Application for Schengen Visa Aplikacioni për Schengen ...

1 1 Application for Schengen VisaAplikacioni p r Schengen Viz PHOTOFOTOFOR OFFICIAL USE ONLY /VET M P R P RDORIMZYRTARDate of Application : visa Application number: Application lodged atEmbassy/consulateCACS ervice providerCommercial intermediaryBorderName:OtherFile handled by:Supporting documents:Travel documentMeans of subsistenceInvitationMeans of transportTMIO ther: visa decision:RefusedIssued:ACVTLV alid:FromUntilNumber of entries:12 MultipleNumber of days: / Profesioni aktual* 19. Current occupation1. Surname (Family name) (x)/ Mbiemri2. Surname at birth (Former family name(s)) (x)/Mbiemri i lindjes, (mbiemri i m parsh m,) (x)3. First name(s) (Given name(s)) (x)/ Emri (x)4. Date of birth (day-month-year) /Dat lindja (dita-muaji-viti)5. Place of birth/ Vendi i lindjes6.

2 Country of birth/ Shteti i nationality/ Shtet sia aktualeNationality at birth, if different /Shtet sia fillestare, n se tjet r8. Sex/ Gjinia MaleFemale/ Mashkullore/ Fem rore9. Marital status/ Statusi martesor SingleMarriedSeparatedDivorcedWidow(er)O ther (please specify)/ I, e pamartuar/ I, e martuar/ I, e ndar / I, e divorcuar/ I, e ve/ Tjet r (ju lutem specifikoni)10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parentalauthority/legal guardian/ N rastin e t miturve: Mbiemri, emri, adresa (n se dallon nga ajo e aplikuesit) dheshtet sia e autoritetit prind ror/kujdestari ligjor:11. National identity number, where applicable/ Numri personal i let rnjoftimit, aty ky aplikohet12. Type of travel document/ Lloji i dokumentit t udh timit Ordinary passportDiplomatic passportService passportOfficial passportSpecial passportOther travel document (please specify)/ Pasaport e zakonshme/ Pasaport diplomatike/Pasaport sh rbimi/Pasaport zyrtare/Pasaport speciale/ Tjet r dokument udh timi (ju lutem specifikoni13.)

3 Number of travel document /Numri i dokumentit t udh timit14. Date of issue /Data e l shimit15. Valid until /E vlefshme deri m 16. Issued by/ L shuar nga17. Applicant's home address and e-mail address /Adresa e sht pis dhe email adresa e aplikuesitTelephone number(s) /Numri/numrat e telefonit18. Residence in a country other than the country of current nationality/Banim n nj shtet tjet r p rve shtetit t shtet sis aktuale NoYes. Residence permit or equivalent/ JoPo. Leje q ndrimi apo ekuivalente ..NoValid until/ Jo..E vlefshme deri m */ * Pyetjet t cilat jan t sh nuara me * nuk duhet t p rgjigjen nga familiar t e shtetasve nga Bashkimit Evropian (BE) ose ngaZona Ekonomike Evropiane (ZZE) ose shtetasit e Zvicr s (CH) (bashk shorti / bashk shortja, f mija, prindi ose gjyshi/gjyshja i/e varur (ekonomikisht)nga personi ftues) p rderis kan d drejt n e l vizjes s lir.

4 Familiar t e shteteve t BE-s , ZEE-s dhe Zvicr s duhet ta d shmojn lidhjen farefisnoreme an t dokumenteve n pikat 34 dhe 35.(x). / (x) Pikat 1-3 duhet t plot sohen n baz t t dh nave n dokumentin e udh fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) whileexercising their right to free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill infields no 34 and 1-3 shall be filled in accordance with the data in the travel documentThis Application form is freeKy aplikacion jepet falas* Emri, adresa dhe numri i telefonit t student , emri dhe adresa einstitucionit arsimor:Employer and employer's address and telephone number.

5 For students, name and address of educationalestablishmentё unёdhёPёё Q llimi/q llimet i/e udh timitMain purpose(s) of the journey TourismBusinessVisiting family or friendsCulturalSportsOfficial visitMedical reasonsStudyTransitAirport transitOther (please specify)/ Turiz m/Biznes/ Vizit tek familja ose miqt / Kultur / Sport/ Vizit zyrtare/ Arsye sh ndet sore/ Studime/ Tranzit/ Tranzit aeroporti/ Tjet r (ju lutem specifikoni) n shtetin an tar/shtetet an tare:Member State(s) of destination e pare n shtetin an tar/shtetet an tare:Member State of first entry* The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) whileexercising their right to free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fillin fields no 34 and * Pyetjet t cilat jan t sh nuara me * nuk duhet t p rgjigjen nga familiar t e shtetasve nga Bashkimit Evropian (BE) ose ngaZona Ekonomike Evropiane (ZZE) ose shtetasit e Zvicr s (CH) (bashk shorti / bashk shortja, f mija, prindi ose gjyshi/gjyshja i/e varur (ekonomikisht)nga personi ftues) p rderis kan d drejt n e l vizjes s lir.

