Schengensky Formular

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*** ** ** ** *** Application for Schengen Visa Td khai xin cap thi thwcSchengen This application form is free Td khai dvgc phát miěn phí PHOTO l. Surname (Family name) (x)l Hp For ofÍicia|use only/ Muc ddnh riéng cho cO qrcm chtrc náng Date of application: Visa application number Application lodged at: n Embassy/ Consulate n CAC n Service provider n Commercial intermediary n Border Name: n Other File handled by: Supporting documents: n Travel document n Means of subsistence n Invitation n Meansof transport n TMI n Other: Visa decision: n Refused r Issued: nA oC o LTV D F Valid 2. Surname at birth (Former fami|y names(s)) (x) l Hq khi sinh (Hq truÓc ddy) 3. First name(s) (Given name(s)) (x) Tén (Tén tÍém) 4. Date of birth (day-month-year)/ Ngoy tháng nčm sinh (nga-y".tháng-nčm) 5. Place of birth/ Noi sinh Ó. Country of birtV Qu c gia sinh 7. Current nationality/ Qu c fich hrQn nay Nationa|ity at birth, i16i77g1gÍ|1/ QuÓc Íich khi sinh (néu khac quÓc tich hien noy): 8. Sex/ GiÓi tính n Melel Nam n Female/,V& 9. Marita| status/ Tinh trang hÓn nhan n Single/ DQc than n Married/ Dd tuil hon n.seprratedl t4,than n Divorced/ I.y hÓn l Widow(er\l GÓa chÓngivo n other (please specify)/ Tinh trqng kluic (xin néurÓ) l0. In the case of minors: Surname, Íirst name, address (if different,from app|icant's) and nationa|ity of parenta| authority/ lega| guardianl Trudng hqlp ngtdi chua thdnh nién: hQ, tén, dia chi (néu khÓng tr ng voi dia chi ngtdi xin ctip th1thrc) vd quÓc tlch cua ng i cÓ quyén nuÓi dtdng/ ngni giám hQ l l. Nationa|ity identitynumber, wherc app|icab|e/ SÓ CMND, néu c,in l2. Type of travel document/.Lo4igiáy to thÓng hanh n ordinary passporť HQ chiiiu phÓ thÓng n Diplomatic passport/ HÓ chiěu ngoal 4ruo n Service passporV HÓ chiéu cÓng vu o oflicia| passporť HÓ chiéu cong (HQ chiéu cong vu1 n Specia| passporť Hq chiéuděc biét n other trave| document (please specify)/ Giti1,td thong hdnh khác (xin néu rÓ) | 3. Number of travel document/ Sb hq chiétlGi(b td thÓng hanh l4. Date of issuel Ngdy cáp |5. Va|id until/ Agd;, há han | 6. lssued by Co quan cdp l7. App|icant's home address and e.mai| address/ Dia chi nhd riéng vd tfu diQn ttr cua ngrai xin cdp thi th|Íc Telephone numberls)/ (CÓc) sÓ dién thoqi l8. Residence in a country other than the country of current nationality/ Quy vi hiéncÓ at trli tai mÓt quác gia khác voi quécgia md minh dang mang quÓc tich khÓng, r:Nol KhÓng n }.es./ Cd. Residence permit or equivalen tl Gi$, phépclr tr hoQc gi , 0 nrong dtrung N"./ ^ld. ...... ' Va|id unti|/Cd gia tri tÓi ngay\ l9. Current occupation/ Nghě nghi?p hién tqt 20. Employer and employer's address and telephone number. For students, name and address of educational establishment./ Tén, dia chi vd s difu Íhoqi cua co quan. Dái vdi hqc sinh, sinh vién: tén vd dia chi tnrdng' 2 l . Main purpose(s) of the journ eyl (C c) myc dích chính cua chuyén di: nTourism/ Du lich o Business/ Thuong mqi nVisiting fami|y or friends/ Thěm thán nh n hoěc bqn bě a Cu|tura|/ |,ěn hÓa n Sportď Thé thao n oíficia| visit/ Thěm chính thtrc n Medica| reasons/ L.y- do y té n Study/ H7c tQp n Transiť Quá cánh o Airport transiť Quá canhsdnbay o Other (please specify)/ Muc dich khác (xinnéu rÓ) I Intil Number of entries: nl a2 oMultiple Number of days: 22. Member State(s) of destination/ (Các) rurÓc dén thuÓc kh i Schengen 23. MemberState of first entry. Ntnc thdnh vién sě nhdpcanhddu tién 24' Number of entries requesteďs tdnnhdp 'canh yéu cdu n Sing|eentry/ Mpt lán n Two entry/ Hai lán n Mu|tipleentries/ Nhiěutdn 25. Duration of the intended stay or transit. lndicate number of days ThŮi gian dv dinh lw tni hoQc qwi canh, néurÓ sÓ ngay

