VURN: VPJEDVXAOG

Harmonised application form

Application for Schengen Visa
Photo
This application form is free

(1)
Family members of EU, EEA or CH citizens or of UK nationals who are Withdrawal Agreement beneficiaries shall not fill in
fields no. 21, 22, 30, 31 and 32 (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

MENKOUR
Date of application:
2. Surname at birth (Former family name(s)):
MENKOUR Application number:

3. First name(s) (Given name(s)):

Application lodged at:
MOUFIDA ☐ Embassy/consulate
4. Date of birth 5. Place of birth: 6. Country of birth: ☐ Service Provider
(day-month-year): MAKOUDA ALGERIA ☐ Commercial intermediary
01-01-1989 ☐ Border (Name):
____________
7. Current nationality: Nationality at birth, if different:
____________
ALGERIA ☐ Other:
Other nationalities:
File handled by:

8. Sex: 9. Civil status: Supporting documents:

☐ Male ☒ Single ☐ Divorced ☐ Travel document
☒ Female ☐ Married ☐ Widow Or Widower ☐ Means of subsistence
☐ Invitation
☐ Registered Partnership ☐ Other (please specify):
☐ TMI
☐ Separated
☐ Means of transport
10. Parental authority (in case of minors) / legal guardian (surname, first name, address, if different from applicant’s, ☐ Other:
telephone no., e-mail address, and nationality):
Visa decision:
11. National identity number, where applicable: ☐ Refused
119890492000010009 ☐ Issued
12. Type of travel document: ☐ A
☒ Ordinary passport ☐ Diplomatic passport ☐ Service passport ☐ Official passport ☐ Special passport ☐ C
☐ LTV
☐ Other travel document (please specify):
☐ Valid:
13. Number of travel 14. Date of issue: 15. Valid until: 16. Issued by (country):
document: 08-08-2019 07-08-2029 ALGERIA From:
197248359
Until:
17. Personal data of the family member who is an EU, EEA or CH citizen or a UK national who is a Withdrawal
Agreement beneficiary, if applicable
Number of entries:
Surname (Family name): First name(s) (Given name(s)): ☐ 1 ☐ 2 ☐ Multiple

Date of birth Nationality: Number of travel document or ID card: Number of days:

(day-month-year):

18. Family relationship with an EU, EEA or CH citizen or a UK national who is a Withdrawal Agreement beneficiary, if
applicable:
☐ Spouse ☐ Child ☐ Grandchild ☐ Dependent ascendant ☐ Registered partnership
☐ Other:

19. Applicant’s home address and e-mail address: Telephone no.:

VILLAGE SEMGHOUNE, 15041 MAKOUDA, ALGERIA +213549738072

MOUFIDAMENKOUR3@GMAIL.COM

(1) No logo is required for Norway, Iceland, Liechtenstein and Switzerland. 1/3
20. Residence in a country other than the country of current nationality:
☒ No No. Valid until
☐ Yes. Residence permit or equivalent

*21. Current occupation:

Teacher
*22. Employer and employer’s address and telephone number. For students, name and address of educational establishment:
DIRECTION EDUCATION TIZI OUZOU RUE KERRAD RACHID
026121342 15000 TIZI OUZOU
ALGERIA
23. Purpose(s) of the journey:
☒ Tourism ☐ Business ☐ Visiting family or friends ☐ Cultural ☐ Official visit ☐ Medical reasons ☐ Sports ☐ Study ☐ Airport transit
☐ Other (please specify):

24. Additional information on purpose of stay:

25. Member State of main destination (and other Member States of destination, if applicable): 26. Member State of first entry:
Finland Finland
27. Number of entries requested:
☒ Single entry ☐ Two entries ☐ Multiple entries

Intended date of arrival of the first intended stay in the Schengen area: Intended date of departure from the Schengen area after the first intended
01-08-2024 stay:
10-08-2024
28. Fingerprints collected previously for the purpose of applying for a Schengen visa:
☒ No ☐ Yes Date, if known Visa sticker number, if known

29. Entry permit for the final country of destination, where applicable:
Issued by Valid from until

*30. 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):
HÔTEL CLARION HELSINKI
Address and e-mail address of inviting person(s)/hotel(s)/temporary accommodation(s): Telephone no.:
RUE DU PACIFIQUE 2, 00220 HELSINKI, FINLAND, RESERVATIONS.CL. +358934174551
HELSINKI@STRAWBERRY.FI
*31. Name and address of inviting company/organisation:

