1. Surname (Family name) (1) 姓氏 | For official u only 簽證機構專用欄 Date of application: Visa application number: Application lodged at: Embassy/consulate CAC Service provider Commercial intermed. Border Name: Other File handled by: Supporting documents: Travel document Means of subsistence Invitation Means of transport TMI Other: Visa decision: Refud Issued A C LTV Valid From Until Number of entries: 1 2 Multiple Number of days : | |||||||
2. Surname at birth (former family name(s)) (1) 出生姓氏（先前姓氏） | ||||||||
3. First name(s) (Given name(s)) (1) 名字 | ||||||||
4. Date of birth (day-month-year) 出生日期(日 / 月 / 年) | 5. _______________________________________________________________________________________________________________________________Place of birth 出生地（縣、市） | 6. Country of birth 出生國家 | ||||||
7. Current nationality 目前國籍 | Nationality at birth, if different 出生國籍 (若不同於目前國籍者) | |||||||
8. Sex 性別 Male 男 Female 女 | 9. Marital status 婚姻狀況 Single 單身 Married 已婚 Separated分居 Divorced 離婚 Widow(er) 鰥寡 Other (plea specify) 其他 (請註明) | |||||||
10. In the ca of minors: Surname, first name, address (if different from applicant’s) and nationality of parental authority/legal guardian 未成年者：請註明父母或監護人之姓名, 地址 (若與申請人地址不同) 贫困户申请书以及國籍 | ||||||||
11. National identity number, where applicable 身分證字號(若適用) | ||||||||
12. Type of travel document 護照種類 Ordinary passport 普通護照 Diplomatic passport 外交護照 Service passport 公務護照 Official passport 官方護照 Special passport 特別護照 Other travel document (plea specify) 其他相關旅行證件 (請註明): | ||||||||
13. Number of travel document護照號碼 | 14. Date of issue 發照日 (日 / 月 / 年) | 15. Valid until 效期截止日(日 / 月 / 年) 怎么画眼睛动漫 | 16. Issued by 發照機構 | |||||
17. Applicant’s home address 申請者住家地址 预备党员的预备期从什么之日算起 E-mail address 電子郵件 | Telephone number(s) 電話號碼 - - | |||||||
18. Residence in a country other than the country of current nationality 是否居住在非原國籍地 No 否 Yes. Residence permit or equivalent No Valid until 是. 居留證或同等證明 證號 效期截止日 | ||||||||
* 19. Current occupation 目前工作職稱 | ||||||||
* 20. Employer and employer’s address and telephone number. For students, name and address of educational establishment 公司名稱、地址、電話 / 學校名稱及學校地址 | ||||||||
21. Main purpo(s) of the journey 停留主要目的 Tourism 旅遊 Business 商務 Visiting Family or Friends 探訪親友 Cultural 文化 Sports 運動 Official visit 公務 Medical reasons醫療 Study 就學 Transit 過境轉機 Airport transit 機場轉機（不入境） Other (plea specify) 其他(請說明) | ||||||||
22. Member State(s) of destination 主要停留申根國家 | 23. Member State of first entry 最先抵達的申根國家 | |||||||
24. Number of entries requested 申請入境次數 Single entry單次 Two entries兩次 Multiple entries多次 | 25. Duration of the intended stay or transit. Indicate number of days 預計停留或過境天數 | |||||||
26. Schengen visas issued during the past three years 過去三年內是否持有申根簽證及其效期(日 / 雪藕月 / 年) No 否 Yes 是. Date(s) of validity: from 效期自 until 至 from 效期自 until 至 from 效期自 until 至 from 效期自 until 至 from 效期自 until 至 from 效期自 until 至 from 效期自 until 至 | ||||||||
27. Fingerprints collected previously for the purpo of applying for a Schengen visa 過去辦理申根簽證曾否留下指紋紀錄 No 否 Yes 是 Date, if known 留下指紋日期（若知道請填寫） | ||||||||
28. Entry permit for the final country of destination, where applicable 轉機者是否持有目的國家之入境許可 Issued by 發照機構 Valid from 效期自 until 至 青岛啤酒广告 | ||||||||
29. Intended date of arrival in the Schengen area 預計抵達申根地區日期(日 / 月 / 年) | 30. Intended date of departure from the Schengen area 預計離開申根地區日期(日 / 月 / 年) | |||||||
* 31. Surname and first name of the inviting person(s) in the Member State(s). If not applicable, name of hotel(s) or temporary accommodation(s) in the Member State(s) 申根國邀請人姓名．若不適用，請填寫申根國境內旅館或臨時住所名稱 | ||||||||
Address and e-mail address of inviting person(s)/hotel(s)/temporary accommodation(s) 邀請人 / 旅館 / 臨時住所之地址及電子郵件信箱 | Telephone and telefax 電話及傳真號碼 + + | |||||||
* 32. Name and address of inviting company / organisation 邀請公司 / 單位之名稱及地址 | Telephone and fax of company / organisation 邀請公司 / 單位電話及傳真號碼 + wps邮箱+ | |||||||
Surname, first name, address, telephone, telefax, and e-mail address of contact person in company/organisation 邀請公司 / 單位之聯絡人姓名、地址、電話、傳真及電子郵件信箱 | ||||||||
* 33. Cost of travelling and living during the applicant’s stay is covered 停留期間旅行及居住所需費用之支付 | ||||||||
by the applicant himlf/herlf 申請者自行負擔 Means of support費用支付方式 | by a sponsor (host, company, organisation), plea specify 贊助單位 (邀請者, 公司或單位) 負擔，請註明 referred to in field 31 or 32 同31、32項 other (plea specify) 其他 (請註明) | |||||||
Cash 現金 Traveller’s cheques旅行支票 Credit card 信用卡 | Prepaid accommodation 預付住宿 Prepaid transport 預付交通費用 Other (plea specify) 其他花旗参和西洋参的区别 (請註明) | |||||||
Means of support 費用支付方式 Cash 現金 Accommodation provided 提供住宿 | Prepaid transport 預付交通費用 Other (plea specify) 其他 (請註明) | |||||||
All expens covered during the stay 負擔停留期間所有費用 | ||||||||