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Schengensky

Transcript of Schengensky Formular

Page 1: Schengensky Formular

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Application for Schengen VisaTd khai xin cap thi thwc Schengen

This application form is freeTd khai dvgc phát miěn phí

PHOTO

l. Surname (Family name) (x)l Hp For ofÍicia| use only/

Muc ddnh riéng cho

cO qrcm chtrc náng

Date of application:

Visa application number

Application lodged at:

n Embassy/ Consulate

n CAC

n Service provider

n Commercial

intermediary

n Border

Name:

n Other

File handled by:

Supporting documents:

n Travel document

n Means of subsistence

n Invitation

n Means of transport

n TMI

n Other:

Visa decision:

n Refused

r Issued:

n A

o C

o LTV

D

F

Valid

2. Surname at birth (Former fami|y names(s)) (x) l Hq khi sinh (Hq truÓc ddy)

3. First name(s) (Given name(s)) (x) Tén (Tén tÍém)

4. Date of birth (day-month-year)/Ngoy tháng nčm sinh (nga-y".tháng-nčm)

5. Place of birth/ Noi sinh

Ó. Country of birtV Qu c gia sinh

7. Current nationality/ Qu c fich hrQn nayNationa|ity at birth, i16i77g1gÍ|1/ QuÓc

Íich khi sinh (néu khac quÓc tich hien noy):

8. Sex/ GiÓi tínhn Melel Nam n Female/,V&

9. Marita| status/ Tinh trang hÓn nhann Single/ DQc than n Married/ Dd tuil hon n.seprratedl t4,thann Divorced/ I.y hÓn l Widow(er\l GÓa chÓngivon other (please specify)/ Tinh trqng kluic (xin néu rÓ)

l0. In the case of minors: Surname, Íirst name, address (if different,from app|icant's) and nationa|ity of parenta| authority/lega| guardianl Trudng hqlp ngtdi chua thdnh nién: hQ, tén, dia chi (néu khÓng tr ng voi dia chi ngtdi xin ctip th1 thrc) vd quÓc tlchcua ng i cÓ quyén nuÓi dtdng/ ngni giám hQ

l l. Nationa|ity identity number, wherc app|icab|e/ SÓ CMND, néu c,in

l2. Type of travel document/.Lo4igiáy to thÓng hanhn ordinary passporť HQ chiiiu phÓ thÓng n Diplomatic passport/ HÓ chiěu ngoal 4ruon Service passporV HÓ chiéu cÓng vu o oflicia| passporť HÓ chiéu cong (HQ chiéu cong vu1n Specia| passporť Hq chiéu děc biét n other trave| document (please specify)/ Giti1, td thong hdnh khác (xin néu rÓ)

| 3. Number of travel document/ Sbhq chiétlGi(b td thÓng hanh l4. Date of issuel Ngdy cáp |5. Va|id until/ Agd;, há han | 6. lssued by

Co quan cdp

l7. App|icant's home address and e.mai| address/ Dia chi nhd riéng vd tfu diQn ttr cua ngrai xincdp thi th|Íc

Telephone number ls)/(CÓc) sÓ dién thoqi

l8. Residence in a country other than the country of current nationality/ Quy vi hién cÓ at trli tai mÓt quác gia khác voi quéc giamd minh dang mang quÓc tich khÓng,r:Nol KhÓngn }.es./ Cd. Residence permit or equivalen tl Gi$, phép clr tr hoQc gi , 0 nrong dtrungN"./ ̂ ld. ...... ' Va|id unti|/ Cd gia tri tÓi ngay\

l9. Current occupation/ Nghě nghi?p hién tqt

20. Employer and employer's address and telephone number. For students, name and address of educational establishment./Tén, dia chi vd s difu Íhoqi cua co quan. Dái vdi hqc sinh, sinh vién: tén vd dia chi tnrdng'

2 l . Main purpose(s) of the journ eyl (C c) myc dích chính cua chuyén di:nTourism/ Du lich o Business/ Thuong mqi nVisiting fami|y or friends/ Thěm thán nh n hoěc bqn bě a Cu|tura|/ |,ěnhÓa n Sportď Thé thao n oíficia| visit/ Thěm chính thtrc n Medica| reasons/ L.y- do y té n Study/ H7c tQpn Transiť Quá cánh o Airport transiť Quá canh sdn bay o Other (please specify)/ Muc dich khác (xin néu rÓ)

