李一心application form original zh此表格必須以英文填寫

ThisThisapplicationformshouldbefilledoutinSchengenVisaApplication Thisapplicationform1.Surname(Familyname)姓氏Forofficialuse2.Surnameatbirth(Formerfamilyname(s)DateofApplicationlodgedatFilehandledMeansofMeansofVisaNumberof 2 Numberofdays:3.Firstname(s)(Givenname(s)4.Dateofbirth(day-month-ceofbirth/Countryofbirth/7Currentnationality/Nationalityatbirth,if8./9.Maritalstatus/狀 Single/未 Male男XFemaleSeparated/分 Divorced/離 Widow(er)/喪Other10.Inthecaseofminors:Surname,firstname,address(ifdifferentfromapplicant’s) tionalityofparentalauthoritylegalguardian/未成年須填上合法監(jiān)護(hù)人的、地址(如與申請(qǐng)人不同)、及國(guó)11.Nationalidentitynumber,where國(guó)民號(hào)碼，如適12.Typeof Diplomaticpassport/護(hù)Servicepassport/公務(wù)護(hù) Officialpassport/護(hù) Specialpassport/特殊護(hù)Otherpleasespecify其它旅行證件（請(qǐng)注明13.Numberof14Dateofissue15Validuntil16IssuedbyG17.Applicant’shomeaddressandaddress申請(qǐng)人地址及電CHAOYANGDISTRICTKEGONBEILI10BUILDING2DOORNO.601BEIJINGBEIJING10002918ResidenceinacountryotherthanthecountryofcurrentnationalityYes.Residencepermitorequivalent……No…Valid *19.Current現(xiàn)職業(yè)WHITE-COLLAR*20.Employerandemployer’saddressandephonenumber.Forstudents,nameandaddressofeducational ANTOURONG(BEIJINGWORKTECHNOLOGYCO.,,HAIDIANDISTRICTBRANCHRESOURCEBUILDINGNO.6ZHONGGUANCUNSOUTHSTREETSOUTHBUILDING7LAYERBEIJINGBEIJING100190,21Mainpurpose(s)ofthejourney Business/商 VisitingFamilyorFriends/探親訪Cultural/文 Sports/體 OfficialvisitMedicalreasons/醫(yī) Study/升 Transit/過(guò)Airporttransit/Otherpleasespecify)/(請(qǐng)注明(x)Fields1-3shallbefilledinaccordancewiththedatainthe22MemberState(s)ofdestination23MemberStateoffirstentryNumberofentriesrequestedSingleentry/一 Twoentries25.DurationoftheintendedstayortransitIndicatenumberofdaysThefieldsmarkedwith*shallnotbefilledbyfamilymembersofEU,EEAorCHcitizens(spouse,childordependentascendant)whileexercisingtheirrighttomovement.FamilymembersofEU,EEAorCHcitizensshallpresentstoprovethisrelationshipandfillinfieldsNo34and35.家庭成員必須根據(jù)字段34及35的數(shù)據(jù)提交證明其親屬關(guān)系的文件。26Schengenvisasissuedduringthepastthreeyears/過(guò)往三年獲批的申根No/沒(méi) 05-………………20123 27.FingerprintscollectedpreviouslyforthepurposeofapplyingforaSchengenvisa以往申請(qǐng)申根有 Yes Date,ifknown/日期，如知28EntrypermitforthefinalcountryofdestinationwhereapplicableIssuedby….……...……………Validfrom……………until 29.IntendeddateofarrivalintheSchengen30.IntendeddateofdeparturefromtheSchengen*31.Surnameandfirstnameofthe (s)intheMemberState(s).Ifnotapplicable,nameofho(s) modation(s)intheMemberStates(s)HOABBATIALSTAddressandaddressofinviting (s)/ho(s)/temporarymodation(s)邀請(qǐng)人/酒店/暫住居所的地址及電郵46BLDSTGERMAIN,5EARRPARIS,FRANCE75005,ephoneand *32.Nameandaddressofinviting/ephoneandefax 及傳Surname,firstname,address,ephone,efax,andaddressof ompany/ *33.Costoftravelingandlivingduringtheapplicant’sstayis/ byasponsor(host, Specify/由贊助人支付，請(qǐng)注明referredtoinfield31or3231Meansofsupport/Cash/AllexpensescoveredduringthestayPrepaidtransport/Otherpleasespecify)/其它(請(qǐng)注明Meansofsupport/Cash/Traveller’scheques/ modation/Prepaidtransport/Otherpleasespecify)/其它(請(qǐng)注明34.aldataofthefamilymemberwhoisanEU,EEAorCHFirstDateofbirth/Numberof