34. Personal data of the family member who is an EU, EEA or CH citizen 歐洲聯盟、歐洲經濟區及瑞士居民親屬之個人資料 | ||||||||
Surname 姓氏 | First name(s) 名字 | Date of birth 出生日期 | Nationality 國籍 | |||||
Number of travel document or ID card 護照或身分證號碼 | 35. Family relationship with an EU, EEA or CH citizen 與歐洲聯盟、歐洲經濟區民及瑞士居民之親屬關係 spou 配偶 child 子女 grandchild 孫子女 dependent ascendant受撫養之長輩 | |||||||
36. Place and date 申請地點及日期 Taipei, | 37. Signature (for minors, signature of parental authority/legal guardian): 申請者親自簽名（未成年者：家長 / 法定監護人簽本人姓名） |
I am aware that the visa fee is not refunded if the visa is refud. 我暸解簽證一旦被拒絕，將無法退費 |
Applicable in ca a multiple-entry visa is applied for (cf. field No 24): 申請多次簽證者（如本表格第24項）： I am aware of the need to have an adequate travel medical insurance for my first stay and any subquent visits to the territory of Member States. 我了解第一次入境或其後再入境申根會員國家都必須備有適當的醫療保險． |
I am aware of and connt to the following: the collection of the required by this application form and the taking of my photograph and, if applicable, the taking of fingerprints, are mandatory for the examination of the visa application; and any personal data concerning me which appear on the visa application form, as well as my fingerprints and my photograph will be supplied to the relevant authorities of the Member States and procesd by tho authorities, for the purpos of a decision on my visa application. Such data as well as data concerning the decision taken on my application or a decision whether to annul, revoke o extend a visa issued will be entered into, and stored in the Visa Information System (VIS)(2) for a maximum period of five years, during which it will be accessible to the visa authorities and the authorities competent for carrying out checks on visas at external borders and within the Member States, immigration and asylum authorities in the Member States for the purpos of verifying whether the conditions for the legal entry into, stay and residence on the territory of the Member States are fulfilled, of identifying persons who do not or who no longer fulfil the conditions, of examining an asylum application and of determining responsibility of such examination. Under certain conditions the data will be also available to designated authorities of the Member States and to Europol for the purpo of the prevention, detection and investigation of terrorist offences and of other rious criminal offences. The authority of the Member State responsible for processing the data is Urząd do Spraw Cudzoziemców, ul. Koszykowa 16, 00-564 Warszawa. 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 the VIS and of the Member State which transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data relating to me procesd unlawfully be deleted. At my express request, the authority examining my application will inform me of the manner in which I may exerci 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 State concerned. The national supervisory authority of that Member State: Generalny Inspektor Ochrony Danych Osobowych, ul. Stawki 2, 00-193 Warszawa will hear claims concerning the protection of personal data. I declare that to the best of my knowledge all particulars supplied by me are corrected and complete. I am aware that any fal statements will lead to my application being rejected or to the annulment of a visa already granted and may also render me liable to procution 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 posssion 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 relevant provisions of Article 5(1) of Regulation (EC) No 562/2006 (Schengen Borders Code) and I am therefore refud entry. The prerequisites for entry will be checked again on entry into the European territory of the Member States. 本人瞭解且同意下列事項：本人有義務繳交簽證申請所需之相關文件及照片，若有需要，甚至留下指紋紀錄，提供簽證申請審查之用。簽證申請表格上任何與本人相關的個人資料、本人指紋及照片，得提供其他申根會員國家簽證單位，以核發簽證。 上述資料以及包括本人簽證申請之審查結果，或是取消、撤回、延簽等事項，皆被登載及儲存在Visa Information System(VIS)(2)，最多五年。此期間，該資料將提供申根會員國之相關簽證單位於境內、境外審查簽證之用，及會員國之移民及庇護權責單位審理是否合法入境、停留或居留，及庇護申請之審核。在某些情況下，上述資料將會提供予會員國特定機關以及Europol，用以防範、偵查恐怖行動或重大犯罪。本國負責此事務之權責單位為Urząd do Spraw Cudzoziemców, ul. Koszykowa 16, 00-564 Warszawa 本人瞭解本人有權利取得申根會員國登載於VIS與本人有關之資訊，並有權要求更正不正確之資訊，及刪除不合法取得的資訊。並要求告知本人相關權益，包括符合該國法律之補救措施。本國負責個人資料保護之申訴單位為Generalny Inspektor Ochrony Danych Osobowych, ul. Stawki 2, 00-193 Warszawa 本人聲明在本人所知的範圍內，所提供之資料正確且完整。本人瞭解若遞交不實資料，將導致簽證申請被拒，已核可之簽證亦將被取消，且可能接受該會員國法律制裁。 本人保證在簽證效期期滿前離開申根國家，本人被告知簽證之取得，只是入境申根國家之先決條件，若因不符合Regulation (EC) No 562/2006(Schengen Borders Code)第五條第一款而被拒絕入境，將不得請求賠償。入境申請之許可，將會在會員國邊界入境時，再度檢查。 |
Place and date 申請地點及日期 Taipei, | Signature (for minors, signature of parental authority/legal guardian): 申請者親自簽名（未成年者：家長 / 法定監護人簽本人姓名） |
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