I Int i l

Number of entries:

n l a 2 o M u l t i p l e

Number of days:

22. Member State(s) of destination/(Các) rurÓc dén thuÓc kh i Schengen

23. Member State of first entry.Ntnc thdnh vién sě nhdp canh ddu tién

24' Number of entries requesteď s tdn nhdp 'canh yéu cdun Sing|e entry/ Mpt lán n Two entry/ Hai lánn Mu|tiple entries/ Nhiěu tdn

25. Duration of the intended stay or transit.lndicate number of daysThŮi gian dv dinh lw tnihoQc qwi canh, néu rÓ sÓ ngay

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The fields marked with * shall not be filled in by members of EU. EEA or CH citizens (spouse, child or dependent ascendant) while exercising theirright to free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields N' 34 and 35/Tfujn nfuin cua cÓng d n Lién minh cháu Áu' KhÓr kinh té ch u Áu hoěc Thuy SÍ ftq, chÓng, con hoQc cha, m9, Óng, bd s ng pha thuQc) khÓng phaidié.n các muc ddnh fuiu * khi thrc hién quyěn tv do di lqi caa minh. Ttty nhién nhťtng ngvŮi nay phai trinh gi(iy td chtng minh quan hQ gia tlinh vddiěnvdo muc 34, 35(x) Fields l.3 sha|| be fi||ed in in accordance with the data in the trave I documenť Myc l -3 phai dtgc dién chính xác nhu trong gitiy td thÓng hanh,

26. Sche ngen visas issued during the past three yearď Thi thq,c Schengen dtryc cáp tong vdng ba nám tro lqi dayaNol KhÓng

'''..tot dén n7dy

27. Fingcrprints collected previous|y for the purpose of app|ying for a Schengen visa/ Quy vi dd wng arqc t(b dáu vdn tay khixin cdp thi thyc Schengen chua?oNolChm n Yes/Rríi

Dqfp- if |rnnwn/ Thži oinn né,, hiÁt

28. Entry permit.for the fina| country of destination., when app|icable/ Giáy td cho phép nhQp canh vdo ntÚc dén cuiji citng tronghdnh trinh, néu cdnlssued by/ Cáp boi .., . . .. .... Valid Írom/ CÓ giá tr! ti, ngay . ... until/ tai ngdy'

29. Intended date ofarrival in the Schengen areďNgdy dr illnh nhdp canh vdo khoi Schengen

30. Intended date ofdeparture from the Schengen areďNgáy dry dinh xuát cánh khoi kh i Schengen

*3l. Surname and Íirst name of the inviting person(s) in the Member State(s). If not applicable' name of hote|(s) or temporaryaccommodation(s) in the Member State(s) l Hq vd tén (nhťtng) ngtvi ndi lai các nuÓc thánh vién' Néu khÓng cÓ, dě nghi néu tén(các) khach s7n hoěc (nhťmg) dia chí tam tru tqi (các) nrÓc thdnh vién'

Address and e-mail address inviting person(s)/hotel(s)/ temporary accommodation(s)/Dia chi vd hdm tht dién tt cua (nhťrnď ngtči mdi, (các) kfužch sqn, (các) dia chi tqm tru

Telephone and telefax/SÓ dién thoqi vd fer

*32. Name and address of inviting company/organisatioďTén vd dla chi co quaru tÓ chttc mdi

Telephone and telefax ofcom pany'/orga nisation/So dÉn thoai va.fax caa co(luan to chÚc mdi

Surname, first name, address, telephone, telefax and email address of contact person in companv/ organisation/Hq vd tén, dia cht,, sii dien thoai, sÓfax. dia chí thu dién tt cua ngtnli tién hé trong-Co quan to cht?c mŮt

*33. Cost of travel|ing and living during the app|icant's stay is covered/ Chi phí di tqi va ěn o cua ngudi xin cáp thi th1tc trongthdi gian lnt tru sě dto. c chi trá

n by the app|icant himse|f/ herse|f/ boi chinh ngttdt xin cáp thi thrcMesns of support/ Hinh th c thanh toánn Cash/ Tién n tn Trave||er's cheques/ Séc du licho Credit card/ Thé tin d4ngn Prepaid accommodationl Ch6 Ú dd dwc thanh toán trttÓco Prepaid trensporť Phwng ti(n di lqi dd dtrqc thanh toÓn trwlco Other (please specify)/ Hinh thrc khac (xin néu rÓ)

n by a sponsor (host, company, organisation).p|ease specifl/ bcti mÓt don v! bao ldnh (ngwdi mdi,co quan, tÓ chtrc), xtn néu ri... '. . f] referred to in field 3| or 32l dtryc néu trongmuc 3l hoěc 32...... D otber (p|ease specify// bén khac (xin néu rd)Means of support/ Hinh thuc thanh toann Cash/ Tién mčtn Accommodation provided/ Ch6 o dugc chu cápo' A|| expenses covered during the stayi Chu cáptdl ca chi phí trong thdi gian lru trun Prepaid transporí Phtmng ti(n di lqt dd dtqcthanh toán truocn other (p|ease speci$)/ Hinh thttc khac (xin néu rÓ)

