(?G _ اB` اK) 9<*(
Please complete this application form in English
ة
Application for Schengen Visa
PHOTO
رة#J
ه ا
رة
This application form is free
1. (اّ ) اّ ا/ Surname (Family name) (x)
FOR OFFICIAL USE
ONLY
2. ( ّدة ) اّ ا ا#اّ "! ا/ Surname at birth [Former family name(s)] (x)
Date of application:
3. &ا/ First name(s) [Given name(s)] (x)
Visa application number:
4. (م#ا-*+ّ,ا-!ّدة )ا#)ر(' ا/
Date of birth (day-month-year)
5. دة#ن ا// Place of birth
7. 0ا! ا/ Current nationality
6. دة# ا/ Country of birth
12 3 إن آ،دة#ا! "! ا/
Nationality at birth, if different
8. 7! ا/ Sex
9. "
< ا0 ا/ État civil
□ * ذآ/ Male
□
□
□
□
□
□
□ 9: أ/ Female
أب/ Single
( ?وّج)ة/ Married
(@)ةA1! / Separated
(ّ)ةB / Divorced
( أر@)ة/ Widow(er)
(حF(G*ى )ا*<ء اDأ/ Other (please specify)
10. # ا
ّ J# ا/ *O ا9 <!ّ و9 إPQG (ّB اNJ ان#!" I" MDان )إن ا#! ا،ّ ا& وا:I(*J K!ّ
In the case of minors: Surname, first name, address (if different from applicant’s) and nationality of parental
authority/legal guardian
11. < إن و،ّ(#+ !R#& اSّ* ا/ National identity number, where applicable
12. *1ّ اTع و#/ Type of travel document
□ * "دي1 از#< / Ordinary passport
□ * ر1 از#< / Official passport
□ #* د1 از#< / Diplomatic passport
□ صD *1 از#< / Special passport
□ 2 *1 از#< / Service passport
□ (YQ# ا9<*() *ىD* أ1 Tو/ Other travel document (please specify)
13. *1ّ اT& وSر/ / Number of
travel document
14. ارJG )ر(' ا/ Date 15. NZAء ا+ )ر(' ا/ 16. ارJG ا+< / Issued by
of issue
Valid until
17. ّB اNA *و/G*( اK وا،SG@ ا
ّ 0 ان#!"/ Applicant’s home address M)+م( اS& )أرSر/ Telephone number(s)
and email address
(x) *1ّ اT وP !ّ
F
)^ ا3 9 إ1 I ت2 ت اPا#) ( أن
(x) Fields 1-3 shall be filled in accordance with the data in the travel document.
Application lodged at:
□ Embassy/Consulate
□ Common application
center
□ Service provider
□ Commercial
intermediary
□ Border
Name:
□ Other
File handled by:
Supporting documents:
□ Travel Document
□ Means of subsistence
□ Invitation
□ Means of transport
□ Travel medical insurance
□ Other:
Visa decision:
□ Refused
□ Issued
□A
□C
□ LTV
Valid:
from
until
Number of entries:
□ 1 □ 2 □ Multiple
Number of days:
18. ّ0ف ا!ّ اZ2 انK ى اNr S< إ#) @ ه/ Residence in a country other than the country of current
nationality
□ / No
(_ YJ
&Sر
□ Yes. Residence permit or equivalent
u أو (دSG اvD*) .& □
No.
Valid until
*19. ّ0 ا1w#ا/ Current occupation
*20. & اx ان#!" ا& و،KB K! .uّص2 اM)+& اS ورuا#!" ا
@ وNJ & ا/ Employer and employer’s address
and telephone number. For students, name and address of educational establishment
21. Nّ* (ب( ا*ّ)ةKO)اKّا/ Main purpose(s) of the journey
□ ءS JO ا9 ا أو إ9 ز(رة إ/ Visit of family or friends
□ N / Tourism
□ درا/ Study
□ أ"
ل/ Business
□ ّKR بKأ/ Medical reasons
□ PT / Cultural
□ Q(ر/ Sports
□ر#K" / Transit
□ رB ر#K" / Airport transit
□ ّ
ز(رة ر/ Official visit
□ (YQ*ى )أوDأ/ Other (please specify)
22. #F ا+<# ا/ Member State(s) of destination
23. I_!,ول |{*ة اOل ا#D ا+< و/ Member State of
first entry
24. #B
ل ا#D " د *ات ا/ Number of entries requested
25. SGر أو ا#K ّS#
ا
ّة ا/ Duration of the intended
stay or transit
□ Nل وا#D د/ Single entry
□ I)* ل#D د/ Two entries
□ ل ّد#D د/ Multiple entries
(ّمO ّد " د اN/ Indicate number of days
26. *ةDOات ا#! ثZ:ّل اZD ّ
اI_!{ )|{*ات/ Schengen visas issued during the past three years
□ /No
9إ
I 0J .& □
□ Yes. Date(s) of validity from
to
27. I_!{ )|{*ة9" ل#A0 اB ~JO
ت اA ~P ^ رK @ ه/ Fingerprints collected previously for the purpose of
applying for a Schengen visa
□ /No
□ N اّر(' إن آن.& / Yes. Date (if known)
28. < إن و،+ّ! ا+<# ا9ل إ#Dّ اY(*A) / Entry permit for the final country of destination, where applicable
*فR I &ّ
Issued by
9إ
Valid from
I YJ
until
ل#JO اN أو أI ا،I(*S) (*(# (*ا ا1!/ ورو أوOد( اAS اB!
