photo
Sticker no.
Application for National Visa
1. Surname
CONSULAR USE ONLY
2. Surname at birth
Data della domanda:
3. Name
4. Date of birth
5. I.D. card number (optional)
Fascicolo esaminato
da:
6. Place of birth (city/town and country)
7. Current citizenship
8. Citizenship at birth
Documenti presentati:
9. Sex
 Male
10. Marital status
 Female
 Single  Married  Separated  Divorced
 Widow/er
 De-facto  Other
11. Father’s name
 Passaporto valido
 Mezzi finanziari
 Invito
 Mezzi di trasporto
 Assicurazione malattia
 Di altro tipo
12. Mother’s name & maiden surname
13. Type of passport:
 National Passport
 Diplomatic Passport
 Travel Document (1951 Convention)
 Service Passport
 Seaman’s Passport
14. Passport number
15. Issued by
16. Date of issue
17. Expiry date
 Alien’s Passport
 Other travel document (specify):
Visto:
18. If you reside in a Country other than your Country of citizenship, do you have permission to return to
 Rifiutato
that Country?  No  Yes (you must show visa which is valid for al least 6 months from return date)  Concesso
19*. Occupation
20*. Current employer’s name, address and telephone number. Students to indicate name and address of
school/university
21. Main destination
22. Type of visa:
 Airport transit
 Transit
 Long stay (over 90 days)
24. Number of entries required
 One
 Two
23. Visa:
 Short stay
 Individual
 Collective
Caratteristiche del
visto:






VTL
A
B
C
D
D+C
25. Length of stay
 Multiple
number of days:
Numero di ingressi:
26. Other visas issued in the last 3 years and period of validity
 1  2  Mult.
27. In case of transit, have you an entry visa for the Country of final destination?
Valido da ….......………..
a …………………………
 No
 Yes, valid until:
28*. Previous entries in the Schengen States
Issued by :
Valido per
……………………..…….
Questions marked with * do not have to be answered by family members of EU or EEA citizens (spouse, children or dependent parents).
The documents proving the relationship must be provided.
29. Purpose of travel
 Tourism  Business  Visiting family/friends  Cultural/Sporting activity  Official  Medical reasons
 Reacquisition of Italian citizenship  Working-holiday  Other: ………………………………………………….
30. Date of entry in Schengen area
31*. Date of departure from Schengen area
32*. Border of entry in the Schengen area
33*. Means of travel
CONSULAR USE ONLY
34*. Host/company/hotel in the Schengen States
Name of host/company/hotel
Telephone/fax:
Full address
email
35*. Who will be paying for your trip and cost of living during your stay?
 Myself
 Host
 Host Company (must present letter of invitation and relevant documentation)
36*. Means of support during your trip
 Cash  Travellers’ cheques  Credit cards  Pre-paid accomodation  Other: ……………………………
 Medical/travel insurance valid until: ………………………………….
37. Surname of spouse
39. Name of spouse
38. Surname of spouse at birth
40. Date of birth
41. Place of birth
42. Children (separate application must be submitted if traveling on separate passport)
Surname
Name
1
2
3
Date of birth
43. Family members of E.U citizens – please complete details of the EU citizen on which you depend
Surname
Name
Date of birth
Citizenship
Passport no.
Relationship
of an EU or EEA citizen
44. I am aware of and consent to my personal information (given above) to be supplied to the relevant authorities in
the Schengen States and processed by those authorities for the purposes of this application. Such information may
be entered into and stored in databases accessible to the relevant authorities in the various Schengen States. At
my expressed request, the Consular authority processing my application will inform me of the manner in which I
may exercise my right to check my personal data and have them altered or deleted, in particular, if inaccurate, in
accordance with the national law of the Country concerned. I declare that, to the best of my knowledge, all
particular supplied by me are true and complete. I am aware that any false declaration will lead to my application
being rejected or to the annulment of the visa already granted; furthermore it may also render me liable to
prosecution under the law of the Schengen State which deals with the application. If granted, I undertake to leave
the territory of the Schengen States upon the expiry of the visa. I have been informed that possession of a visa is
only one of the pre-requisites for entry in the European territory of the Schengen States. The mere fact that a visa
has been granted to me does not mean I will be entitled to compensation if I fail to comply with the relevant
provisions of Article 5.1 of the Convention implementing Schengen and I am thus refused entry. He prerequisites
for entry will be checked again on entry into the European territory of the Schengen States
45. Address:
47. Place and date
46. Telephone
48. Signature (for minors, signature of parents/guardians)
Consolato Generale d’Italia a Sydney - Level 19, 44 Market Street - Sydney NSW 2000 – Australia
www.conssydney.esteri.it - Email: [email protected] - Tel: +61 (2) 9392 7900 - Fax: +61 (2) 9392 7980