ANNEX I
Harmonised application form
APPLICATION FOR SCHENGEN VISA
This application form is free
Family members of EU, EEA or CH citizens or of UK nationals who are beneficiaries of the EUUK
Withdrawal Agreement 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):Boudra
For official use only
Date of application:
2. Surname at birth (Former family name(s)): Application
number:
3. First name(s) (Given name(s)): Mohamed Elaid
4. Date of birth 5. Place of birth: 7. Current nationality:
Application lodged
(day- Constantine Algerian
at:
monthyear):
Nationality at birth, if ☐Embassy/consulate
27/07/2006 6. Country of birth: different: ☐Service provider
Algeria ☐ Commercial
Other nationalities:
intermediary
8. 9. Civil status: ☐ Border (Name):
Sex:
☐ Male ☐Single ☐ Married ☐ Registered Partnership ☐ ..................
☐ Female Separated ☐ Divorced ☐ Widow(er) ☐ Other ☐ Other:
☐ Other (please specify):
10. File handled by:
Parental authority (in case of minors)/legal guardian
(surname, first name, address, if different from applicant’s,
telephone No, email address, and nationality):
11. National identity number, where applicable: Supporting
documents:
100060887130440006 ☐Travel document
☐Means of
subsistence
☐ Invitation
[Link] of travel document: ☐Ordinary passport ☐ Diplomatic
passport ☐ Service passport ☐ Official passport ☐ Special passport
☐Other travel document (please specify):
14. Date of issue: 15. Valid until: 16. Issued by ☐ TMI
13. Number of
(country): ☐ Means of
travel
04 July 2025 03 July 2030 El Khroub,
document: transport
314312653 ☐ Other:
Algeria
Visa
17. Personal data of the family member who is an EU, EEA or CH citizen decision: ☐
or a UK national who is a beneficiary of the EU-UK Withdrawal Refused ☐
Agreement, if applicable Issued:
Surname (Family name): First name(s) (Given name(s)): ☐ A
☐ C
☐ LTV
☐ Valid:
From:
Until:
Date of birth Nationality: Number of travel
(day- document or ID card:
monthyear):
18. Family relationship with an EU, EEA or CH citizen or a UK national
who is a beneficiary of the EU-UK Withdrawal Agreement, if
applicable:
☐spouse ☐ child ☐ grandchild ☐ dependent ascendant ☐registered
partnership ☐ other:
[Link]’s home address and email address: Telephone no.:
Ru 188 LOGTS ADDL GECO BT B4 Ali Mendjeli +213555970149
mohamedboudraa320@[Link]
[Link] in a country other than the country of current nationality:
☐ No
☐ Yes. Residence permit or equivalent . . . . . . . . . . . . . No. . . . . . . . . . .
. . . Valid until. . . . . . . . . . . . .
*[Link] occupation:
Student / Trainee Number of
entries:
☐1 ☐ 2
* 22. Employer and employer’s address and telephone number. For
students, name and address of educational establishment: ☐ Multiple
Number of
[Link](s) of the journey: days:
☐Tourism ☐ Business ☐ Visiting family or friends Cultural ☐ Sports
☐ Official visit ☐ Medical reasons Study ☐ Airport transit ☐ Other
(please specify):
[Link] information on purpose of stay:
Tourist Visit
[Link] State of first entry:
25. Member State of main
destination (and other
Member States of destination, Spain
if applicable): Bulgaria
[Link] of entries requested:
☐Single entry ☐ Two entries ☐ Multiple entries
Intended date of arrival of the first intended stay in the Schengen area:
27/12/2026
Intended date of departure from the Schengen area after the first
intended stay: 03/01/2027
28. Fingerprints collected previously for the purpose of applying for a
Schengen visa: ☐ No ☐ Yes.
Date, if known . . . . . . . . . . . . . . . . . . . . . . . . . . Number of the visa, if known . .
........................
[Link] 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):
Hotel of Bulgarian Academy of Sciences & Kniaz Boris Hotel
Telephone No:
Address and email address of
inviting person(s)/
hotel(s)/temporary +359 87 520 5115
accommodation(s):
50 Shipchenski prohod Str., Geo Milev,
Sofia, 1113, Bulgaria
*[Link] and address of inviting company/organisation:
Telephone No of
Surname, first name, address,
company/organisation:
telephone No, and email address of
contact person in company/
organisation:
*[Link] of travelling and living during the applicant’s stay is covered:
☐by the applicant Means ☐ by a sponsor (host, company,
of support: organisation), please specify:
☐ Cash ..............................
☐Traveller’s cheques . . . . . . . . . .☐ referred to in field
30 or 31
☐ Credit card
..............................
☐ Pre-paid
. . . . . . . . . .☐ other (please
accommodation specify): Father
☐ Pre-paid Means of support:
transport ☐ Cash
☐Other (please specify): ☐Accommodation provided
☐ All expenses covered
during the stay ☐ Pre-paid
transport
☐ Other (please specify):
33. Surname and first name of the person filling in the application form,
if different from the applicant:
Telephone No:
Address and email address of the
person filling 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 issued:
I am aware of the need to have 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: Ministry of Foreign Affairs.
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 [Commission for Personal Data
Protection, contact details: Address: 2 Prof. Tsvetan Lazarov Blvd., Sofia 1592; Е-mail:
kzld@[Link]; Web-site: [Link]] 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) 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 of applicant: authority/legal
(signature of parental
Alger guardian, if applicable):