ورو أوOد ا0ّ)Z ت اZء اF"@ أKS I +1 ( ا، * Z" +K) اI( !وKّ!
+ K:
اT#& ) (& ا+" (*(# (*ا ا1!/ اI ورو أوOد( اAS اB!
ورو أو اOد ا0) اI رة0!
ت اZء اF" أ.@!*(ّ اN P &+ّN ر رR إP (I#1/
ا
.35 و34 &Sت ر2ء ا1 ا9 إPQG ا*ا
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.
29. I_!, دول ا9ل إ#J# " ا
*ر#
ا/ Intended date of
arrival in the Schengen area
30. I_!," ا
*ر _درة دول ا#
ا/ Intended date of
departure from the Schengen area
*31. !دق( أو1! ق )ا1 ا& ا،^ ذY( & وإن.I_!, دول ا9P ءF"O ان اK أو اK اP ة#"ّ ب ا0Jص أ2{O أو اv2ّ,ا& و ا
.I_!,ء دول اF" ان أK أو اK اP SG ا/ (I(ان )ا!و#! ا/ 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)
!دق1! ق أو ا1 /ة#"ّ ب ا0Jص أ2{O أو اv2ّ, *و/G*( اKان وا#!ا
SG اIن أو أآ/
/ Address and email address of inviting
person(s)/hotel(s)/temporary accommodation(s)
7آ1 واM)+ ا/ Telephone and telefax
*32. 1F
ّ اx
ان ا
!ّ
أو ا#!" ا& و/ Name and address of inviting ّ!
ّ أو اx
ا7آP وM) ه/ Telephone and
telefax of company/organisation
company/organisation
ّ!
ا/ّx
لA)ول اx
*و/Gان ا#! وا7آ1 واM)+& اSان ور#!" إ& و و/ Surname, first name, address,
telephone, telefax, and email address of contact person in company/organisation
*33. B ا
مS*ة إP لZD ة0* وا1 اM/) B_) &( / Cost of travelling and living during the applicant’s stay is
covered
□ (
!
ا،ّx
ا،MF
)اIF@ اKS I/ by a
□ A2{ B *ف ا
مR I / by the applicant
himself/herself
sponsor (host, company, organisation)
□ 32 أو31 2 اP uر إ,/ referred to in field 31
ق1Gارد ا# / Means of support
or 32
□ ( # / Cash
□ (YQ#ّ ا9<*() *ىD أ/ other (please specify)
□ /! SB / Credit Card
□ N ت/{ / Traveller’s cheques
ق1Gارد ا# / Means of support
□ ~P اK S إ/ Prepaid accommodation
□ ( # / Cash
□ ~P اK @ / Prepaid transport
□ *ةP# S إ/ Accommodation provided
□ (YQ#ّ ا9<*() *ىDأ/ Other (please specify)
□ SG!ء اTة أB_ M/@ ا
ّ آ/ All expenses covered
during the stay
□ ~P اK @ / Prepaid transport
□ (YQ#ّ ا9<*() *ىD أ/ Other (please specify)
34. .(*(# (*ا ا1!/ورو أو اOد( اAS اB!
ورو أو اOد ا0ّ) اI I( ر0!
ء ا اF"O ّA2{ ت/ Personal
data of the family member who is a EU, EEA or CH citizen
( اّ ) اّ ا/ Surname
&G ا/ First name(s)
دZ
)ر(' ا/ Date of birth
! ا/ Nationality
ّ(#+ اSB * أو1 اT& وS ر/ Number of travel
document or ID card
ل#JO اN أو أI ا،I(*S) (*(# (*ا ا1!/ ورو أوOد( اAS اB!
