Embassy of Italy in Washington DC

Application for Schengen Visa

This application for 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, 31, 32 and 33 (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

Date of
2. Surname at birth (Former family name(s)): Application number:
3. First name(s) (Given name(s)):
4. Date of birth (day- 5. Place of birth: 7. Current nation- A at:
month-year): ality: Embassy/consu-
late
different: Service provider
Other nationalities: Commercial in-
6. Country of birth: termediary
8. Sex: 9. Civil status: Border (Name):
Male Single Married Registered Partnership Separated Divorced .............. .. ..
Female Widow(er) Other (please specify): Other:
Other
10. Parental authority (in case of minors)/legal guardian (surname, first name, address, if File handled by:
different from telephone No, email address, and nationality):
11. National identity number, where applicable: Supporting
documents:
Travel document
Means of subsis-
tence
Invitation

12. Type of travel document:

TMI
D Special
passport Means of trans-
port
Other travel document (please specify):
Other:
Visa decision:
Refused
13. Number of travel 14. Date of issue: 15. Valid until: 16. Issued by Issued:
document: (country): A
C

1
17. Personal data of the family member who is an EU, EEA or CH citizen or a UK national who LTV
is a beneficiary of the EU-UK Withdrawal Agreement, if applicable Valid:
From:
Until:
Surname (Family name): First name(s) (Given name(s)):

Date of birth (day- Nationality:

month-year): document or ID card:

18. Family relationship with an EU, EEA or CH citizen or a UK national who is a beneficiary of
the EU- Agreement, if applicable:
spouse child grandchild dependent ascendant
registered partnership other:

19. A home address and email address: Telephone no.:

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

No
Yes. Residence permit or equivalent . . . . . . . . . . . . . No. . . . . . . . . . . . . . Valid until. . . . . . . . . . . . .

21. occupation: Number of entries:

1 2 Multiple

22.
of educational establishment:

23. Purpose(s) of the journey:

Medical
reasons Study Airport transit Other

24. Additional information on purpose of stay:

25. Member State of main destination 26. Member State of first entry:

plicable):

27. Number of entries requested:

Single entry Two entries Multiple entries

28.

29. Fingerprints collected previously for the purpose of applying for a Schengen visa:
No Yes.
Date, if known . . . . . . . . . . . . . . . . . . . . . . . . . . Number of the visa, if known . . . . . . . . . . . . . . . . . . . . . . . . . .

30. Entry permit for the final country of destination, where applicable:

Issued by . . . . . . . . . . . . . . . . . . . . . . . . Valid from . . . . . . . . . . . . . . . . . . . . . . . until . . . . . . . . . . . . . . . . . . . . . . .

31.
name of hotel(s) or temporary accommodation(s) in the Member State(s):

Address and email address of inviting person(s)/ Telephone No:

hotel(s)/temporary accommodation(s):

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

Telephone No of company/organisation:
email address of contact person in company/
organisation:

33. *Cost of travelling and living during the stay is covered:

by the applicant by a sponsor (host, company, organisa-

Means of support:
Cash
referred to in field 30 or 31
cheques
Credit card other (please specify):
Pre-paid accommodation
Pre-paid transport Cash
Other (please specify): Accommodation provided
All expenses covered during the stay
Pre-paid transport
Other (please specify):

34. 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 Telephone No:

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

Applicable in case a multiple-entry visa is issued:

photograph and, if applicable, the taking of fingerprints, are the examination application; and any
personal data concerning me which appear on the application form, as well as my fingerprints and my photograph will be

Such data as well as data concerning the decision taken on my application or a decision whether to annul, revoke or extend

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
or examining
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
..................................................................................................................................................................... )].
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

A
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
...
the protection of personal data.

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
A
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):