Surname, first name, address, telephone no., and e-mail address of contact person in company/organisation:

Telephone no. of company/organisation:

*32. Cost of travelling and living during the applicant’s stay is covered:

☒ by the applicant himself/herself ☐ by a sponsor (host, company, organisation), please specify:

☐ referred to in field 30 or 31
Means of support:
☐ other (please specify):
☒ Cash
☐ Traveller's cheques Means of support:
☐ Credit card ☐ Cash
☐ Prepaid accommodation ☐ Accommodation provided
☐ Prepaid transport ☐ All expenses covered during the stay
☐ Other (please specify): ☐ Prepaid transport
☐ Other (please specify):

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I am aware that the visa fee is not refunded if the visa is refused.

Applicable in case a multiple-entry visa is applied for:

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.

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 application; and any personal data concerning me which appear on the
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 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) 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: The Ministry for Foreign Affairs of Finland.

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
Member State concerned. The national supervisory authority of that Member State [contact details: The Office of the Data Protection Ombudsman in
Finland (www.tietosuoja.fi/en)] 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 6(1) of Regulation (EU) No 2016/399 (Schengen Borders
Code) and I am therefore refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Member States.

Place and date: Signature:

(signature of parental authority/legal guardian, if applicable):

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Tourism / Family or Friend visit / Other - Tourisme / Familiale, amicale / Autre Tourisme / Visite familiale, amicale / Autre

⚠ Missing documents may negatively affect the visa decision. For official use only
☒ Yes ☐ No Visa application form with a photograph ☐ Pending
Schengen visa application form shall be duly completed, dated and signed by the applicant. Please check the visa application photo
requirements on the website https://www.icao.int/Security/mrtd/Downloads/Technical%20Reports/Annex_A-Photograph_Guidelines.pdf.

Formulaire de demande de visa avec photo

Le formulaire de demande de visa Schengen doit être dûment complété, daté et signé par le demandeur. Pour voir les spécifications des
photos de la demande de visa, veuillez cliquer ici https://www.icao.int/Security/mrtd/Downloads/Technical%20Reports/Annex_A-
Photograph_Guidelines.pdf.
☒ Yes ☐ No Travel document ☐ Pending
The travel document must be valid for a minimum of three (3) months after the planned journey, issued within the previous 10 years and
have at least two (2) blank pages.

Copy of the information page of the passport and copies of any pages with markings on them, e.g. previous Schengen visas, arrival and
departure stamps, etc.

Le document de voyage
Le passeport doit être valable au moins 3 mois après le voyage prévu. Le passeport doit avoir été délivré au cours des 10 dernières années et
doit avoir au moins deux feuillets vierges.

Copie de la première page du passeport et de toutes autres pages marquées, par exemple les copies des éventuels visas Schengen (valables et
périmés) et cachets de départs et retours.
☒ Yes ☐ No Travel medical insurance ☐ Pending
Travel medical insurance must be valid for the duration of travel and cover the entire Schengen area. An applicant for a multiple-entry visa
may provide an insurance policy, which is valid during the first trip. The minimum coverage of the policy must be 30 000 (thirty thousand)
euros. The policy has to cover costs in case of sudden illness or accident and assistance on site, including the costs of medical repatriation to
the place of permanent residence of the insured person or the repatriation in case of death.

Assurance de voyage maladie

L'assurance de voyage maladie doit être valable pour la durée du voyage et couvrir l'ensemble de l'espace Schengen. Un demandeur de visa à
entrées multiples peut fournir une police d'assurance, qui est valable lors du premier voyage. La couverture minimale du contrat doit être de
30 000 (trente mille) euros. La police doit couvrir les frais en cas de maladie soudaine ou d'accident et d'assistance sur place, y compris les
frais de rapatriement sanitaire jusqu'au lieu de résidence permanente de l'assuré ou le rapatriement en cas de décès.
☒ Yes ☐ No Proof of accommodation ☐ Pending
A hotel reservation or other proof of accommodation, for ex. Invitation letter

Preuve d'hébergement
Réservation d’hôtel ou preuve d’autre type d’hébergement par ex. lettre d'invitation
☐ Yes ☒ No Invitation letter ☐ Pending
Invitation letter by the host written in English, Finnish, Swedish or French:
- dated and signed by the host
- specifying the purpose and duration of the visit
- including details of the inviting and invited person
- specifying the nature of the relation: friend/spouse/family member
- copy of the Finnish passport or copy of valid residence permit and passport of the host

