Harmonized application form

*r*
* lr Application for Schengen Visa
* * Thisapplication form is freel
* *** i

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tNcHS-GR0223877
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, 3l and 32 (marked with *) Fields l-3 shall be filled in
in accordance with the data in the fravel document
FOROFFICIALUSE
1. Sumame (Family name): YADAV ONLY

2. Sumame at birth (Former family name(s)): YADAV

Date of application:
3. First name (s) (Given name (s): MUKESH
Application number:

4. Data of birth 5. Place of birth: 7. Current nationality

(day-rnonth - year): DEORIA, UfiAR PRADESH Application lodged at:
INDIA

Nationality at birth:
o Embassy/consulate
25r,?no02
6. Country of birth:
n Service provider
INDIA
o Commercial
intermediary
INDIA
Other nationalities: o Border (Name):
o Other:

File handled by:

8. Sex: 9. Civil status:

n Single Supporting
g Male E Married documents:
n Registered partnership o Travel documents
n Female o Means of
n Separated
subsistence
s Divorced n Inviation
n Other n Widow(er) o TMI
u Other (please specify): n Means oftransport
n Other:

10. Parental authority (in case of minors) / legal guardian (sumame, first name, address, if different Visa decision:
from applicant's, telephone no., e-mail address, and nationality): n Refused
n Issued:
oA
nC
n LTV

I l. National identity number where applicable: o Valid:

From:

[Link] of travel document: To:

Number of entries:
I Ordinary passport r Diplomatic passport n Service passport rla2nMult
Number of days
o Official passport o Special passport u Other travel document (please specifu):

I No logo is required for Norway, lceland. Liechtenstein and Switzerland

13. Number oftravel document: 14. Date of issue: 15. Valid until: 16. Issued by (country):

w8799270 ilrc8ra026 3{v0inmit INDIA

17. Personal data of the family member who is an EIJ, EEA or CH citizen or an UK national who is a Withdrawal Agreement
benefi ciary, if applicable:
Surname (Family name): First name (s) (Given name (s)):

Number oftravel document or ID card:

Date of birth (day-month-year): Nationalitv:

18. Family relationship with an EU, EEA or CH citizen ,or an UK national who is a Withdrawal Agreement
benefi ciary, if applicable:
o spouse o child o grandchild n dependent ascendant

n registered partnership n other

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

INDIA I DEORTA IV|LL KUSHAHART POST KUSHAHART, DEORIA, UTTAR PRADESH 1274001 |
+917807805454
HARMAN2oo1 01 01 @[Link]
+91780780il54
20. Residence in a country other than the country ofcurrent nationality

xNo I Yes
Residence permit or equivalent... No... Valid until...

*21. Current ocupation:

SALES EXECUTIVE

*22. Employer and employer's address and telephone number. For students, name and address ofeducational
establishment:
NETSET SOFTWARE SOLUTIONS I INDIA I SAS NAGAR I E 281 PHASE, 8A, INDUSTRIAL AREA, SECTOR 75, SAHIBZADA AJIT SINGH
NAGAR, PUNJAB I 160055 I +919517980683

23. Purpose(s) ofjoumey:

E tourism n business n visiting family or friends n culture tr sport

n official visit n medical reason n study n airport transit n other (please specify):

24. Additional information on purpose of stay:

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

GREECE GREECE

27. Number of entries requested:

X single entry tr two entdes r multiple entries

Intended date ofarrival ofthe first intended stay in the Schengen area:
07/1ono25

Intended date ofdeparture from the Schengen area after the first intended stay: 13/10nO25
28. Fingerprints collected previously for the purpose ofapplying for a Schengen visa:

ENo nYes
Date, if known ... Visa sticker number, if known .....

29.E*ry permit for the final country of destination, where applicable:

Issued by ... Valid from. until

* 30. Surname and first name ofthe inviting person(s) in the Member State(s). If not applicable, name of hotel(s) or temporary
accommodation(s) in the Member State(s):
ELATOS

Telephone no:
Address and e-mail address of inviting person(s)/trotel(s) temporary accommodation(s):
LOUTRA TPATTS I LOUTRA rPATrS, GREECE | 35016 | HARMAN2oo10101@[Link] +91780780il54

*31. Narne and address of inviting company/organization:

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

*32. Cost oftravelling and living duringthe applicant's stay is covered:

ts by the applicant himself/herself o by a sponsor (host, company, organisation), please

Means of support specifi:

I0 cash n referred to in field 30 or 3l

o traveller's cheques n other (please specifu):...

Means of support
x credit card
n cash
x pre-paid
accomodation/ o accomodation provided
n pre-paid transport/
o all expenses covered during the stay
D other (please specifr) o pre-paid transport

o other (please specifr)

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 in the application form: Telephone No:
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 ofthe need to have an adequate travel medical insurance for my first stay and any subsequent visits to the territory ofMember States.

I am aware of and consent to the following: the collsction of the data required by this application form and the taking of my photograph and, if applicable, the
taking offingerprints, are mandatory for the examination ofthe application; and any personal data conceming me which appear on the application form, as well
as my fingerprints and my photograph will be supplied to the relevant authorities ofthe Member States and processed by those authorities, for the purposes ofa
decision on my application.

Such data as well as data conceming the decision taken on my application or a docision whether to annul, rovoke or extend a visa issued will be entered into, and
stored in the Visa Information System (VlS) for a maximum pefod of five years, during which it will be accessible to the visa authorities and the
authorities competent for carrying out checks on visas at extemal borders and within the Member States, immigation and asylum authorities in the
Member States for the purposes of veriling whether the conditions for the legal entry into, stay and residence on the territory of the Member States are
fulfilled, of identi$ing fersons who do not or who no longer firlfrl 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 ofthe Member States and to Europol for the purpose ofthe
Drevention. detection and investigation ofterrorist offences and ofother serious criminal offences. The authority responsiLrle for processing the data is: Mtnistry of
For"rgn Atrui.s, lstVasilissis Sofias Avenue, 10671, Athens, Tel-: +30 2i0 3681000, Far: +30 210 3681717, [Link], e-mail: dc4@[Link], dst2@[Link].

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 unla*4ully 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 conceming me and have them corrected or deleted, including the related remedies according to the national law ofthe Member State concemed.
The national supervisory authority, Hellenic Data Protection Authority, 1-3 Kifisias Stree! 1st floor, 1 1523, Athens" te1.: +30 210 6475600, fax +30 2106475628,
e-mail: contact@[Link], will hear claims conceming the protection of personal data.
I declare that to the best of my knowledge ail 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 ofa visa already granted and may also render me liable to prosecution under the law ofthe Member State which
deals with the application.
ofthe Member Statos before the expiry ofthe visa, ifganted. I have been informed that possession ofa visa is only one ofthe
I undertake to leave the tenitory-European
prerequisites for entry into the territory ofthe Member Stites. The mere fact that a visa has been granted to me does not mean that I will be entitled
io compensation if I fail to comply with the relivant provisions of Article 6(1) of Regulation (EU) No 20161399 (Schengen Borders Code) and I am therefore
refused entry. The prerequisites for entry will be checked again on entry into the Euopean territory of the Member States.

Place and date: Signature (signature of parental authority,4egal guardian, if

applicable):
Chandigarh