ورو أوOد ا0ّ)Z ت اZء اF"@ أKS I +1 ( ا، * Z" +K) اI( !وKّ!
+ K:
اT#& ) (& ا+" (*(# (*ا ا1!/ اI ورو أوOد( اAS اB!
ورو أو اOد ا0) اI رة0!
ت اZء اF" أ.@!*(ّ اN P &+ّN ر رR إP (I#1/
ا
.35 و34 &Sت ر2ء ا1 ا9 إPQG ا*ا
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.
35. (*ي#د ا0)ورو أو اOد( اAS اB!
أو ا،9ورOد ا0) ر"( اN ا*ا ~ أJ / Family relationship with an EU,
EEA or CH citizen
□ I(*S / Spouse
□ ! أو اI ا/ Child
□I#1/
ل ا#JO اN أ/ Dependent ascendant
36. '(ن وار/
ا/ Place and date
□ ة1N أو1N / Grandchild
37. (9# ا9J# ا/* ا9ء وF إ،I(*J K!) ءFGا/ Signature
(for minors, signature of parental authority/legal guardian)
ا|{*ةY! Pل رN 9P م ا|{*ة (& رده# "& |ن ر9" أ
I am aware that the visa fee is not refunded if the visa is refused.
Q أرا9 إNّZر ا1Oل اZD و9وO اSل إZD K! *1ّ!ء اT أ0J I|) 9" ل#:0*ورة اF Z" )& إ:(24 &S رD *ل )أ#D )|{*ة ّدة اR لN P
ءF"Oا ول ا
Applicable in case a multiple-entry visa is applied for (cf. field No. 24): 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.
P !ّ
F A2{ أي ت. )|{*ة9" ل#A0 اR < أ<@ *اI *O ا9FS
) إن اA ~Pّ ورP*ا#)#P (*ي#A) ه وB ا
رة اP #B
ت اK* <
~ اP#) & :( 9" P وأوا3Rإ
. اّ|{*ةB ّ
ا*ار اD ف أ+ ^ء وذF"Oّ ا ّول اA2
ت اBّ*ف اR I + و+
( ) & )
A وP*ا#)#1رة ا#ّA ا9 إPQG ا|{*ةB J2ه ا
رة ا
هAS وها ّة أ1(VIS) ل اّ|{*ات#N ت#
ا#! I
Q +?D و+< أو )
( ّ|{*ة ~ إدرا0 *ار إ_ء أوS ي
ّ )|{*ة أو أ9" ل#A0 اB )^ ا
ّ *ار ا9 إPQG تKه ا
ا ّولP ء#ّ*ة وا+ ل اP ّA2
ت اBء وF"O@ ا ّول اDر< ودا2 ود ا0 ا9" اّ|{*اتKS *ا1ّ/
ّ اA2
ت اB ّ|{*ات و1ّ/
ت اB N +ZD ن#/) ات#! 7
D
( 0)ء و#ّ اB ف درا+ّ*وط و,& ه ا+P *P#) ) & & أو+P *P#) I(ّص ا2{O ( ا0) ف+ء وF"O ا ّول اQ أرا9" !
اSGل وا#Dّ *ام {*وط اN اI ف ا|آ+ ءF"Oا
*ىDO*ة اB2ره وا*ا& اG ( ا*ا& ا0) وI (S# أ<@ اI وروO اR*, ا/
ء وF"O@ ا ّول اKS I !ّ
ت اB تKت ! )ح ه اN P و.< ه ا
*اI" وx
ت اBا
:*و/G*( اKان ا#!" ،Bundesverwaltungsamt, 50728 Köln, Germany :ان#! ا،(BVA) دي0)داري اG ا/
ا:ت هK ه اA2
ا#F اK اB إن.+P 0ّ ا9 إPQG
[email protected]
Y0A) R < 9 إ+Nr مS اّي#F اK اP* P N 9 إPQG ل اّ|{*ات#N ت#
ا#! I
Q w#10
ت ا
ّ اK رBD إ9" #F" ي
ّ ل ى أ#A0 اP 0 Z" )& إ
ا|آP ّN ر+ZD I !!/
( ّّ*( اB Z"r KB < *ا3S ّ اBّم ا#) ،Y(*A اKR !" .ّ#S * (*B +" ل#A0ه إن ) ّ& ا#0 أوR#_ 3ّ! إن آA2) ّت اKا
#/0ض ا#1 : Kا ا+ ّ!R# اKS ا
*اB ) و.ذه2)< " ا#( ا
ّ !