If necessary, a proof of sponsorship with its attachments: https://um.fi/documents/35732/0/yll%C3%A4pitositoumus_eng.pdf/a31ab357-

3926-6007-a21a-67e640e06829?t=1704706041856

Lettre d'invitation en anglais, finnois, suédois ou français:

- datée et signée par l'hôte
- précisant l'objet de voyage et les dates de la visite
- noms et prénoms des personnes invitées et d'hôte
- précisant la nature de la relation:ami/conjoint/ membre de la famille
- copie du passeport finlandais ou de la carte de résidence valable et copie du passeport d'hôte

Le cas échéant, une preuve de prise en charge avec les pièces jointes: https://um.fi/documents/35732/0/yll%C3%A4pitositoumus_eng.pdf
/a31ab357-3926-6007-a21a-67e640e06829?t=1704706041856

APPLICATION ID: VPJEDVXAOG APPLICANT: MENKOUR MOUFIDA 1/4

☐ Yes ☒ No Proof of family tie ☐ Pending
Certificate of the Algerian population register that proves family ties

Proof of being a family member of a Finnish citizen

Spouse/Partner
- marriage certificate and extract from the Finnish DVV
- other proof of being a family member of a Finnish citizen

Minors
- birth certificate
- court decision of the custody

Preuve de lien familial

Fiche familial algérien qui prouve le lien de parenté

Preuve d’être en membre de famille d’un citoyen finlandais

Conjoint/partenaire
- certificat de mariage et extrait du registre DVV
- autres preuves d’être un membre de la famille d’un citoyen finlandais

Mineur
- acte de naissance
- décision de justice de la garde à vue
☒ Yes ☐ No Proof of employment ☐ Pending
Employee:
- Work certificate or recent contract of employment
- Pay slips for the last 3 months
- Certificate of social security, CNAS or explicative letter from employer
Self-employed / Entrepreneur:
- Recent company registration
- Certificate of social security CASNOS
Farmer:
- Certificate of agricultural entrepreneur
- Professional agricultural card

Preuve d'emploi
Salarié/Fonctionnaire:
- Attestation de travail ou contrat de travail récent
- 3 derniers bulletins de salaire
- Attestation d'affiliation à la CNAS ou lettre explicative de l'employeur
Commerçant:
- Registre de commerce récent
- Attestation d'affiliation à la CASNOS
Agriculteur:
- Attestation d'exploitant agricole
- Carte agriculteur

APPLICATION ID: VPJEDVXAOG APPLICANT: MENKOUR MOUFIDA 2/4

☒ Yes ☐ No Proof of financial means ☐ Pending
Employee:
- Algerian bank statement for the past 3 months
Self-employed / Entrepreneur:
- Company’s bank statement or personal bank statement covering the last 3 months
- Form C20, that proves the turnover and financial statement of the company
Farmers:
- Declaration of annual income
Persons with no occupation:
- Proof of socioeconomical situation of the person who supports you financially; work contract, pay slips for the past 3 months, bank
statement for the past 6 months and certificate of social security, certificate of the Algerian population register that proves family ties
Students:
- Proof of parent's income (work contract, pay slips for the past 3 months, bank statement for the past 3 months and social security
certificate, certificate of the Algerian population register that proves family ties)
Pensioners:
- Bank statement for the past 3 months of the account where the pension is paid into
Minors:
- Parent's income; work contract, pay slips for the past 3 months, bank statement for the past 3 months and social security certificate,
certificate of the Algerian population register that proves family ties

Preuve de moyens financiers

Salarié/Fonctionnaire:
- Relevé d'un compte bancaire en Algérie des 3 derniers mois
Commerçant:
- Extrait bancaire de l’entreprise ou compte personnel des 3 derniers mois
- Formulaire C20 mentionnant le chiffre d'affaires et le bilan
Agriculteur:
- Dernière déclaration du revenu annuel
Personnes sans emploi:
- Preuves d'une situation socioéconomique de la personne qui vous soutient; attestation de travail, bulletin de salaire de 3 derniers mois,
extrait bancaire des 6 derniers mois, attestation d'affiliation CNAS, fiche familiale qui preuve le lien de parenté
Etudiant(e)/élève:
- Déclaration des revenus des parents (attestation de travail, bulletin de salaire de 3 derniers mois, extrait bancaire des 3 derniers mois,
attestation d'affiliation CNAS, fiche familiale qui preuve le lien de parenté)
Retraité(e):
- Extrait bancaire des 3 derniers mois du compte où la pension est versée
Mineurs:
- Déclaration des revenus des parents; attestation de travail, bulletin de salaire de 3 derniers mois, extrait bancaire des 3 derniers mois,
attestation d'affiliation CNAS, fiche familiale qui preuve le lien de parenté

