Photo Application for Schengen Visa
照片 申根簽證申請表格 ( 請用英文填寫)
This application form is free of charge - 本表格為免費
1. Surname (Family name) 姓 (1) 2. Surname at birth (former family name(s)) (國人可免填) (1) 3. First name(s) (Given name(s)) 名 (1) For official use 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 5. Place of birth 出生城市 6. Country of birth 出生國家 4. Date of birth (day-month-year) 出生日期 (日/月/年) 7. Current nationality 目前國籍: 9. Marital status 婚姻狀況 Single 單身 Married 已婚 Divorced 離婚 Widow(er) 鰥寡 Nationality at birth, if different 原始國籍 (若不同於目前國籍者) 8. Sex 性別 Male 男性 Female 女性 Separated分居 Other (please specify) 其他 (請註明) 10. In the case 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 (若與申請者地址不同) 以及國籍 11. National identity number, where applicable 身分證號碼 Name: 12. Type of travel document 護照種類 Other Ordinary passport 普通護照 Diplomatic passport 外交護照 Service passport 公務護照 Official passport 公務護照 Special passport 特別護照 Other travel document (please specify) 其他相關旅行證件 (請註明): File handled by: 13. Number of travel document 護照號碼 14. Date of issue 發照日 15. Valid until 效期截止日 16. Issued by 發照機構 (Passport) Supporting documents: 17. Applicant’s home address 申請者住家地址 Telephone number(s) 電話 E-mail address 電子郵件 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 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 / 學校名稱和校址 Travel document Means of subsistence Invitation Means of transport TMI Other: Visa decision: Refused Issued A C LTV Valid From .............................. Until .............................. Number of entries: 1 2 Multiple Number of days : 21. Main purpose(s) of the journey 停留目的 Tourism 旅遊 Business 商務 Visiting Family or Friends 探訪親戚,朋友 Cultural 文化 Sports 運動 Official visit 公務 Medical reasons醫療 Study 就學 Transit 轉機 Airport transit 機場過境 Other (please specify) 其他(請說明) 22. Member State(s) of destination 23. Member State of first entry 主要停留國家 最先抵達的申根國家 24. Number of entries requested 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申請停留天數 26. Schengen visas issued during the past three years 過去三年內是否持有其他申根簽證及其效期. No 否 Yes 是. Date(s) of validity from 效期自 to 至 27. Fingerprints collected previously for the purpose 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 Issued by 發照機構 Valid from 效期自 Date, if known 日期 (若知道請填寫) until 至 28. Entry permit for the final country of destination, where applicable 如為轉機是否持有目的國之入境許可 29. Intended date of arrival in the Schengen area 抵達申根國家日期 30. Intended date of departure from the Schengen area 離開申根國家日期 The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) while exercising their right to
free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields No 34 and 35.
*註記之問題，歐盟、冰島、挪威及瑞士居民之親屬不需要回答。(請另附親屬關係證明文件並填寫第34、35欄)
(1) Fields 1-3 shall be filled in in accordance with the data in the travel document 1-3 項有(1)之問題，回答須與護照相同
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). 觀光目的者 ： 申根國邀請人(親友) 姓名 或 旅館名稱 Address and e-mail address of inviting person(s)/hotel(s)/temporary accommodation(s) 邀請人(親友) 或 旅館之地址及電子郵件 Telephone and telefax 電話及傳真 - * 32. Name and address of inviting company/organisation 其他目的者 ： 邀請公司(或 學術單位 / 就讀學校 / 會議資料) 名稱及地址 Telephone and telefax of company / organisation 公司(或單位)電話及傳真 - Surname, first name, address, telephone, telefax, and e-mail address of contact person in company/organisation 上述聯絡人姓名, 部門或單位之地址, 電話, 傳真及電子郵件 * 33. Cost of travelling and living during the applicant’s stay is covered 停留期間費用 by the applicant himself/herself 申請者自付 Means of support方式 Cash 現金 Traveller’s cheques 旅行支票 Credit card 信用卡 Prepaid accommodation 食宿預付 Prepaid transport 交通預付 Other (please specify) 其他 (請註明) by a sponsor (host, company, organisation), please specify 由贊助者 (邀請者, 公司或單位)提供， 請註明 referred to in field 31 or 32 請參閱31、32項 other (please specify) 其他 (請註明) Means of support 方式 Prepaid transport 交通預付 Cash 現金 Accommodation provided 食宿預付 Other (please specify) 其他 (請註明) All expenses 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 EU、冰島、挪威居民及瑞士居民親屬資料 Surname 姓 First name(s) 名 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EU、冰島、挪威居民及瑞士居民之親屬關係 spouse 配偶 child 子女 grandchild 孫 dependent ascendant 撫養 36. Place and date 申請地點及日期 37. Signature (for minors, signature of parental authority/legal guardian) 申請者親自簽名 (需與護照同, 不 可塗改) / 未成年者由監護人代簽 I am aware that the visa fee is not refunded if the visa is refused 我暸解簽證一旦被拒絕, 將無法退費 Applicable in case a multiple-entry visa is applied for (cf. field No 24): 申請簽證為多次者 (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 subsequent visits to the territory of Member States第一次入境或之後再入境都必須有適當的醫療保險 I am aware of and consent 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 processed by those authorities, for the purposes 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 purposes 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 these 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 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 the data is […]. 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 processed unlawfully be deleted. At my express request, the authority examining 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 corrected or deleted, including the related remedies according to the national law of the State concerned. The national supervisory authority of that Member State […] 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 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 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 relevant provisions of Article 5(1) of Regulation (EC) No 562/2006 (Schengen Borders Code) and I am therefore refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Member States. 本人瞭解，簽證審查前有義務提供申請表所要求的資料、照片，甚至指紋。並同意上述資料，若有必要，得轉傳其他申根會員國家簽證機構，以核發簽證。 上述資料，連同對該申請的決議，包括取消、撤銷、或者予以延簽等，將會記錄於Visa Information System (VIS) (2)五年。期間，該資料將提供申根各會員國之相關簽證單位於境內、境外審查簽證時使用；用於會員國之移民與庇護單位審理合法入境、停留、居留權之行使；用於確認申請者條件履行狀況、審查庇護申請及確認上述審核責任。某些情況下，申根國警政單位Europol亦會調閱相關資料，用以反恐或偵查重大犯罪。 依照規定，簽證審核期間，申請者得要求簽證單位出示其儲存在VIS系統當中的資料，若有不當儲存，得加以修正或刪除，並要求告知相關權利與申訴途徑，以便依法進行補救。 本人保證在此申請表所填寫之資料真實無誤；本人瞭解若有任何不實資料將導致簽證申請被拒絶，已持有之簽證亦將被取消並擔負法律責任。 本人保證在簽證效期期滿前離開簽證適用國。本人瞭解持有簽證只是入境之先決條件，若違反Regulation (EC) No 562/2006 (Schengen Borders Code)第五條第一款而被拒絶入境，將不得要求賠償。 Place and date 申請地點及日期 (2) In so far as the VIS is operational 當VIS生效時 Signature (for minors, signature of parental authority/legal guardian): 申請者親自簽名 (需與護照同, 不可塗改) / 未成年者由監護人代簽
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