Application for Schengen Visa
申根簽證申請表格 ( 請用英文填寫)
This application form is free 本表格免費提供
1.  Surname (Family name) (1) 姓氏          
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
Name:
  Other
File handled by:
Supporting documents:
  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 :
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 (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 (若與申請人地址不同) 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 (please 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)
     
16. Issued by  發照機構
     
17. Applicant’s home address 申請者住家地址
     
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 purpose(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 (please 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 / 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 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             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            
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)       
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 * 之項目，歐洲聯盟、歐洲經濟區及瑞士居民之親屬（配偶、子女或是受撫養之長輩）在行使旅行的權益時，不需要填寫。歐洲聯盟、歐洲經濟區及瑞士居民之親屬應出示親屬關係證明文件並填寫第34、35項。
(1) Fields 1-3 shall be filled in accordance with the data in the travel document 第1至3項資料必須與護照相同．
* 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)   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
+     
+     
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 himself/herself  申請者自行負擔
Means of support費用支付方式
by a sponsor (host, company, organisation), please 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 (please 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 (please specify) 其他 (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 (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 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
spouse 配偶    child 子女      grandchild 孫子女  dependent ascendant受撫養之長輩
valid from是什么意思
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 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 subsequent 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 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 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 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: 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 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、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件，若因不符合Regulation (EC) No 562/2006(Schengen Borders Code)第五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）
(2) In so far as the VIS is operational  當VIS生效時

版权声明：本站内容均来自互联网，仅供演示用，请勿用于商业和其他非法用途。如果侵犯了您的权益请与我们联系QQ:729038198，我们将在24小时内删除。