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'COTO

Application for Schengen Visa


sterreichische Botschaft M a n ila

(<ith <hite *acBgroun+) please paste 1

This application form is free


1. Surname (Family Name) Apelyido (x) FOR OFF ! A" #S$ ON"% $#RO &&&&&&..&. '$SOS &&&&&&&. (ate of application) 5. 'lace of *irth 6. !urrent nationality

0. Surname at *irth (former family name(s)) (x)

1. First name(s) (2i-en name(s)) Pangalan (x)

3. (ate of *irth (+ay4month4year) &..

4 4
&& male

7. !ountry of *irth

Nationality at *irth8 if +ifferent)

&&&&&&&&&&&.. Visa application num*er) &&&&&&&&&&&..

&&&. female

:. /arital status Single /arrie+

Separate+ (i-orce+

9. Sex

Application lo+ge+ at) $m*assy,!onsulate ;i+o<(er) Other (please specify)) &....................................... !A! 1=. n the case of minors) Surname8 first name8 a++ress (if +ifferent from applicant>s) an+ nationality of Ser-ice pro-i+er parental authority,legal guar+ian !ommercial interme+iary .or+er Name) &&&&&&& Other 11. National i+entity num*er8 <here applica*le

10. Type of tra-el +ocument Or+inary passport Special passport 11. Num*er of tra-el +ocument (iplomatic passport Ser-ice passport Official passport Other tra-el +ocument (please specify)) 13. (ate of issue 15. Vali+ until

File han+le+ *y) &&&&&&&&&&&.. Supporting +ocuments) Tra-el +ocument /eans of su*sistence n-itation /eans of transport T/ Other) &&&&&&&&&&&.. %es. Resi+ence permit or e?ui-alent) No.) Vali+ until)

17. ssue+ *y

Telephone num*er(s)

16. Applicant>s home a++ress an+ e4mail a++ress

19. Resi+ence in a country other than the country of current nationality No

Visa +ecision) Refuse+ ssue+) A ! "TV Vali+ from &..&&&..&.. until &&.&&..&&&.&. Num*er of entries) 1 0 /ultiple Num*er of +ays) &&&&

@ 1:. !urrent occupation

@ 0=. $mployer8 employer>s a++ress an+ telephone num*er. For stu+ents8 name an+ a++ress of e+ucational esta*lishment.


01. /ain purpose(s) of the Aourney) Tourism Official -isit Transit .usiness /e+ical reasons Airport transit Visiting family or frien+s Stu+y Other (please specify)) &&&&&&&&&&&&&&& !ultural Sports

The ?uestions marBe+ <ith * +o not ha-e to *e ans<ere+ *y family mem*ers of $#8 $$A or !C citiDens (spouse8 chil+ or +epen+ent ascen+ant) <hile exercising their right to free mo-ement. Family mem*ers of $#8 $$A or !C citiDens ha-e to present +ocumentation to pro-e this relationship an+ fill in fiel+s No. 13 an+ 15.

(x) Fill out accor+ing to the information in your tra-el +ocument.

00. /em*er State(s) of +estination

01. /em*er State of first entry

FOR OFF ! A" #S$ ON"% Relia*ility checB of application Can+le+ *y) &&&&&&&&&&&.. (ate) &&&&&&&&&&&.. Relia*le Not relia*le Type of -isa applie+ for) Airport transit (A) Short stay (!) "ong stay (()

03. Num*er of entries re?ueste+ Single entry T<o entries /ultiple entry 07. Schengen -isas issue+ +uring the past three years No %es. (ate(s) of -ali+ity from from from

05. (uration of the inten+e+ stay or transit n+icate num*er of +ays) to to to

06. Fingerprints collecte+ pre-iously for the purpose of applying for a Schengen -isa No %es. (ate (if Bno<n))

until

09. $ntry permit for the final country of +estination8 <here applica*le ssue+ *y

Vali+ from

1=. nten+e+ +ate of +eparture from the Schengen area

0:. nten+e+ +ate of arri-al in the Schengen area


A++ress an+ e4mail a++ress of in-iting person(s),hotel(s), temporary accomo+ation(s)

* 11. Surname an+ first name of the in-iting person(s) in the /em*er state(s). f not applica*le8 name of hotel(s) or temporary accommo+ation(s) in the /em*er State(s)

Telephone an+ telefax


*10. Name an+ a++ress of in-iting company,organiDation


Telephone an+ telefax of company, organiDation


* 11. !ost of tra-elling an+ li-ing +uring the applicant>s stay is co-ere+) *y the applicant himself,herself /eans of support) !ash Tra-eller>s che?ues !re+it car+ 'repai+ accomo+ation 'repai+ transport Other (please specify))

