj,nkin nuc dbh dlm ra qqt dinh divoi don xin aip thi trc aati. such dataas we||as dataconcemin8 decisiontakenon my app|ication a decisionwhether annu|. the oi to evoke extenda visa issuedwi|| be entEed or into' and stocdin the visa lnfomalionsystem (vlsxl) for a maximum peiodof five yeas'duing*hich it will be accessible to the visa authoritiesand ihe authoities competentfor caryingout checks on visas extemal bordesand within the Mcmber states. immig'ation and asy|um authorities in lhe Memb statcs fo the puposes verirying whethertho conditions for the le8al enrry into, st]ay esidence the toritory of 6d on ofthe Membestales aJe fu|i||ed' ofidentifoing personswho do not o. who no longer fu|fil theseconditions, of examining an asylum app|icationand ofdetermining responsibi|itvlbr such examination'Udecetainconditions the data wi|| be also avai|ableto desi8natedautltoritiesofthe Member states ond to Euopot the pupose the pevention. for of detectionand investigalioof teroi ofrencesand of otheseiouscimina|offences-The authority of thc Membes(ate esponsib|e processingthc dala is: Minislry of Foreign Afairs. I'oretnsk fo nmst cZ-| l t 00 Pahal: Diccloate Alien Po|ice'o|ansk P'o. Box 78' cz-l30 5l Paha and Ministyof the lnterio, 5' of 2, 3 Nad tolo\r cz.17o 34 3' Praha 7. Nhngd liundy cilng nh,r nhng Lg'tin linquan toi quytltdinh i ddn xin crip ,hi thw aja t i hoc linq n tdi quya dinh h bo, .hu hi hay gia h4n th! th ,h{c s dwc nhPvd ||!urn fun{ H. |t, ng Th ng tin Th! .hlft (yt' tro,8 lhh 8Mn ti da ld 5 ,ln' Trong thoi gian nay' ac co qucn ctb tb thttt vi c-cco q-, co clnfu ,kdngkin |ra |hi nlc.!aI binqih bnngodi w ho|,8 ph4n i ni dia cdc nloc thanh vincang nht aic co qufun ,n quan l' xut nkip canh d ti np1 di d)a acmmc thinh,in c tM tfuy ctip cc i liu,d .hng tin l'|.|trcng I/Is nhn nuc .l.h: xc ninh xen clic diii kin,h4p ia,h ,a l,* nqp p p tat cc n ic lhnh in c dlrc dp n8 har kh,ha nhin dqn7 nhhg c hkin kh! a ho\c khdns cn dlip n2 dztqcnh,ng },eu cllu d' kin tm don xin ii nqn vd qllyt dinh v |M qu,vn ,rong yick tra' Trcng nhbt{ ditu kinnfuil dinh cac cd qua,|c rMn quyn dwc chi dinh cua dic nu6c .hnh ihv Europol c''ng i tM .n!y cdp nt.rng lhlinq un dt liu nay nhdn nAc dchphnq ch ng' pM| hn vd d u ,ra cl'c |i phqn ktningb ya cc hdnh ,,i phqn tfu nguy hin lhic' o qua,, c lfujn qu'Yn x li, di liua;,a ft . |funh vinI B N+oqiqiao. Lore,insu nmsli5' Cz-I 18 (l0 P,tha l: co qwn canh st ryoqi kiu. olanski 2' P'o. BoX 78' CZ-130 5I Praha 3 t B Nii w' Nad tolou CZ-]70 34 Pruha 7' 3' I am aware thal I have the right to obtain any of the Member states notiicationof the da relating to me recorded in th. vls 8nd of the Membe st8to hich tansmitted daa and to requesl thd data e|aling me which are inaccurale be corected th data elatingto me processedun|autr||y be deleted' At my the to .d express request.the authoityexamiing my application $ill inform mo of the manner in which t may cxcrcise my right to check t}e pesona| data conceming me 8nd have them corected deleted.inc|uding the relatedemedies or accodingto lhe nation8||8w ofthe stlte concemed' The office of PeBonal Data Proteotionof thc czech Republic(Pplk.Sr*horu727 CZ.