34. Personal data of the.fami|y member who is an EU, EEA or CH citizerr/ ThÓng tin cÓ nhán cua thdnh vién gia dinh ld cÓng d nLién minh ctuiu Áu,Khái kinh É c|uiu Áu hoác Thuv Si

Sumame/ Ho First name(s)/ Ián

Date of birth/ Ngdy tfuing něm sinh Nationaliw/ ouÓc tich Number of travel document or ID carďSa gi(b td th ng hdnh hoěc CMND

35. Fami|y relationship with an EtI, EEA or CH citizeď Quan h( hq hangvÓi cÓng in Lién minh ch u Áu,KkhÓi kinh é chdu Áuhoqc Thuy S! n Spouse l Vq/ChÓng a Chi|dl Con n Grandchi|dl Chtiu

_o Dependent ascenden tl Cha, mg, Óng, bd siing phtt

thuQc

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36. Pface and date/ Ngdy vd noi ldm don 37. Sigrature (for minors, sigyrature of parental authority/ legalguardian)/ ChŮ b'. (DÓi vÚi ngtdi chra thdnh nién'. cdn co chťr kycua ngudi cÓ quyén nuÓi dudng/ngmJi gián hQ)

I am a aÍe that the visa fee is not 'efunded ifthe visa is íefuseď I i n,'d' th c rÓ i)n?lé phí thi thvc sě khÓng duqc h@n l4i hia don xin aip thi th|.c bi tdÍ ch i'

Appli.|ble in c.c. r multip|e{nt.y viir i8 rpplicd for (cf. Íletd No zy Tro,,g.ruvng hqp xln thi thrc ntulp cánh nhiu kin (xen m1c 24):| {m rwrr. of tbc n.cd !o hÍv rí rdcqurte trrv | med|c.| |ns lríc. Íor my first st.y 'nd rny subs{queít vilitr to Íbc t.rritory of Membcr strtcďTlit ,,tui |hk cdn lhiél pfii cÓ bao hiě,n ! tě du lich phi hgp cho lán lf l| diu lién vá nht|1a tdn luu hi rép Eo t?i lanh !h6 cdc quÍjc gn thár,h yicn'

I am &weÍe of áíd oonsent to thc fol|o$ing: lhe collection ofthe data Íequiíed by lhis application form and the t8king ofmy photogÍaph 8nd, ifapplicab|e' the tskinBofÍingeÍpťints, arc mandalory foÍ the examinalion ofthe visá applicátion; and any peÍsonaI data conceming me which appcaÍ on the visa applicdion form, ás wgl| asmy ÍingeÍp.ints and my photograph will be supplicd to the íe|eváít authorities of the Member states and processcd by those 8uthoÍities' foÍ the purpose of a decisionon my visa application.rd nhdn .kic á d ng ', ring: 'Tronqqui t'/l,1h xé, hi sd xin aip thi thlrc' ec an. cáp nhÚn{ thÓng |ih yéu'cáu trong tě ktai xin ctip thi thrc, chup ánh va tirddu win tay a|i4 t6i .|o,8 lrvŮna hqp cdn ,hié, ld bá, bu,ac: nQi thÓng tin cá nfuin ghi |ronq |d khai cang nhl. dáu in tay vá áhh aůa tÓi É dtpc chuyén dén cÁc coq&n clnic nčnq a]a aic nKic tlÚ.rh vién \0 a,qc các co q,ah náy x1r Lj, nkin nuc dbh dlm ra qqét dinh déi voi don xin aip thi tÍrc aůa tÓi.

