Harmonised application form

Application for Schengen Visa

This application form is free PHOTO

Family members of EU, EEA or CH citizens or of UK nationals who are beneficiaries of the EU-UK Withdrawal Agreement
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] : MANDAL For official use only

Date of application :
2. Surname at birth [former family name(s)] : 19/01/2025
Application number :
FRA1DA20257 000368
3. First name(s) [given name(s)] : Kalyani
Application lodge at :
 Embassy/consulate
4. Date of birth (day-month- 5. Place of birth : 7. Current nationality :  Service provider
year) : 10/04/1969 Bangladeshi
DHAKA  Commercial
intermediary
Nationality at birth, if different :
 Border
6. Country of birth :
(name) :
Bangladesh Other nationalies :
 Other :

File handled by :

Supporting documents :
8. Sex : 9. Civil status :  Travel document
 Single 
■ Married  Registred partnership  Separated
 Means of subsistence
 Male 
■ Female  Other  Divorced  Widow(er)  Other (specify) :
 Invitation
10. Parental authority (in case of minors)/legal guardian (surname, first name, address, if different from applicant’s,  TMI
telephone No, email address, and nationality) :  Means of transport
 Other :

Visa decision :
 Refused
 Issued
 A
11. National identity number, where applicable : 2849634361  C
 LVT

12. Type of travel document :

■ Ordinary passport  Diplomatic passport  Service passport  Official passport  Special passport
 Other travel document (please specify) : Valid :

13. Number of travel document : 14. Date of issue : 15. Valid until : 16. Issued by (country) : From .......….…….…..
17/01/2024 16/01/2034 ………
A13802698 Bangladesh
Until.....…….….……
….…....
17. Personal data of the family member who is an EU, EEA or CH citizen or a UK national who is a beneficiary of the EU-
UK Withdrawal Agreement, if applicable : Number of entries :
 1  2  Multiple
Surname (family name) : First name(s) [given name(s)] : Number of days : ............

Date of birth (day-month-year) : Nationality : Number of travel document or ID card :

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*FRA1DA20257000368*
18. Family relationship with an EU, EEA or CH citizen or a UK national who is a beneficiary of the EU-UK Withdrawal Agreement, if applicable :

 Spouse  Child  Grandchild  Dependent ascendant  Registered partnership  Other

19. Applicant’s home address and email address : Telephone no :

PATHAKKHANDI, KAZI MOSTAFA ROAD, W-1 8801712291532
7900
MADARIPUR
Bangladesh
[email protected]

20. Residence in a country other than the country of current nationality :


■ No  Yes : Residence permit or equivalent N°…………….…..…..….……………….…… Valid until………..…………..

* 21. Current occupation :

No profession

* 22. Employer and employer’s address and telephone number. For students, name and address of educational establishment :

23. Purpose(s) of the journey :


■ Tourism  Business  Visiting family or friends  Cultural  Sports  Official visit
 Medical reasons  Study  Airport transit  Other (please specify) :

24. Additional information on purpose of stay :

25. Member State of main destination (and other Member States of 26. Member State of first entry :
destination, if applicable) : France
France, Germany, Luxembourg

27. Number of entries requested :


■ Single entry  Two entries  Multiple entries
Intended date of arrival of the first intended stay in the Schengen area : 02/04/2025
Intended date of departure from the Schengen area after the first intended stay : 15/04/2025

28. Fingerprints collected previously for the purpose of applying for a Schengen visa :
■ No  Yes Date, if know : ……….…………. Number of the visa, if know :………………………………………………

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) :

HOTEL AMERICAIN

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Address and email address of inviting person(s)/hotel(s)/temporary accommodation(s) : Telephone no :

72 RUE CHARLOT, 75003, PARIS +33 1 48 87 58 92

France
[email protected]

* 31. Name and address of inviting company/organisation : Telephone no of company/

organisation :

Surname, first name, address, telephone no, and email address of contact person in company/organisation :

* 32. Cost of travelling and living during the applicant’s stay is covered :

 by the applicant 
■ by a sponsor (host, company, organisation), please specify :
 referred to in field 30 or 31
Means of support :
■ Other (specify) : SHAKTI RANJAN MANDAL
 Cash
 Traveller’s cheques
 Credit card
 Pre-paid accommodation Means of support :
 Pre-paid transport  Cash
 Other (specify) :  Accomodation provided

■ All expenses covered during the stay
 Pre-paid transport
 Other (specify) :

33. Surname and first name of the person filling in the application form, if different from the applicant :

Address and email address of the person filling in the application form : Telephone no :

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*FRA1DA20257000368*
I am aware that the visa fee is not refunded if the visa is refused.

