Italy Visa Application Form - Fill, Sign Online, Download & Print - No Signup
Embassy of Italy in Washington DC
Application for Schengen Visa
This application for is free
Familymembers of EU, EEAor CH citizens or of UKnationals who are beneficiaries of the EU-UKWithdrawal
A
greement
shall not fill infields No21,22, 31, 32 and 33 (marked with ).
Fields 1 3 shall be filled in in accordance with the data in the travel document.
1.
Surname (Family name):
For official use only
D
ate of
A
pplication number:
2.
Surname at birth (Former family name(s)):
3.
First name(s) (Given name(s)):
4.
D
ate of birth (day-
month-year):
5.
Place of birth:
6.
Country of birth:
7.
Current nation-
ality:
different:
Other nationalities:
A
at:
Embassy/consu-
late
Service
provider
Commercial in-
termediary
8.
Sex:
Male
Female
Other
9.
Civil status:
Single
Married
Registered Partnership
Separated
D
ivorced
Widow(er)
Other (please specify):
Border
(Name):
... . .. . .. .. .. . .. . .
Other:
10.
Parental authority (in case of minors)/legal guardian (surname, first name, address, if
differentfrom
telephone No,email address,and nationality):
File handled by:
11.
National identity number, where applicable:
Supporting
documents:
Travel
document
Means of subsis-
tence
Invitation
12.
Type of travel document:
D
Special
passport
Other travel document (please specify):
TMI
Means of trans-
port
Other:
Visa decision:
Refused
Issued:
A
C
13.
Numberof travel
document:
14.
D
ate of issue:
15.
Valid until:
16.
Issued
by
(country):
1
PHOTO
17.
Personal data of the family member whois an EU, EEA or CH citizen or a UK national who
is a beneficiary of the EU-UK Withdrawal
A
greement, if applicable
LTV
Valid:
From:
Until:
Surname (Family name):
First name(s) (Given name(s)):
D
ate of birth(day-
month-year):
Nationality:
document or I
D
card:
18.
Familyrelationship with an EU, EE
A
or CH citizen or a UK national who is a beneficiary of
the EU-
A
greement, if applicable:
spouse
child
grandchild
dependent ascendant
registered partnership
other:
19.
A
home address and email address:
Telephone
no.:
20.
Residence in a country other than the country of current nationality:
No
Yes. Residence permit or equivalent . ... .. .. .. .. . No. ..... ........ Valid until... .. ... .. .. .
21.
occupation:
Number of entries:
1
2
Multiple
22.
of educational establishment:
23.
Purpose(s) of the journey:
Medical
reasons
Study
A
irport transit
Other
24.
A
dditional information on purpose of stay:
25.
Member State of main destination
plicable):
26.
Member State of first entry:
27.
Number of entries requested:
Single entry
Two entries
Multiple entries
28.
29.
Fingerprints collected previously for the purpose of applying for a Schengen visa:
No
Yes.
D
ate, if known . . .. . .... ... ... ... ... ... .. Number of the visa, if known . . ... .. ... .... .. .... ... .. .
30.
Entry permit for the final country of destination, where applicable:
Issued by ... .. . .. ... .... ... ... ... Valid from .. ... ... ... ... ... ... ... until .. .. ... ... .... ... ... .. .
31.
name of hotel(s) or temporary accommodation(s) in the Member State(s):
A
ddress and email address of inviting person(s)/
hotel(s)/temporary accommodation(s):
Telephone
No:
32.
*
Name and address of inviting company/organisation:
email address of contact person in company/
organisation:
Telephone No of company/organisation:
33.
*
Cost of travelling and living during the
stay is covered:
by the applicant
Means of support:
Cash
cheques
Credit
card
Pre-paid accommodation
Pre-paid transport
Other (please specify):
by a sponsor (host, company, organisa-
referred to in field 30 or 31
other (please specify):
Cash
A
ccommodation provided
A
ll expenses covered during the stay
Pre-paid transport
Other (please specify):
34.
Surname and firstname of the person filling in the application form, if differentfrom the
applicant:
A
ddress and email address of the person filling in
Telephone
No:
I am aware that the visa fee is not refunded if the visa is refused.
A
pplicable in case a multiple-entry visa is issued:
photographand, if applicable, the taking of fingerprints, are
the examination
application; and any
personaldata concerning me whichappear on theapplication form, as well as my fingerprints and my photographwill be
Such data as well as data concerning the decision taken on my application or a decision whether to annul, revoke or extend
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
or
examining
and of determining responsibility for 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
.....................................................................................................................................................................
)].
I am awarethat I have theright toobtain, in any of the Member States, notification of the data relating tome recorded in
A
application will inform me of the manner in whichI may exercise my right to check the personal data concerning me and
have them corrected or deleted, including the related remedies according tothe national law of the Member State
...
the protection of personal data.
liable toprosecution under thelaw of theMember State whichdeals with theapplication.
I undertaketoleave the territory of the Member States before the expiry of the visa, if granted. I havebeen informed that
possession of a visa is only one of the prerequisites for entry intothe European territory of the Member States. The mere
fact that avisa has beengranted tome does not mean that I will be entitled to compensation if Ifail to comply with the
A
The prerequisites for entry will be checked again on entry into the European territory of the Member States.
Place and date:
Signature of applicant:
(signature of parental authority/legal guardian, if
applicable):