|70 00 Paha will hea D1' 7) c|aimsconc.mingthepotection ofpcsonal dat.. T i bt ri q li c quynyucu tat b ai nuc ndo trong s a)c nc thanh in|h g bllo i cticdi ItQuhn quon dn !i duc hfu lr tong l/ls y |n n&,c lhhh yin dd truyh di lud' cfrngnht dwc qrynyucdu chinh gaa cc db hukh ng chinh xc lnquan l di nhn ti cli, g nht xfu cc dft liu cc linqwn dn l6i n, da bi x|t li, nl cch ph phip' Khi ! yuCau bdng n ban' co quan thp li, don d ngfu cua ld se ng bdo vot 6t cch thn a1i c lh lh|! hinquyn kin rfo aic d lieu c nfuin'ln quan I.JIt| yb chnh sta hay nia b cking bao gin co c c phlong|n phdp l,,|heo tu?itphp cua nuc thbnh inc linquan. Cd quan nha ntoc c quyn g n s| caa nuoc thnh i,ld s tp nhin cc khau i vi(c bao rn<it nq thng M c(i nhin la-Cd quan bdo ttl'it dfr lieu c nh n' Pplk' Sochoru 727/27. CZ-l70 (n Praho 7' I declarc that to the best ofmy knowledge a|| paicu|rs supplied by me aecorectond complete.I am awae ti ay fa|sestatements wi|| lcad to my appIication beinB oject oto the annulmcntofa visa al..ady grantedand may 8lso .endemc liab|e to prosecutionunde law ofthe Member staewhich deals with tlre the application. Tlii con doan va .! ca.sg hiubtcaa ninh rdag nhtng rh h{ rin na .d dd ctl"g crb a a,ng a dy du' T l' th|i|c | g b! c1i hljn. nn k|pi ,,,annlo ci|nP r din tbi yichli so xln cdp thi w da r6i bi hr ch., hoac !h! thr da c.ip cho |tji bi tluybo vd rlii co thbi rruy eo lu.j|ptfuipd;!an|fuc thanh vinth! ti h,i so' l undetake |eavethe teitoy the Membcstates before lhe expiry of the visa, if ganted'I have becn informed that possessionofa visa is on|y one of the to of prerequisitesfoentry ito lhe Europcan teritoryofthe Member states. Thc meefaot that a visa hss becn grantedto me does not mean that I will be entitled to compcnsalion if I f| to comp|y with tie re|evsntprovisions of atic|c5(l) of Regularion (Ec) No 5622006 (schengcn Bo.ders code) nd I am theefore et,sed en!ry.-Theplerequisitesfor entywi|l be ch 4ked again o entry into the Europe.n teritory lhc Membestatcs' of Nuaqc.cp lhi lhw' ld can l2l sz i kh6i ldnh.lh cdc ftIc thnh n|nrc hhi lhi rhvc.ha han' T! c g dwc cho bi,ringviQc c thi tltztc t ,nd tlronf. chi yicd$c cb .hi |h|rt t|hjng; n?hta l,2.lii ac quyin di hoi bin,o,g ,u i di ca t vdo ldth th6 cluiu u '(Eqs'56v2ofu :!r8 !'u |n.n :M| 'thuic cc ftldc |hb|h in'
bi..i: cltj: nl'1? nu :anh d9 kll:,ns.dtiP ng dW. cc diu kin trongl.honI di,!5 L, canhsdqc*in|ra lqi khi nl4ipca,h yo ktnhth6chu thu<jc ruoc ,hnhvin. u cdc
rt,, n, s,a ih;i;d.msi,,
H;d,tp
P|ace and dat Ngay vd nai ldm don
Signature (for minors, signrture of parental euthority/ legal guardian)/ Ch (Doi vi ngti chra thdnh nin: chfr b,, cua ngtdi c bj, quyn nui dung/ngrci sin ha)
(')
In .o far as the VIS is operationa|.l Trong khi VIS hoat cQng
EMBASSY OF THE CZECH REPUBLIC IN VIETNAM