For information:
- A bank statement of more than one account can be presented
- Provided bank statements cannot be more than 5 days old
- The bank statement should bear the applicant’s name

Pour information:
- L'extrait bancaire de plus d’un compte peut être présenté
- Les extraits bancaires fournis ne peuvent pas être datés de plus de 5 jours
- La déclaration bancaire doit porter le nom du demandeur
☐ Yes ☒ No Proof of studies ☐ Pending
School certificate

Preuve d'études
Certificat de scolarité
☐ Yes ☒ No Proof of pension ☐ Pending
Proof of pension

Preuve de pension
Attestation de perception d'une pension de retraite
☐ Yes ☒ No Other additional documents ☐ Pending
Travel programme:
- Document indicating the itinerary and the purpose of the trip or confirmation of the reservation of an organized trip

Other possible documents considered necessary by the applicant

Programme de voyage :
- Document indiquant l'itinéraire et le but du voyage ou confirmation de la réservation d'un voyage organisé

Autres documents supplémentaires

Autres documents éventuels jugés nécessaires par le demandeur
☐ Yes ☒ No Documents for third country citizens ☐ Pending
Copy of the permanent residence card (valid for at least 3 months after the visa expiry date) if you are not Algerian.

Documents pour les ressortissants de pays tiers

Copie de la carte de séjour permanent (valable au minimum 3 mois après l’expiration du visa demandé) si vous n’êtes pas algérien.

APPLICATION ID: VPJEDVXAOG APPLICANT: MENKOUR MOUFIDA 3/4

☐ Yes ☒ No Request for visa revocation ☐ Pending
Request for visa revocation is added at the Visa Application Centre, if needed.

La demande de révocation de visa est ajoutée au Centre de demande de visa, si nécessaire.

☐ Yes ☒ No Other submission documents ☐ Pending
Other submission documents are added at the Visa Application Centre, if needed.

D'autres documents de soumission sont ajoutés au Centre de demande de visa, si nécessaire.

Signatures
I have understood that I (or my authorised representative) have to submit the above-mentioned documents to the Visa Application Centre. By
signing this form, I hereby confirm that all the information stated in the documentation is true.
J'ai compris que moi (ou mon représentant autorisé) dois soumettre les documents susmentionnés au Centre de demande de visa. En signant
ce formulaire, je confirme par la présente que toutes les informations indiquées dans la documentation sont vraies.

Signature of the applicant / representative of the applicant

Signature du demandeur / représentant du demandeur

For official use only (at the Visa Application Centre)

Pour usage officiel uniquement (au Centre de demande de visa)

☐ I have understood that I have to submit the above-mentioned missing documents to the Embassy of Finland by the date mentioned
above. If I do not submit the documents by the date mentioned above, I accept by signing this form that the visa application will be
examined without the requested documents and that the decision may be to my disadvantage.
J'ai compris que je dois soumettre les documents manquants mentionnés ci-dessus à l’ambassade de Finlande de demande de visa
avant la date mentionnée. Si je ne soumets pas les documents à la date mentionnée ci-dessus, j'accepte en signant ce formulaire que la
demande de visa sera examinée sans les documents demandés et que la décision pourra être à mon désavantage.

☐ I do not intend to submit the above-mentioned missing documents to the Embassy of Finland. I accept by signing this form that the
visa application will be examined without the requested documents and that the decision may be to my disadvantage.
Je n'ai pas l'intention de soumettre les documents manquants mentionnés ci-dessus à l’ambassade de Finlande de demande de visa.
J'accepte en signant ce formulaire que la demande de visa sera examinée sans les documents demandés et que la décision pourra être
en ma défaveur.

Signature of the applicant / representative of the applicant Signature of the submission officer
Signature du demandeur / représentant du demandeur

APPLICATION ID: VPJEDVXAOG APPLICANT: MENKOUR MOUFIDA 4/4