such data as we|| as data concemin8 the decision taken on my app|ication oi a decision whether to annu|. Íevoke or extend a visa issued wi|| be entEÍed into' andstoÍcd in the visa lnfoÍmalion system (vlsxl) for a maximum peÍiod of five yeaÍs' duÍing *hich it will be accessible to the visa authorities and ihe authoÍitiescompetent for caÍrying out checks on visas ď extemal bordeÍs and within the Mcmber states. immig'ation and asy|um authorities in lhe MembéÍ statcs foÍ thepuÍposes of verirying whether tho conditions for the le8al enrry into, st]ay 6Íd Íesidence on the toÍritory ofthe MembeÍ stales aJe fu|Íi||ed' ofidentifoing persons whodo not o. who no longer fu|fil these conditions, of examining an asylum app|ication and ofdetermining responsibi|itv lbr such examination' UídeÍ ceÍtain conditionsthe data wi|| be also avai|able to desi8nated autltorities ofthe Member states ond to EuÍopot for the puťpose of the pÍevention. detection and investigalioÍ of teÍroÍiíofrences and of otheÍ seÍious cÍimina| offences- The authority of thc MembeÍ s(ate Íesponsib|e foÍ processing thc dala is: Minislry of Foreign AÍfairs. I'oretánskénáměstí 5' cZ-| l t 00 PÍaha l: DiÍccloÍate of Alien Po|ice' o|šanská 2, P'o. Box 78' cz-l30 5l PÍaha 3 and MinistÍy of the lnterioÍ, Nad Štolo\r 3' cz.17o 34Praha 7.Nhžng dÚ liéu ndy cilng nh,r nhíŽng th Lg'tin lién quan toi quytlt dinh i ddn xin crip ,hi thw aja t i hoěc lién q n tdi quya dinh hÚ bo, .hu hái hay gia h4n th!,h{c sě dwc nhéP vd ||!u rn fun{ H. |t, ng Th ng tin Th! .hlft (yt' tro,8 lhh 8Mn tái da ld 5 ,lán' Trong thoi gian nay' ac co qucn ctb tb thttt vi c-Óc co q-,co clnfu ,kdng kién |ra |hi nlc.!aI bién qih bén ngodi w ho|,8 ph4n i nÓi dia cdc nloc thanh vién cang nht aic co qufun di ,nů quan l' xuát nkip canh d ti np1d)a ažc mmc thinh,ién cÓ tM tfuy ctip các ďi liéu,d .hÓng tin l'|.| trcng I/Is nhžn nuc .lí.h: xác ninh xen clic diii kién ,h4p ia,h ,a l,* nqp p p tat cácn ic lhánh iěn cÓ dlrÝc dáp n8 har kh,ha nhin dqn7 nhhg cá hkin kh! a ho\c khdns cÓn dlip n2 dztqc nhí,ng },eu cllu dÓ' kién tm don xin ii nqn vd qllyétdinh vě |M qu,vn ,rong yiéc ké tra' Trcng nhbt{ ditu kién nfuil dinh cac cd qua,| cÓ rMn quyěn dwc chi dinh cua dic nu6c .hánh iéh vě Europol c''ng iÓ tM.n!y cdp nt.ťrng lhlinq un ě dťt liěu nay nhdn nAc dích phÓnq ch ng' pM| hťn vd d u ,ra cl'c |Ói phqn ktning bá ya các hdnh ,,i phqn tfu nguy hién líhic' čo qua,,c lfujn qu'Yn x li, di liéu a;,a ft . |funh vién Iá BÓ N+oqi qiao. Lore,insu námésli 5' Cz-I 18 (l0 P,tha l: co qwn canh sát ryoqi kiu. olšanski 2' P'o. BoX78' CZ-130 5I Praha 3 tú BÓ Nii w' Nad Štolou 3' CZ-]70 34 Pruha 7'

I am aware thal I have the right to obtain any of the Member states notiÍication of the dďa relating to me recorded in th. vls 8nd of the MembeÍ st8to hichtÍansmitted the daa and to requesl thd data Íe|aling to me which are inaccurale be corÍected .íd thď data Íelating to me processed un|autr||y be deleted' At myexpress request. the authoÍity examiíing my application $Íill inform mo of the manner in which t may cxcrcise my right to check t}e peÍsona| data conceming me8nd have them corÍected or deleted. inc|uding the related Íemedies accoÍding to lhe nation8| |8w ofthe stlte concemed' The office of PeBonal Data Proteotion ofthc czech Republic (Pplk. Sr*horu 727 D1' CZ.|70 00 PÍaha 7) will heaÍ c|aims conc.ming the pÍotection ofpcÍsonal dat..T i bÉt ri q lÓi cÓ quyán yéu cáu tat bá ai nuÚc ndo trong sá a)c nÚÚc thanh ién |h g bllo i ctic di ItQu hěn quon děn !Ói duÝc hfu lrú tong l/ls yá |énn&,c lhěhh yiěn dd truyéh các di lÉu dÓ' cfrng nht dwc qryén yéu cdu chinh gaa các db héu kh ng chinh xác lÉn quan l di nhán tÓi cli, g nht xfu các dft liéulién qwn děn l6i n,ě da bi x|t li, nél cách ph phip' Khi ! yéu Cau bdng án ban' co quan thp li, don dě ngfu cua ld se ng bdo vot 6t cách thn a1i cÓ lhělh|!ť hién quyén kién rfo aic dŮ lieu c nfuin 'lÉn quan I.JI t| yb chnh sta hay nia bÓ cking bao gin co c c phlíong |Én phdp l,,|heo tu?it pháp cua nuŮc thbnhién cÓ lién quan. Cd quan nha ntoc cÓ quyán g n sá| caa nuoc thánh ié,ldÓ sě tép nhin các khažu nq i vi(c bao rn<it thÓng M c(i nhin la-Cd quan bdo ttl'it

