申根簽證申請(qǐng)表模板

(x)Fields1-3shallbefilledinaccordancewiththedatainthetraveldocument 字段1-3須依據(jù)旅行證件填上相關(guān)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(guó)24.Numberofentriesrequested申請(qǐng)入境次數(shù)Singleentry/一次Multipleentries/多次Twoentries/兩次25.DurationoftheintendedstayortransitIndicatenumberofdays預(yù)計(jì)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(jì)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(quán)利，不必回答帶（*）號(hào)的問題。歐盟、歐洲經(jīng)濟(jì)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(guān)系的文件。 Iamawarethatthevisafeeisnotrefundedifthevisaisrefused/本人知道即使簽證被拒也不能退還簽證費(fèi)Applicableincaseamultiple-entryvisaisappliedfor(cf./適用于申請(qǐng)多次入境簽證fieldNo24): (參照字段24)Iamawareoftheneedtohaveanadequatetravelmedicalinsuranceformyfirststayandanysubsequentvisitstotheterritor本人知道須預(yù)備有足夠保額的旅游醫(yī)療保險(xiǎn)作為首次及其后各次出發(fā)到申根國(guó)家領(lǐng)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(qǐng)表中所有關(guān)于本人的個(gè)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(qǐng)表中所填寫的所個(gè)人信息、指紋樣本和照片均可提供給申根國(guó)家的相關(guān)主管部門，以便其受理本人的簽證申請(qǐng)并對(duì)申請(qǐng)作出決定。該信息以及簽證結(jié)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(zhǎng)保存五年，在此期間，所有申根成員國(guó)相關(guān)簽證部門、邊境及境內(nèi)的簽證檢查部門以及移民局和難民局均有權(quán)登入VIS系統(tǒng)，核查簽證申請(qǐng)人是否已滿足入申根國(guó)境并在境內(nèi)逗留的相應(yīng)提條件；核實(shí)不滿足或不再滿足該前提條件的簽證申請(qǐng)人；審核難民申請(qǐng)并確定出該申請(qǐng)的主管部門。必要時(shí)，各申根成員國(guó)的特定部門以及歐盟警組織均有權(quán)參考該信息，用于預(yù)防、偵察和調(diào)查恐怖活動(dòng)及其它嚴(yán)重犯罪行為。波蘭負(fù)責(zé)管理該類信息的部門是外國(guó)人管理局。（地址：Urz?ddoSCudzoziemców,ul.Koszykowa16,00-564Warszawa）。本人知悉本人有權(quán)要求任何一個(gè)申根成員國(guó)告知VIS系統(tǒng)中都收錄了本人哪些個(gè)人信息，是由哪個(gè)申根成員國(guó)收錄進(jìn)去的。除此之外，本人亦有權(quán)請(qǐng)更正系統(tǒng)中收錄的錯(cuò)誤信息并刪除不合法信息。審核本人簽證申請(qǐng)的領(lǐng)事機(jī)構(gòu)會(huì)應(yīng)本人要求提供相關(guān)說明性信息，如簽證申請(qǐng)人應(yīng)如何行使審核人信息的權(quán)力，依據(jù)相關(guān)申根成員國(guó)的法律規(guī)定要求更正甚或刪除不正確的個(gè)人信息的權(quán)力以及如何行使向相關(guān)申根成員國(guó)的主管部門就個(gè)人信息護(hù)事宜依法申訴的權(quán)力。波蘭負(fù)責(zé)此項(xiàng)事宜的部門是人信息保護(hù)局總藍(lán)察員（地址：GeneralnyInspektorOchornyDanychOsobowych,ul.S00-193Warszawa）。本人確保以上信息均系本人如實(shí)提供，確保信息正確而完整。本人知悉提供虛假信息可導(dǎo)致本人簽證申請(qǐng)被拒簽或已得到的簽證被注銷甚或受理本簽證的申根國(guó)會(huì)因此而對(duì)本人追究刑事責(zé)任。如本人的簽證申請(qǐng)被批準(zhǔn)，本人