6 Familiar t e shteteve t BE-s ZEE-s dhe Zvicr s duhet ta d shmojn lidhjen farefisnoreme an t dokumenteve n pikat 34 dhe i hyrjeve t k rkuara/ Nj hyrje/ Dy hyrje/ Disa hyrjeNumber of entries requestedSingle entryTwo entriesMultiple entries zgjatja e q ndrimit ose tranzitit/ Numri i dit veDuration of the intended stay or transitIndicate number of Shenjat e gishtrinj ve t marra m her t me q llim aplikimi p r viz Schengen / Jo/ Data, n se dihetFingerprints collected previously for the purpose of applying for a Schengen visaNoYes. Date, if known Leja e hyrjes p r shtetin final t destinimit, atyku aplikohet/ L shuar nga ../ E vlefshme deri ../deri ..Entry permit for the final country of destination, where applicableIssued byValid e planifikuar e largimit nga zona e Schengen -itIntended date of departure from the Schengen areaTelephone and telefax/Telefoni dhe Viza Schengen t dh na gjat tri viteve t fundit/ to.

7 /Po. Data(t) e vlefshm ris visas issued during the past three yearsNoYes. Date(s) of validity from Address and e-mail address of inviting person(s)/hotel(s)/temporaryaccommodatio n(s)/ Adresa dhe email adresa eftuesit/hotelit(hoteleve)/akomodimit(ak omodimeve) t p rkohsh m (p rkohshme)* Mbiemri dhe emri i ftuesit n shtetin an tar/shtetet an rast se nuk b het fjal p r k t : emri i hotelit ose adresa e p rkohshme n shtetin an tar/shtetet an tare:Surname and first name of the inviting person(s) in the Member State(s). If not applicable, name of hotel(s) ortemporary accommodation(s) in the Member State(s) e planifikuar e arritjes n zon n e Schengen -itIntended date of arrival in the Schengen area /2 The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) whileexercising their right to free movement.

8 Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill infields no 34 and 35. /* Pyetjet t cilat jan t sh nuara me * nuk duhet t p rgjigjen nga familiar t e shtetasve nga Bashkimit Evropian (BE) ose ngaZona Ekonomike Evropiane (ZZE) ose shtetasit e Zvicr s (CH) (bashk shorti / bashk shortja, f mija, prindi ose gjyshi/gjyshja i/e varur (ekonomikisht)nga personi ftues) p rderis kan d drejt n e l vizjes s lir . Familiar t e shteteve t BE-s , ZEE-s dhe Zvicr s duhet ta d shmojn lidhjen farefisnoreme an t dokumenteve n pikat 34 dhe 35.* dhe adresa e kompanis /organizat s ftuese:Name and address of inviting company/organisationTelephone and telefax ofcompany/organisation/ Telefoni dhefaksi i kompanis /organizat s ftueseSurname, first name, address, telephone, telefax, and e-mail address of contact person in company/organisation/Mbiemri, emri, adresa, telefoni, faksi dhe email adresa e personit kontaktues n kompanin /organizat n ftuese:* Shpenzimet e udh timit dhe t tjerat gjat q ndrimit t aplikuesit jan t mbuluara nga.

9 Cost of travelling and living during the applicant's stay is covered/nga aplikuesi/aplikuesja by the applicant himself/herselfMeans of supportCashTraveller's chequeCredit cardPre-paid accommodationPre-paid transport/ Mb shtetja financiare/ Para n dor s / eqe udh timi/ Kredit kartel / Akomodimi i para-paguar/ Transporti i para-paguar by a sponsor (host, company, organisation), pleasespecifyreferred to in field 31 or 32other (please specify)Means of supportCashAccommodation providedAll expenses covered during the stayPre-paid transportOther (please specify/ nga sponsori (kompania, organizata) ju t dh nat n pikat 31 dhe 32/ tjet r (ju lutem specifikoni)/ Mb shtetja financiare/ Para n dor / Akomodimi i siguruar/T gjitha shpenzimet e mbuluara gjat q ndrimit/ Transporti i para-paguar) / Tjet r (ju lutem specifikoni)34.

10 Personal data of the family member who is an EU, EEA or CH citizen/ T dh nat personale t familjarit i/e cili/a sht shtetas/e i/e BE-s , ZEE-s ose Zvicr MbiemriFirst name(s)/ Emri/emratDate of birth/ Data e lindjesNationality / Shtet siaNumber of travel document or ID cardNumri i dokumentit t udh timit apokart s s identitetit35. Family relationship with an EU, EEA or CH citizen/ Lidhja farefisnore me nj shtetas t BE-s , ZEE-s ose Zvicr s spousechildgrandchilddependent ascendant/ bashk short/e ../ f mij ../ nip/mbes ../ prind ose gjyshi/gjyshe i,e varu36. Place and date/ Data dhe vendi37. Signature (for minors, signature of parentalauthority/legal guardian) / N nshkrimi (p r t miturit, n nshkrimi i autoritetit prindor/kujdestariligjor)I am aware that the visa fee is not refunded if the visa is refused/ Un jam i/e vet dijsh m/vet dijshme q pagesa e viz s nuk kompenzohet nese vizarefuzohetApplicable in case a multiple-entry visa is applied for (cf.)