Surname8 first name8 a++ress8 telephone8 telefax an+ e4mail a++ress of contact person in company,organiDation

*y a sponsor (host8 company8 organiDation) referre+ to in fiel+ 11 or 10 other (please specify)) /eans of support) !ash Accomo+ation pro-i+e+ All expenses co-ere+ +uring the stay 'repai+ transport Other (please specify))

13. 'ersonal +ata of the family mem*er8 <ho is an $#8 $$A or !C citiDen Surname First name(s)

(ate of *irth (+ay4month4year) Nationality


chil+ gran+chil+ +epen+ent ascen+ant 16. Signature (for minors8 signature of parental authority, legal guar+ian) Num*er of tra-el +ocument or ( car+

4 4
spouse 17. 'lace an+ +ate

&.. && &&&. 15. Family relationship <ith an $#8 $$A or !C citiDen

am a<are that the -isa fee is not refun+e+ if the -isa is refuse+. Applica*le in case a multiple4entry -isa is applie+ for (cf. fiel+ No. 03)) am a<are of the nee+ to ha-e an a+e?uate tra-el me+ical insurance for my first stay an+ any su*se?uent -isits to the territory of /em*er States. am a<are of an+ consent to the follo<ing) the collection of the +ata re?uire+ *y this application form an+ the taBing of my photograph an+8 if applica*le8 the taBing of fingerprints8 are man+atory for the examination of the -isa applicationE an+ any personal +ata concerning me <hich appear on the -isa application form8 as <ell as my fingerprints an+ my photograph <ill *e supplie+ to the rele-ant authorities of the /em*er States an+ processe+ *y those authorities8 for the purposes of a +ecision on my -isa application. Such +ata as <ell as +ata concerning the +ecision taBen on my application or a +ecision <hether to annul8 re-oBe or exten+ a -isa issue+ <ill *e entere+ into8 an+ store+ in the Visa nformation System (V S) (1) for a maximum perio+ of fi-e years8 +uring <hich it <ill *e accessi*le to the -isa authorities an+ the authorities competent for carrying out checBs on -isas at external *or+ers an+ <ithin the /em*er States8 immigration an+ asylum authorities in the /em*er States for the purposes of -erifying <hether the con+itions for the legal entry into8 stay an+ resi+ence on the territory of the /em*er States are fulfille+8 of i+entifying persons <ho +o not or <ho no longer fulfil these con+itions8 of examining an asylum application an+ of +etermining responsi*ility for such examination. #n+er certain con+itions the +ata <ill *e also a-aila*le to +esignate+ authorities of the /em*er States an+ to $uropol for the purpose of the pre-ention8 +etection an+ in-estigation of terrorist offences an+ of other serious criminal offences. The authority of the /em*er State responsi*le for processing the +ata is) F&G. am a<are that ha-e the right to o*tain in any of the /em*er States notification of the +ata relating to me recor+e+ in the V S an+ of the /em*er State <hich transmitte+ the +ata8 an+ to re?uest that +ata relating to me <hich are inaccurate *e correcte+ an+ that +ata relating to me processe+ unla<fully *e +elete+. At my express re?uest8 the authority examining my application <ill inform me of the manner in <hich may exercise my right to checB the personal +ata concerning me an+ ha-e them correcte+ or +elete+8 inclu+ing the relate+ reme+ies accor+ing to the national la< of the State concerne+. The national super-isory authority of that /em*er State Fcontact +etailsG <ill hear claims concerning the protection of personal +ata. +eclare that to the *est of my Bno<le+ge all particulars supplie+ *y me are correct an+ complete. am a<are that any false statements <ill lea+ to my application *eing reAecte+ or to the annulment of a -isa alrea+y grante+ an+ may also ren+er me lia*le to prosecution un+er the la< of the /em*er State <hich +eals <ith the application. un+ertaBe to lea-e the territory of the /em*er States *efore the expiry of the -isa8 if grante+. ha-e *een informe+ that possession of a -isa is only one of the prere?uisites for entry into the $uropean territory of the /em*er States. The mere fact that a -isa has *een grante+ to me +oes not mean that <ill *e entitle+ to compensation if fail to comply <ith the rele-ant pro-isions of Article 5(1) of Regulation ($!) No 570,0==7 (Schengen .or+ers !o+e) an+ am therefore refuse+ entry. The prere?uisites for entry <ill *e checBe+ again on entry into the $uropean territory of the /em*er States.
'lace an+ +ate Signature (for minors8 signature of parental authority, legal guar+ian)

(1) n so far as the V S is operational.