Harmonised application form

Application for Schengen Visa

This application form is free

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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

PATEL
2. Surname at birth (Former family name(s)): Date of application:

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

NAYAN CHANDRAKANT
4. Date of birth (day-month-year): Application lodged at:

24-May-1986 □ Embassy/consulate
5. Place of birth: □ Service provider
□ Commercial intermediary
PETLAND ANAND GUJARAT □ Border (Name):
6. Country of birth:

INDIA
7. Current nationality:

INDIA
Nationality at birth, if different:
□ Other:
Other nationalities:
File handled by:

8. Sex: □ Male □ Female

9. Civil status: □ Single □ Divorced Supporting documents:
□ Married □ Widow(er) □ Travel document
□ Registered partnership □ Other (please specify): □ Means of subsistence
□ Separated □ Invitation
□ TMI
□ Means of transport
□ Other:
10. Parental authority (in case of minors) / legal guardian (surname, first name, address, if different from applicant’s, telephone number,
e-mail address, and nationality):
Visa decision:
□ Refused
□ Issued:
□ A
□ C
□ LTV

□ Valid:
11. National identity number, where applicable:

From:
12. Type of travel document: □ Ordinary passport
□ Diplomatic passport
□ Service passport
Until:

□ Official passport
□ Special passport
□ Other travel document (please specify):
Number of entries:
□ 1 □ 2 □ Multiple
13. Number of travel document: Number of days:
T9841022
14. Date of issue:
06-Jul-2020
15. Valid until:
05-Jul-2030
16. Issued by (country):
UNITED KINGDOM
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 □ Dependent ascendant

□ Child □ Registered partnership
□ Grandchild □ Other:
19. Applicant’s home address and e-mail address: Telephone number:

7 ALDRICH GARDEN, SUTTON. SM39AD UK, nayanpatel241986@gmail.com +44 7365921699

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

□ No
□ Yes. Residence permit or equivalent
SHARE CODE
………………………………………….......... SXZ GFP 5W4
No. ………………………………………
01/07/2025
Valid until …………………………………………

*21. Current occupation:

SALES ASSISTANT
*22. Employer and employer’s address and telephone number. For students, name and address of educational establishment:
BARMING POST LTD,
15-16 BULL ORCHARD ROAD MAIDSTONE ME169EU, UK
+44 020 8887 7623

23. Purpose(s) of the journey: □ Tourism □ Study

□ Business □ Airport transit
□ Visiting family or friends □ Other (please specify):
□ Cultural
□ Sports
□ Official visit
□ Medical reasons
24. Additional information on purpose of stay:

25. Member State of main destination (and other Member States of destination, if applicable):
ICELAND
26. Member State of first entry:
ICELAND
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 stay:
15-May-2025 18-May-2025

28. Fingerprints collected previously for the purpose of applying for a Schengen visa:

□ No
□ Yes 12-Jul-2022
Date, if known……………………......... IRL002028065
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):

HOTEL REYKJAVIK SAGA

Address and e-mail address of inviting person(s) / hotel(s) / temporary accommodation(s): Telephone number:

12 LAEKJARGATA REYKJAVIK 101 ICELAND

saga@hotelreykjavik.is +354 510-5600

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

Surname, first name, address, telephone number, and e-mail address of contact person in company/organisation:

Telephone number 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 Means of support:

□ Traveller’s cheques □ Cash

□ Credit card □ Accommodation provided
□ Pre-paid accommodation □ All expenses covered during the stay
□ Pre-paid transport □ Pre-paid transport
□ Other (please specify): □ Other (please specify):
TRAVEL INSURANCE

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 Directorate of Immigration in Iceland.

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, The Data Protection Authority in Iceland, Rauðarárstígur 10, 105 Reykjavík, Iceland,
www.personuvernd.is, 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):