Federal Department of Justice and Police

Online visa system

Application for Schengen Visa

This application form is free of charge

Online ID 000922824

For official use only

Date of application : Supporting documents :
Visa application number : Travel document
File handled by : Means of subsistence
Visa decision : Invitation
Issued C LTV A Means of transport
Refused Travel medical insurance
Valid from : until: Other
Number of 1 2 Multiple Number of days :
entries :

Personal data of the applicant

Surname (Family name) Gebregziabiher First name(s) Yibel
Surname at birth
Date of birth (dd.mm.yyyy) 07.06.1972 Minor No
Country of birth Ethiopia Place of birth Addis Ababa
Current nationality Ethiopia Nationality at birth Ethiopia
Other nationalities
Gender Male
Marital status Married Further information (marital
status)
National identity number
Family relationship with an No Guardian No
EU, EEA or CH citizen

Travel document of the applicant

Type of travel document Passport Further information (travel
document)
Travel document number EP6524612 Issued by Ethiopia
Date of issue (dd.mm.yyyy) 11.06.2021 Valid until (dd.mm.yyyy) 10.06.2026

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Home address of the applicant
Additional address c/o
Street / No. Bole Sub-city, CMC, Woreda P.O. Box / P.O. Box No.
8, House No. 03
Postcode ZIP / Place 0000 Addis Ababa Canton / region
Country Ethiopia
E-mail yibel.haileselassie@gmail.com
Number +251911190164 / Mobile phone

Residence regulations of the applicant

Residence regulations in No
other State
Residence permit no. Valid until (dd.mm.yyyy)

Occupation of the applicant

Occupation Company executive Further information
(occupation)

Information on the employer and/or training facility of the applicant

Information on the Employer Name (s) ZAK Manufacturing and
employer/training facility Trading Plc (SAMANU)
Additional address c/o Bole Road, Noah Plaza (Next
to Alem Cinema), 11th Floor
Street / No. Bole Road P.O. Box / P.O. Box No.
Postcode ZIP / Place 0000 Addis Ababa Canton / region
Country Ethiopia
E-mail contact@samanu.com
Number +251116673329 / Office

Planned travel
Purpose of the journey Visit to family or friends
Additional information
Member State of destination Switzerland State of first entry in the Germany
/ Main purpose of the Schengen area
journey
Number of entries MULT
Length of stay in days 32 Arrival date (dd.mm.yyyy) 01.07.2024
Departure date 01.08.2024
(dd.mm.yyyy)

Previous Schengen visas

Fingerprints previously No
recorded
Recording date, if known Visa sticker number
(dd.mm.yyyy)

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Entry permit
Issued by
Valid from (dd.mm.yyyy) Valid until (dd.mm.yyyy)

Information on host and/or accommodation

Inviting person
Surname(s) Ruch First name(s) Kurt
Surname(s) of the contact Ruch First name(s) of the contact Kurt
person person
Additional address c/o
Street / No. Gummenholzweg 33a P.O. Box / P.O. Box No.
Postcode ZIP / Place 3173 Oberwangen b. Bern Canton / region
Country Switzerland
E-mail emebetruch@gmail.com
Number +041 0796 518103 / Mobile phone

Travel and living expenses

By the applicant himself / herself

Cash No Credit card No

Traveller's cheques No Prepaid accommodation No
Transport prepaid Yes Other No

By a host (referred to in field 31 or 32)

Cash No Accommodation provided No

All expenses covered Yes Transport prepaid No
during the stay
Other No

Other

Cash No Accommodation provided No

All expenses covered No Transport prepaid No
during the stay
Other No

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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 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) 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 State
Secretariat for Migration SEM.
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 (Federal Data Protection and Information Commissioner PDPIC, Feldeggweg 1, 3003 Bern) 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.

Place, date Signature

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