申根簽證申請表模板

(x)Fields1-3shallbefilledinaccordancewiththedatainthetraveldocument 字段1-3須依據(jù)旅行證件填上相關資料 22.MemberState(s)ofdestination/申根目的地22.MemberState(s)ofdestination/申根目的地23.MemberStateoffirstentry/首入申根國24.Numberofentriesrequested申請入境次數(shù)Singleentry/一次Multipleentries/多次Twoentries/兩次25.DurationoftheintendedstayortransitIndicatenumberofdays預計逗留或過境日數(shù)26.Schengenvisasissuedduringthepastthreeyears/過去三年獲批的申根簽證No/沒有Yes.Date(s)ofvalidityfrom……….to…………..有。有效期由至Thefieldsmarkedwith*shallnotbefilledbyfamilymembersofEU,EEAorCHcitizens(spouse,childordependentascendant)freemovement.FamilymembersofEU,EEAorCHcitizensshallpresentdocumentstoprovethisrelationshipandfillinfieldsN歐盟、歐洲經(jīng)濟區(qū)或瑞士公民的家庭成員(配偶、子女或贍養(yǎng)的老人)行使其自由往來的權利，不必回答帶（*）號的問題。歐盟、歐洲經(jīng)濟區(qū)或瑞公民的家庭成員必須填寫第34條及35條的問題并提交證明其親屬關系的文件。 Iamawarethatthevisafeeisnotrefundedifthevisaisrefused/本人知道即使簽證被拒也不能退還簽證費Applicableincaseamultiple-entryvisaisappliedfor(cf./適用于申請多次入境簽證fieldNo24): (參照字段24)Iamawareoftheneedtohaveanadequatetravelmedicalinsuranceformyfirststayandanysubsequentvisitstotheterritor本人知道須預備有足夠保額的旅游醫(yī)療保險作為首次及其后各次出發(fā)到申根國家領域之用Iamawareofandconsenttothefollowing:thecollectionofthedatarequiredbythisapplicationformandthetakingofmyphotakingoffingerprints,aremandatoryfortheexaminationofthevisaapplication;andanypersonaldataconcerningmewhicform,aswellasmyfingerprintsandmyphotographwillbesuppliedtotherelevantauthoritiesoftheMemberStatesandprocepurposesofadecisiononmyvisaapplication.Suchdataaswellasdataconcerningthedecisiontakenonmyapplicationoradecisionwhethertoannul,revokeorextendavistoredintheVisaInformationSystem(VIS)(1)foramaximumperiodoffiveyears,duringwhichitwillbeaccessibletothevisaautcompetentforcarryingoutchecksonvisasatexternalbordersandwithintheMemberStates,immigrationandasylumauthoritipurposesofverifyingwhethertheconditionsforthelegalentryinto,stayandresidenceontheterritoryoftheMemberStatwhodonotorwhonolongerfulfilltheseconditions,ofexamininganasylumapplicationandofdeterminingresponsibilityforaconditionsthedatawillbealsoavailabletodesignatedauthoritiesoftheMemberStatesandtoEuropolforthepurposeoftheprevention,detectioninvestigationofterroristoffencesandofotherseriouscriminaloffences.TheauthorityoftheMemberStateresponsiblefprocessingthedataisCudzioziemców(TheOfficeforForeigners),address:16KoszykowaSt.,00-564Warsaw.aIamawarethatIhavetherighttoobtaininanyoftheMemberStatesnotificationofthedatarelatingtomerecordedinthetransmittedthedata,andtorequestthatdatarelatingtomewhichareinaccuratebecorrectedandthatdatarelatingtomedmyexpressrequest,theauthorityexaminingmyapplicationwillinformmeofthemannerinwhichImayexercisemyrighttocheckthepersonalconcerningmeandhavethemcorrectedordeleted,includingtherelatedremediesaccordingtothenationallawoftheStateconauthorityofthatMemberStatewillhearclaimsconcerningtheprotectionofpersonaldata:InspectorGeneralfortheProtect00-193Warsaw.dIdeclarethattothebestofmyknowledgeallparticularssuppliedbymearecorrectedandcompleted.Iamawarethatanyapplicationbeingrejectedortotheannulmentofavisaalreadygrantedandmayalsorendermeliabletoprosecutionundertdealswiththeapplication.IundertaketoleavetheterritoryoftheMemberStatesbeforetheexpiryofthevisa,ifgranted.IhavebeeninformedthatprerequisitesforentryintotheEuropeanterritoryoftheMemberStates.ThemerefactthatavisahasbeengrantedtomedoecompensationifIfailtocomplywiththerelevantprovisiofnsArticle5(1)ofRegulation(EC)No562/2006(SchengenBordersCode)andIamthererefusedentry.TheprerequisitesforentrywillbecheckedagainonentryintotheEuropeanterritoryoftheMemberStates.本人知悉并同意以下條款：該申請表中所有關于本人的個人信息、照片或采集的指紋樣本均為審核本人的簽證所需。本人在該申請表中所填寫的所個人信息、指紋樣本和照片均可提供給申根國家的相關主管部門，以便其受理本人的簽證申請并對申請作出決定。該信息以及簽證結果甚或簽證注銷、撤消或延期的決定將一并收錄到簽證信息系統(tǒng)(1)（VIS系統(tǒng)）并最長保存五年，在此期間，所有申根成員國相關簽證部門、邊境及境內的簽證檢查部門以及移民局和難民局均有權登入VIS系統(tǒng)，核查簽證申請人是否已滿足入申根國境并在境內逗留的相應提條件；核實不滿足或不再滿足該前提條件的簽證申請人；審核難民申請并確定出該申請的主管部門。必要時，各申根成員國的特定部門以及歐盟警組織均有權參考該信息，用于預防、偵察和調查恐怖活動及其它嚴重犯罪行為。波蘭負責管理該類信息的部門是外國人管理局。（地址：Urz?ddoSCudzoziemców,ul.Koszykowa16,00-564Warszawa）。本人知悉本人有權要求任何一個申根成員國告知VIS系統(tǒng)中都收錄了本人哪些個人信息，是由哪個申根成員國收錄進去的。除此之外，本人亦有權請更正系統(tǒng)中收錄的錯誤信息并刪除不合法信息。審核本人簽證申請的領事機構會應本人要求提供相關說明性信息，如簽證申請人應如何行使審核人信息的權力，依據(jù)相關申根成員國的法律規(guī)定要求更正甚或刪除不正確的個人信息的權力以及如何行使向相關申根成員國的主管部門就個人信息護事宜依法申訴的權力。波蘭負責此項事宜的部門是人信息保護局總藍察員（地址：GeneralnyInspektorOchornyDanychOsobowych,ul.S00-193Warszawa）。本人確保以上信息均系本人如實提供，確保信息正確而完整。本人知悉提供虛假信息可導致本人簽證申請被拒簽或已得到的簽證被注銷甚或受理本簽證的申根國會因此而對本人追究刑事責任。如本人的簽證申請被批準，本人