اK D*(~ ا ّا,ّ*ف اR I ّدة0
ّ ا#@ اKّ < ا9ه إ#0 أو+00A) وJ2ّ اA2,ت اK اI
:*و/G*( اK ا،0049 (0)228-997799-550 :7آ1 ا،0049-(0)228-997799-0 :M)+ ا،Husarenstraße 30, 53117 Bonn, Germany, :ان#! ا، ت#
*( اNت وK
( اN ونx,
Oا
.ّA2,ت اK
( ا0 ّ
اB
ض#1
راBD إI/
( .www.bfi.bund.de :*و/G~ اS#
ا،[email protected]
KB) يQ ّت <?اK) u!" *ّ !( أنI/
(
آN#!
أو إ_ء اّ|{*ة اKB P رu!" ّ)*( RD نK ن آ@ إدء
ّ | Z"~ إS و. وآ00J P*R I ّ ت اK@ ا
ّ آ،
" N uّ*ّح أJأ
.B
" ا*ّاI_!{ دوIا#
.ءF"O ان اK ّوروO اQراO ا9ل إ#Dّ ى {*وط اN إ
ّ إ7 اّ|{*ة9" ل#A0ن ا
ّ أZ"~ إS آ
و. +NZJ ء ةF@ اKS اّ|{*ة وذك3
ّ) ء إذاF"O ا ّول اQ _درة أرا+ّ )آ
أ
. !اكN KB P~ رS ووI_!{ S1ّ) KB ا
ه ة اI ، 9وO اBّ! ا،72@ اA1 اP !ّ
F
ّ*وط ا, ( إذا & أ#ّ اP N *ورةQ !( ^ن ذ
ّ P ل#Dرة )
)|{*ة د#J P uّ أN
.ءF"Oورو ول اOل اّ*اب ا#Dل ّدا "! د#Dّ *ام {*وط اN اKSو) ّ& *ا
I am aware of and consent to the following: the collection of the data 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. 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 or extend a visa issued will be entered into, and stored in
the Visa Information System (VIS)1 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 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 the data is: Bundesverwaltungsamt, 50728 Köln, Germany, [email protected].
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: Der
Bundesbeauftragte für den Datenschutz und die Informationsfreiheit, Husarenstraße 30, 53117 Bonn, Germany, Tel.: +49 (0)228-997799-0, Fax: +49 (0)228-997799-550,
[email protected], www.bfi.bund.de will hear claims concerning the protection of personal data.
I declare that to the best of my knowledge all particulars supplied by me are correct 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 the Schengen Borders Code and am thus refused entry. The prerequisites for entry will be
checked again on entry into the European territory of the Member States.
'(ن وار/
ا/ Place and date
1
" VIS #! ن#/) N P/ Insofar as the VIS is operational
(# ا
ّ J# ا/(#O اBّء اF إ،I(*J K!) ءFGا/ Signature (for minors,
signature of parental authority/legal guardian)
Information provided to applicants pursuant to Section 54 (2) 8 in conjunction with
Section 53 of the Residence Act)
A foreigner can be expelled if he or she has furnished false or incomplete information in order to
gain a German residence permit or a Schengen visa.
The applicant is obliged to provide all information to the best of his or her knowledge and belief. If
he or she refuses to provide data or knowingly furnishes false or incomplete information, the visa
application may be refused or, if a visa has already been issued, the applicant may be expelled from
Germany. In signing this document, the applicant certifies that, before submitting the application,
he or she was informed of the legal consequences of refusing to provide data or furnishing false or
incomplete information in the visa application process.
_______________________
Place, date
_______________________________
Signature
'()*' ا+ *(ن ا53 ادة# ر
ط54 ادة2 اة8
ت ا
أ
أو )|{*ةS إAD ر9" ل#A0 ف ا+ ` أو * آRD تK دءG مS أ
إذاI K!< إد أي أI/
(
.I_!{ ?اP
`RD تK " I" دءGت أو اK دءG اP و"! ر.*
Q وu
" N تKدء ~ اG ?مB اNJ
.1 ا|{*ةY! لN P أI B اNJ إد9 ا|{*ة أو إY! R P ر9دي ذ^ إx( أنI/
( أو * آ
رR إP /` أو * اR2ت اK ا9" K)*
ا#ت اK|ن ا, " N أu أuS#) <#
B اNJ آx(
.u ص2 اB@ ) (& اKS ^إ<*اءات ا|{*ة وذ
_____________________
~S#ا
____________
'(ن وار/
ا
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