dfr lieu cá nh n' Pplk' Sochoru 727/27. CZ-l70 (n Praho 7'

I declarc that to the best ofmy knowledge a|| paÍicu|árs supplied by me aÍe coÍrect ond complete. I am awaÍe tiď aíy fa|se statements wi|| lcad to my appIicationbeinB Íojectď oÍ to the annulmcnt ofa visa al..ady granted and may 8lso .endeÍ mc liab|e to prosecution undeÍ the law ofthe Member staÍe which deals with tlreapplication.Tlii con doan va .á! ca.sg hiéu bÉt caa ninh rdag nhtng rh h{ rin na .d dd ctl"g crb a a,ng a dáy du' T l ' th|i|c rě |á g bá! c1i íhljn. nn k|pi ,,,an nlo ci|nPdin tbi yiéc hli so xln cdp thi w da r6i bi hr ch., hoac !h! thr da c.ip cho |tji bi tluy bo vd rlii co thé bi rruy eo lu.j| ptfuip d;!a n|fuc thanh vién th! ti h,i so'

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l undeÍtake to |eave the teÍÍitoÍy of the MembcÍ states before lhe expiry of the visa, if gÍanted' I have becn informed that possession ofa visa is on|y one of theprerequisites foÍ entry iíto lhe Europcan teÍritory ofthe Member states. Thc meÍe faot that a visa hss becn granted to me does not mean that I will be entitled tocompcnsalion if I fď| to comp|y with tie re|evsnt provisions of aÍtic|c 5(l) of Regularion (Ec) No 5622006 (schengcn Bo.ders code) ánd I am theÍefore Íet,seden!ry.-The plerequisites for entÍy wi|l be ch 4ked again oí entry into the Europe.n teÍritory of lhc MembeÍ statcs'Néu aqc.cáp lhi lhw' ld can l2l sz i kh6i ldnh.lhÓ cdc ftIÚc thánh Én |nrÚc hhi lhi rhvc.ha han' TÓ! ců g dwc cho bié, ringviQc cÓ thi tltztc chi tá ,nd tlronf.:!r8 !é'u |n.n di :M| ca t vdo ldth th6 cluiu Áu 'thuic các ftldc |hb|h ién' yiéc d$c cb .hi |h|rt t|híjng;Ó n?hta l,2 .lii áac quyin dÓi hoi bči n,o,g ,éu ibi..i: cltj: nl'1? :anh d9 kll:,ns.dtiP ng dW. cÓc diu kién néu trong l.hoán I diě,! 5 L,

'(Eqsá'56v2ofu rt,ů, nÉ, s,a ih;i;d.Ňmsi,ě, Hé;dé ,tÚp

canh sě dÚqc *ién |ra lqi khi nl4ip ca,h yáo ktnh th6 chžu Áu thu<jc cdc ruoc ,hěnh vién.

P|ace and datď Ngay vd nai ldm don Signature (for minors, signrture of parental euthority/ legalguardian)/ ChťÍ bj, (Doi vÓi ngtŮi chra thdnh nién: chfr b,, cua ngtdi cÓquyén nuÓi duÚng/ngrci sián ha)

(') In .o far as the VIS is operationa|.l Trong khi VIS hoat cÍQng

Page 4: Schengensky Formular

EMBASSY OF THE CZECH REPUBLIC IN VIETNAMopcning houN foŤ rpp|ic'tio! for scbcngcn visr: Frid.y.9!00 to 12:00

Tb€ visr foŤm ir fř...You mult submit your rpp|icrt|on rt |c.it 15 d.ys in .dv.nce to youŤ inte d€d jouřÍey. oth€rwfu.' th. EfubrsŠy docs Dot gu|nntc. thrt tbc ús. shr|| beissued in time.