Applicable in case a multiple-entry visa is issued

I am aware of the need to have 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 are : Ministère de
l’Intérieur (Place Beauvau -75800 Paris CEDEX 08) et le Ministère de l’Europe et des Affaires Etrangères (27 rue de la Convention –75732 PARIS Cedex 15).
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 [ Commission Nationale de l'Informatique et des Libertés – 3 Place de Fontenoy - TSA 80715 - 75334 PARIS CEDEX 07 ] 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) 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 of applicant (signature of parental authority/legal guardian, if applicable) :
19/01/2025 14: 30: 53 (hour of
Dhaka)

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22/01/2025 17:28:43 (hour of Dhaka) 1/2

France-Visas
The official website for visa application to France

Registration receipt

On 19/01/2025, your information has been recorded by the France-Visas system.

Reference of the application : FRA1DA20257000368

Last name/s : MANDAL

First name/s: Kalyani

*FRA1DA20257000368*
Birth date (DD/MM/YYYY): 10/04/1969

REQUIRED SUPPORTING DOCUMENTS TO SUBMIT YOUR APPLICATION

The day of your appointment, thank you for coming with originals and copy of all documents listed below, translated into French /
English or Spanish (if accepted by the visa center)*.
If you are a student and have scanned all your supporting documents, please bring the originals of the documents listed below only.

FORMS

Signed and dated application form

Receipt France-Visas

PRE-REQUISITES

A travel document, issued less than 10 years ago, containing at least two blank pages, with a period of
validity at least 3 months longer than the date on which you intend to leave the Schengen Area or, in the
case of a long stay, at least three months longer than the expiry date of the visa requested. Be sure to
transmit (scan) ALL PAGES of your travel document containing visas, entry and exit stamps or any other
inscription.

If you are not a national of Bangladesh, residence permit in Bangladesh valid for three months minimum
after the return date.

If you have an official travel document, a note verbale is required.

Two passport pictures (ICAO standard).

PURPOSE OF TRAVEL/STAY

Booking confirmation of an organised trip with detailed program, letter from applicant describing the
planned trip.

Reservation of a return ticket or travel itinerary.

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SOCIO-PROFESSIONAL SITUATION

Employee : Employment certificate stating the name, the position, the date of hiring, the salary and the
dates of leave autorisation. For self employed or business owners, copy of the trade licence and its
translation into English, memorandum and articles of association, form 12 if any, certificate of incorporation.

FUNDS

Last six months personal bank statement, pay slips (if applicable), for self employed or business owners :
last 6 months personal bank statements and last 6 months company bank statements + "form XI.

ACCOMMODATION

Hotel bookings or hotel vouchers or original of the attestation d'accueil (certificate of board and lodging to
be obtained by your host at the French city hall (Mairie)) for all countries to be visited and for all the
duration of your stay in the Schengen area.

TRAVEL HEALTH INSURANCE

Travel medical insurance certificate, If insured through a corporate medical medical insurance scheme, the
certificate has to state the name, DOB of the employee, the area of coverage, the amount insured and the
expiration date of the coverage.

APPLICABLE VISA FEE

On the day of your appointment, you will have to pay the application fee of : 90 €**,or about 11 338 TAKA.
What currency is accepted? What are the payment method types? Please read the Fees section after choosing the pages specific
to your local. You will find information on the fees and, more generally, the most accurate information for your visa application. In
the case where the submission of your application is made with a service provider, service fees will be collected.
* Please note : if any documents are missing, this may lead to the non-issuance of the visa you have applied for. The visa center
reserves the right to ask for further documentation and information.
** This amount is for informational purposes only. Certain individual cases may give rise to different prices, in accordance with
applicable regulations.