Fill and Sign the Nyc Pregnancy Passport Form

Photo Sticker n. Italian Consulate in Cape Town Schengen Visa Application Form This application form is free of charge 1. Surname(s) (family name(s)) FOR EMBASSY / CONSULATE USE ONLY 2. Surname(s) at birth (earlier family name(s)) Date application : 3. First names (given names) 4. Date of birth (year-month-day) 5. ID-number (optional) File handled by : 6. Place and country of birth 7. Current nationality/ies 8. Original nationality (nationality at birth) 9. Sex 10. Marital status : Male Female Single Married Separated Widow(er) Other 11. Father’s name Supporting documents: Valid passport Financial means Invitation Means of transport Health insurance Other : Divorced 12. Mother’s name 13. Type of passport: National passport Diplomatic passport Service passport Travel document (1951 Convention) Alien’s passport Seaman’s passport Other travel document (please specify): ……………………………………………………………… ………….… 14. Number of passport 15. Issued by 16. Date of issue 17. Valid until 18. If you reside in a country other than your country of origin, have you permission to return to that country? No Yes, (number and validity) ……………….…………………………………………………… * 19. Current occupation Visa : * 20. Employer and employer’s address and telephone number. For students, name and address of school. Refused Granted Characteristics of Visa : 21. Main destination 22. Type of Visa : Airport transit Transit Long stay 24. Number of entries requested Single entry Two entries Short stay 23. Visa : Individual 25. Duration of stay Collective LTV A B C D D+C Number of entries : Multiple entries Visa is requested for: ______ days 26. Other visas (issued during the past three years) and their period of validity 1 2 Multiple Valid from ……………….. To ………………………… * 28. Previous stays in this or other Schengen states Valid for : …………………………… . The questions marked with * do not have to be answered by family members of EU or EEA citizens (spouse, child or dependent ascendant). Family members of EU or EEA citizens have to present documents to prove this relationship. 27. In the case of transit, have you an entry permit for the final country of destination? No Yes , valid until: Issuing authority: 29. Purpose of travel Tourism Business Visit to Family or Friends Cultural/Sports Official Medical reasons Other (please specify): ….…………………………………………………….. * 31. Date of departure 33. Means of transport * 30. Date of arrival * 32. Border of first entry or transit route * 34. Name of host or company in the Schengen states and contact person in host company. If not applicable, give name of hotel or temporary address in the Schengen states Name Telephone and telefax Full address e-mail address * 35. Who is paying for your cost of travelling and for your costs of living during your stay? Myself Host person/s Host company. (State who and how and present corresponding documentation):……………………………...……………………………………………………………………… …………………………………………………… …………………………………. * 36. Means of support during your stay Cash Travellers' cheques Credit cards Accommodation Other: Travel and/or health insurance. Valid until: ……………………………………………….. 37. Spouse’s family name 39. Spouse’s first name 38. Spouse’s family name at birth 40. Spouse’s date of birth 41. Spouse’s place of birth 42. Children (Applications must be submitted separately for each passport) Name 1 2 3 First name Date of birth 43. Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens. Name First Name Date of Birth Nationality Number of passport Family relationship : of an EU or EEA citizen 44. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in the Schengen states and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states. At my express request, the consular authority processing 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 altered or deleted, in particular, should they be inaccurate, in accordance with the national law of the state concerned. 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 Schengen state which deals with the application. I undertake to leave the territory of the Schengen states upon 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 Schengen 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 5.1 of the Schengen Implementing Convention and am thus refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Schengen states. 46. Telephone number 45. Applicant’s home address 47. Place and date 48. Signature FOR EMBASSY / CONSULATE USE ONLY Signed in front of me this (date).................................by ...................…………………………………………………………………………………... I.D. N.............................. --------------------------------------------------------------------(Signature & Official Seal of the receiving Consular Officer, Police Officer or Commissioner of Oaths) NOTES (OFFICE USE ONLY) .................................................................................................................................………………………………………………… ……………….. .................................................................................................................................………………………………………………… ……………….. ..................................................................................................................................………………………………………………… ………………. Date______________ Signature of the Consular Officer_______________________ RESPONSE: ..................................................................................................................................………………………………………………… ………………. ................................................................................................................................………………………………………………… ………………... ___________________________ (Head of the Visa Section)