KTNDLY NOTICE

. Exc-€pt foÍ visas limited to one or some ofthe MembeÍ states, lh€ visa shall be v8lid for all th€ Member states listed as follows: Germany, Austria' Belgium' spain'Finland, FÍan.€, Greece, NetheÍl.nds' lca|and, ltaly' Luxembourg, Noťway. Portugal, sw€d€n, Estonia' L,atvi4 Lithu&i8' HungaÍy, Malt4 Pol8nd. sloveni.' slovakia'czech R€pub|ic and switzerland'. App|i..ntr shr|| rpply in pcrlon at the Emb8ssy ofthe czech R€pub|ic in Haíoi'. Thc Meml'Gr strt€ compctcnt foÍ examinin8 and deciding on an appli.ation foÍ a unifoÍm visa shall be| (a) the MembeÍ state whose t€Íritory constifut€s the so|€desti.ation of the visit(s); (b) if the visit includes more thon one destinatioÍ! the Memb€Í state whm€ teÍIitory coístitutes the main destination of the visi(s) in terms ofth€ lehgth oÍ puÍposo of stay; oÍ (c) ifno main destinolion can be deteÍmined, the MembeÍ state \Yhos€ extemal border thc app|icant int€nds to cÍoss in oťdeÍ to enter thelenilory ofthe MembeÍ st8tes.

. when the app|icďion is .dmissible, the Embassy shall st|mp th6 travel documen! exoept foÍ diploÍrBtic and offici.l passpoÍts' such stamp has.o |egal implications.

. Applicďions shall b€ submitted within tb. immcdilt. 3 months to the iot.ndcd JouÍncy. As an cxc€ption' beaÍeÍs ofa multiple.€ntry visa v8lid for al l€ast ó monthsmay do it befoÍe its expiry date. In oas€ of failu'e to me€t this term the 8pp|ication shs|| not be admittod foÍ proccssing' as we|| as in th€ following cases|

+ yotr submit e non-ofricia| foÍm+ you do not aitaoh a plsspořt oÍ travel document Ýhich meets the conditions €stablish€d by schengen Re8u|ations'+ you do not attach a photogaph which meets tbe conditions €st5b|ish€d by schengen RegulatioÍls'+ you fail !o pay the visa fee.

The f.c for proc.sďng r vi3r fal|s due upon admitting the app|ication t]o b€ pťocess€d and Ýi|l not be Íefi,nded exc€pt in case that it weÍe not admittď !o be p.ocessedin accordelce to lhe pÍevious paragÍaph oÍ ifthe Embossy weÍe not compete to deal with it' visa fee foí a scheng€n visa is EURo ó0.-; children fŤom 6 and b€low 12y€aÍs o|d shall pay a fee ofEURo 35,-'The visa proccssing is Íie€ foÍ holdeÍs of dip|omatic passports in any case. and ofofncial passpoÍts when on officiaI pu.pos€ tsip' chi|dÍen undeÍ six y€ars' school pupi|s'students, postgraduď. sfudcnts artd acoompanying teacheÍs who undenake stays foÍ the puÍpose of sfudy or educďional rainin& sci€ntists on Íes€aÍch projects asdeÍined in Recommendďon No 2005'6|/Ec of the EuÍopean PaÍliament and of the Counci! of 28 September 2005' repÍesentativ€s of NGos aged up to 25 whencnrolled on s6minaÍs' conferences or spoťtive, cu|fural oÍ educational ev€nts organised b} N6os.

vietnamese citizens sÍe subject to prioř consultrtion b€fore being gř6íted the visa' |n the event ofa refus.|. the .easons on which it is based .hrll be Íotiticd to you byme8ns ofa standard foÍm' AfreÍ Í€ceiving youÍ visa' kindly vcrify thrt the informltion on your visr stickcr is correct.

You can Íind otbcr relevrnt iníorm.tiol oÍl visa ríd immigation mďleÍs at the website ofúe Ministn ofForeim A|Ťairs ofthe cz€ch Reoublic| \\\\ n]li ť/

D+I sÚQUÁN coNG HÓA sÉc T4,I \'I!T NAMciú mi' cúr cho vk. scbgtg.j: Tbú sóu' o9:0G'| 2:00

Tč th.| !h dD tbi tbFc ituýc pbát mÉn phiHó 3d xin thi thvc pbi| itÚťt íop ít ||hól 15 ng.y tnrÚt chuyéí dl TmÍg tnrŮlg hq'D nguýc qt, Dli sú qurn knóng itfun bóo vi.c lhi thEc ituqc dp |túng h{n.