opcning houN forpp|ic'tio! for scbcngcnvisr: Frid.y.9!00 to 12:00 Tb visr fomir f... You mult submit your rpp|icrt|on rt |c.it 15 d.ys in .dv.nce to youinte d d jouey. oth r wfu.' th. Efubrsy docs Dot gu|nntc. thrt tbc s. shr|| be issuedin time. KTNDLY NOTICE . Exc-pt fovisas limited to one or some ofthe Membestates, lh visa shall be v8lid for all th Member stateslisted as follows: Germany, Austria' Belgium' spain' Finland, Fan., Greece, Nethel.nds'lca|and,ltaly' Luxembourg,Noway.Portugal, swdn, Estonia' L,atvi4 Lithu&i8' Hungay,Malt4 Pol8nd. sloveni.' slovakia' czech Rpub|ic and switzerland' . App|i..ntr shr||rpply in pcrlon at the Emb8ssy ofthe czech R p ub|ic in Haoi' . Thc Meml'Gr strt compctcnt fo examinin8 and deciding on an appli.ation fo a unifomvisa shall be| (a) the Membestate whose tritory constifuts the so| desti.ation of the visit(s); (b) if the visit includes more thon one destinatio! Memb state whm teIitorycostitutesthe main destinationof the visi(s) in terms of the th lehgth opuposo stay;o(c) ifno main destinolioncan be detemined, Membestate \Yhos extemal borderthc app|icantintnds to cossin ode enterthe of the to lenilory ofthe Membest8tes. . when the app|icion is .dmissible, the Embassy shall st|mp th6 travel documen! exoeptfodiplorBticand offici.l passpots' such stamphas.o |egalimplications. . Applicions shall b submittedwithin tb. immcdilt. 3 months to the iot.ndcd Jouncy. As an cxcption' beaes multiple.ntry visa v8lid for al last months ofa may do it befoe expiry date.In oas of failu'e to met this term the 8pp|icationshs||not be admittodfoproccssing' as we||as in th following cases| its + yotrsubmit e non-ofricia|fom + you do not aitaoha plsspot otravel documenthich meetsthe conditions stablishd by schengenRe8u|ations' + you do not attacha photogaph which meetstbe conditions st5b|ishd by schengen Regulatiols' + you fail !o pay the visa fee. The f.c for proc.sng r vi3r fal|s due upon admittingthe app|icationt]o pocessd and i|l not be efi,nded pt in case that it weenot admitt !o be p.ocessed b exc paragaph ifthe Embossyweenot compete to deal with it' visa fee fo a schengn visa is EURo 0.-; children fom and blow 12 in accordelce to lhe pevious o 6 y a s o|dshallpay a feeofEURo 35,-' The visa proccssing is ie foholdesof dip|omaticpassportsin any case.and ofofncial passpots when on officiaI pu.pos tsip' chi|den unde yars' school pupi|s' six students,postgradu. sfudcnts artd acoompanyingteaches who undenake stays fo the puposeof sfudy or educional rainin& scintists on esach projects as deinedin Recommendon No 2005'6|/Ec of the EuopeanPaliamentand of the Counci! of 28 September2005' repesentativsof NGos aged up to 25 when cnrolled on s6minas' conferencesor spotive, cu|furaloeducationalevnts organisedb} N6os. vietnamesecitizens sesubjectto prio consultrtion bfore being g6ted the visa' |n the eventofa refus.|. the .easonson which it is based.hrll be otiticd to you by me8ns ofa standard fom' Afre c eiving you visa' kindly vcrify thrt the informltion on your visr stickcr is correct. You can indotbcr relevrnt inorm.tiol olvisa rd immigationmlesat thewebsite ofe Ministn ofForeim A|airs ofthe cz c h Reoublic| \\\\ n]li /
D+IsQUN coNG HA scT4,I\'I!T NAM
ci mi' cr cho vk. scbgtg.j: Tbsu' o9:0G'| 2:00 T th.| !h dD tbi tbFc ituc pbt mnphi H 3d xin thi thvc pbi| itt op t||hl 15 ng.y tnrt chuy Tmg tnrlg hq'Dnguc qt, Dli squrn knng itfun bo vi.c lhi thEc ituqc dp |tng dl h{n.
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