Harmonised application form PHOTO

Application for Schengen Visa 3.50cm x 4.50cm

This application form is free

Family members of the 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

RANA Date of application:

2. Surname at birth (Former family name(s)):
Application number:

3. First name(s) (Given name(s)): Application lodged at:

AKASH □Embassy/consulate
4. Date of birth (day-month-year): 5. Place of birth: 7.Current nationality: □ Service provider
14-01-2001 INDIAN
SAFIDON,HARYANA Nationality at birth,
□ Commercial
intermediary
6. Country of birth: if different:
□ Border (Name):
INDIA
Other nationalities: ………………
□ Other:

8. Sex: File handled by:

9. Civil status:

□ Single Supporting documents:

□ Male □ Travel document
□ Married □ Means of subsistence
□ Female □ Invitation
□ Registered Partnership
□ TMI
□ Separated □ Means of transport
□ Other:
□ Divorced
Visa decision:
□ Widow(er)
□ Refused
□ Other (please specify): □ Issued:
□A
10. Parental authority (in case of minors) /legal guardian (surname, first name, address, if different
from applicant's, telephone no., e-mail address, and nationality): N/A □C
□ LTV

□ Valid:
From:
11. National identity number, where applicable:
Until:
894354115686
12. Type of travel document: Number of entries:
□ 1 □ 2 □ Multiple

□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport

Number of days:
□ Special passport

□ Other travel document (please specify):

13. Number of travel 14. Date of issue: 15. Valid until: 16. Issued by
document: 28/08/2023 27/08/2033 (country):
Y7782017 INDIA

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:

Surname (Family name): First name(s) (Given name(s)):

Date of birth (day month year): Nationality: Number of travel document or

ID card:

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 Telephone no.:

address:
VILLAGE SINGHANA
DISTT., JIND, 126112
HARYANA, INDIA
@GMAIL.COM

20. Residence in a country other than the country of current nationality:

□ No
□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid
until……………

*21. Current occupation: BUSINESS - SHIV TILES

* 22. Employer and employer’s address and telephone number. For students, name and address of
educational establishment:
1011, NEAR NAFE SINGH HOSPITAL, AHAR-KURANA CHOWK, PANIPAT,
12-HARYANA, 91-INDIA, 132107
+91 00000 00000
23. Purpose(s) of the journey:
□ Tourism
□ Business s
□ Visiting family or friends
□ Cultural
□ Sports
□ Official visit
□ Medical reasons
□ Study
□ Airport transit
□ Other (please specify):
24. Additional information on purpose of stay: I will be traveling to Malta from 13/05/2025 to
20/05/2025 for tourism purpose.

25. Member State of main destination (and other 26. Member State of first entry:
Member States of destination, if applicable): MALTA
MALTA

27. Number of entries requested:

□ Single entry
□ Two entries
□ Multiple entries

Intended date of arrival of the first intended stay in the Schengen area: 13/05/2025

Intended date of departure from the Schengen area after the first intended stay: 20/05/2025

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):
Ax The Victoria Hotel
Address and e mail address of inviting Telephone no:
person(s)/hotel(s)/temporary accommodation(s): +35621334711
Gorg Borg Olivier Street, SLM1807,
Tas-Sliema, MLT

*31. Name and address of inviting company/organisation:

N/A
Surname, first name, address, telephone no, and Telephone no of company/organisation:
e mail address of contact person in
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),

Means of support: please specify:
□ Cash ……. □ referred to in field 30 or 31 /
□ Traveller’s cheques ……. □ other (please specify): /
□ Credit card Means of support:
□ Pre paid accommodation □ Cash
□ Pre paid transport □ Accommodation provided
□ Other (please specify): □ All expenses covered during the stay
□ Prepaid transport
□ Other (please specify):

33. Surname and first name of the person filling in the application form, if different from the
applicant:

Address and email address of the person filling Telephone No:

in the application form:

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: jointly the Ministry of Foreign and European Affairs and Trade
and Identita’.

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 Office of the Information and Data Protection Commissioner
(idpc.info@idpc.org.mt) 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):