LLfu Ý:-T rucácú i l hvcc óhÉu]ucg i Óhqnchomr thoácmó t ! á |quóCg|aůánhv |ěn .ú i thucsěCóhÉu luccho l á l c á cacquo(g l a thanh t |énbaogóm 'D] . c .Ao .B i . I ayBanNha"Phántan'Pháp'Hyláp'HáLan,Ai-xo.|en'I- la.||-aLuc.xám-bua"NaUy.BóDáoNhaThuyDién.E-xlÓ.n|.a.Lál-vt-a.Lit.va.Hung.ga-Íi.Man-t4Balva.k|.a, cÓng hóa séc vá T}tgy si'. NguŮt n thi thvc phii .řtt dép it.n íop bó !d Bi DBi sú qún cong hóa séc tai Há Noi.- o . gh tbttrb vitn có cbih nlng xem xét vá drra ra quyét ainn aol lci don \in cáp úi thur schengen la (a' ouoc gia lhanh v|én lá dich dén du} nhát cua todn bo chuyén di:(b) nšu Eong chuyén di.co nhicv hon mot dlém dén. Quóc gia thanh v'čn lá diém dén chlnh cúa chu)čn dI \et vě mál thol g|an hoác muc dlch |Úu tÍu: hoéc (c) lrong Eučn8 hopkhóng xác dinh duoc diěm dén chính, Quóc gia {hánh vién md ngÚdi xin thi thuc dlt dinh nháp cánh dáu t'én dé váo tanh thó oíc quóc gia thánh vien'. Khi hó so xin c,1ip tbi tltvc duqc cháp nhán' Dgi sú quán sě i'ó!g d{u váo ho chiéu/ Biáy tb thón8 hánh. tru cac truong hop Ínang ho ch|éu ngoai giao ve m chéu óng v9' Dáu náykhóng có tlnh pháp Iý'. Hó so xin cáp th| thuc phái dÚ$ nop trotr8 kbďn8 thť|.gt.n 3 tň{íg truÚt chuyén it|' Riéng vÓi !rudng hqp nhúng ngudi có thi thuc nháp cónh nhiéu Én vú thdi han tů ólhán8 tÍÚ |én có thé nop hó 50 tÍurc khi thi th{c hét han Hó so xin cap úi thýc sč khóng dÚoc chap nhán xét duyet néu khóng dáp llng diéu kicn nói tÉn ho4c Íoi váo mot tÍongnhilng tručng hgp sau:

+ Don xin cáp thi úuc khóng dúng máu'+ Khóng cÓ h0 chiéU ho& giáy td úóng hánh hqp |é theo Quy ché sch€ngen'+ Ánh dinh kěrn khÓng dúng quy dinh dugc d{t ra tÍong Quy ché schengen'+ Khóng thánh toán 1e phí thi thvc.

|-{ pbí xét duy$ thi th|It sě duq( llnh khi nh{Í hó so vi sě khónB duvc hoěn !rá tÍů phi hó so khóng duoc cháp nhán xét duyet nhu dá néu tÍén bo{c hó so khóng thuoc th,mquyén \ét duyeÍ cúa Dai su quán Leph|thiúW|áó0EURo:|éphithith{cd6iv&tÍéemtÚ6den|2tuó|lá35EURo'các trudng hgp sau duqc Íniěn té phl xét duylt thi lhuc:

Nguťi Ínang ho chiéu ngo{i giao, hoěc ngudi mang ho chiéu cóng W di cóng tá..TŤč 9m duói ó tuói'Hoc sinh' sinh vién, sinh vién cao hqc vá giáo vien di kéÍn xin thi lhvc luu tÍti vri muc dicb hqc táp hoě'c dáo tao.các nhd knoa hac thuoc các du án nghi€n cúu theo Khuyén nghi só 2oo5,ó | ,Ec cúa NBhi vién cMu Áu vá Hoi dting ngáy 28 tMng 09 nňm 2oo5Ngudi tů 25 tuói tsÚ xuóng lá thánh pben ťlam dv các cuoc xé-m!na' hoi tháo ho{c các sv kien thé thao' \án hóa' giáo duc do các tó chúc phi chính phú tó ohúc.

cóng dán Viet Nďn phái qua thů qrc ThrrD vóÍ truÓc khi duqc cáp thi thvc TloÍg trudne hop b| tů ctói, |ý do khién rÍon xin cáp thi tbpc bi tů chói 3! dÚvt thóng bóo lheo máuchinh thuc' Khi nhán thi thvc' Ýui lrng }iénr trr .g cbính úc cúr C'c tbóng m tr.n tu rtrró'Có thc xem thtm dc tMn8 t|Í I.}{c ó li.n qu.n tói các vlin dé vě thi thvc vá d| tru trén trang w€b cůs Bo Ngoai giao có' ng hÓa séc úeo dia chi: httlr ]\\ \\ \\ nll! v