orID 35.FamilyrelationshipwithanEU,EEAorCHcitizen申請(qǐng)人與歐盟、歐洲經(jīng)濟(jì)區(qū)或公民的關(guān) dependent 36.ceanddate/地區(qū)及日37.Signature(forminors,signatureofparentalauthority/legalIIamawarethatthevisafeeisnotrefundedifthevisaisrefused aseamultiple-entryvisaisappliedfor(cf.fieldNo24):/適用于申請(qǐng)多次入 IamawareoftheneedtohaveanadequatetravelmedicalinsuranceformyfirststayandanysubsequentvisitstotheterritoryofMember Iamawareofandconsenttothefollowing:thecollectionofthedatarequiredbythisapplicationformandthetakingofmyphotographand,ifapplicable,thetakingoffingerprints,aremandatoryfortheexaminationofthevisaapplication;andany ald aswellasmyfingerprintsandmyphotographwillbe dtotherelevant oftheMemberStatesandprocessedbythose ,forthepurposesofadecisiononmyvisaapplication.Suchdataaswellasd oncerningthedecisiontakenonmyapplicationoradecisionwhethertoannul,revokeorextendavisaissuedwillbeenteredinto,andstoredintheVisaInformationSystem(VIS)(1)fora umperiodoffiveyears,duringwhichitwillbeaccessibletothevisa andthecompetentforcarryingoutchecksonvisasatexternalbordersandwithintheMemberStates,immigrationandasylum intheMemberStatesforthepurposesofverifyingwhethertheconditionsforthelegalentryinto,stayandresidenceontheterritoryoftheMemberStatesarefulfilled,ofidentifying whodonotorwhonolongerfulfilltheseconditions,ofexamininganasylumapplicationandofdeterminingresponsibilityforsuchexamination.Undercertainconditionsthedatawillbealsoavailabletodesignated oftheMemberStatesandtoEuropolforthepurposeoftheprevention,detectionandinvestigationofterroristoffencesandofotherseriouscriminaloffences.TheauthorityoftheMemberStateresponsibleforprocessingthedatais:CommissionNationaledel'InformatiqueetdesLibertés–8,rueVivienne–75083PARIScedex02IamawarethatIhavetherighttoobtaininanyoftheMemberStatesnotificationofthedatarelatingtomerecordedintheVISandoftheMemberStatewhichtransmittedthedata,andtorequestthatdatarelatingtomewhichareinaccuratebecorrectedandthatdatarelatingtomeprocessingunlawfullybedeleted.Atmyexpressrequest,theauthorityexaminingmyapplicationwillinformmeofthemannerinwhichImayexercisemyrighttocheckthe aldoncerningmeandhavethemcorrectedordeleted,ludingtherelatedremediesaccordingtothenationallawoftheStateconcerned.ThenationalsupervisoryauthorityofthatMemberState(CommissionNationaledel'InformatiqueetdesLibertés–8,rueVivienne–75083PARIScedex02)willhearclaimsconcerningtheprotection aldata.Ideclarethattothebestofmyknowledgeallparticulars dbymearecorrectedandcompleted.IamawarethatanyfalsestatementswillleadtomyapplicationbeingrejectedortotheannulmentofavisaalreadygrantedandmayalsorendermeliabletoprosecutionunderthelawoftheMemberStatewhichdealswiththeapplication.IundertaketoleavetheterritoryoftheMemberStatesbeforetheexpiryofthevisa,ifgranted.IhavebeeninformedthatpossessionofavisaisonlyoneoftheprerequisitesforentryintotheEuropeanterritoryoftheMemberStates.ThemerefactthatavisahasbeengrantedtomedoesnotmeanthatIwillbeentitledtocompensationifIfailtocomplywiththerelevantprovisionsofArticle5(1)ofRegulation(EC)No562/2006(SchengenBordersCo