Application for Visa
This application form is freePHOTO

1. Surname (Family name) (x)

FOR OFFICIAL USE ONLY

2. Surname at birth (Former family name(s)) (x)Date of application:
Visa application number:

3. First name(s) (Given name(s)) (x)4. Date of birth (day-month-year)

5. Place of birth

7.Current nationality

6. Country of birth

Nationality at birth, if different:

8. Sex□ Male □ Female

9. Marital status□ Single □ Married □ Separated □ Divorced □ Widow(er)□ Other (please specify)

Application lodged at□ Embassy/consulate□ CAC□ Service provider□ Commercialintermediary□ BorderName:□ Other

10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of parental
authority/legal guardian

11. National identity number, where applicable

12. Type of travel document□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport □ Special passport□ Other travel document (please specify)
13. Number of travel document

14. Date of issue

17. Applicant's home address and e-mail address

15. Valid until

16. Issued byTelephone number(s)18. Residence in a country other than the country of current nationality□ No□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid until* 19. Current occupation

File handled by:
Supporting documents:□ Travel document□ Means of subsistence□ Invitation□ Means of transport□ TMI□ Other:

Visa decision:□ Refused□ Issued:□A□C□D□ Valid:
FromUntil
Number of entries:□ 1 □ 2 □ Multiple
Number of days:

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* 20. Employer and employer's address and telephone number. For students, name and address of educational
establishment.

21. Main purpose(s) of the journey:□ Tourism…….□ Business…….□ Visiting family or friends ….□ Cultural ……□ Sports ……..□ Official visit□ Medical reasons□ Study …..□ Transit □ Airport transit ……□ Other (please specify)
22. Member State(s) of destination
23. Member State of first entry

24. Number of entries requested□ Single entry….□ Two entries ….□ Multiple entries

25. Duration of the intended stay or transit
Indicate number of days

* The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant) while
exercising their right to free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship andfill in fields no 34 and 35.
(x) Fields 1-3 shall be filled in accordance with the data in the travel document.
26. Schengen visas issued during the past three years□ No□ Yes. Date(s) of validity from …………………. to27.Fingerprints collected previously for the purpose of applying for a visa
□ No ………………………………□ Yes.
……………………………………. Date, if known

28. Entry permit for the final country of destination, where applicable
Issued by ………………………………..Valid from …………………………until……………………………………………….

29. Intended date of arrival in the Republic of Bulgaria

30. Intended date of departure from the Republic of Bulgaria* 31. Surname and first name of the inviting person(s) in the Republic of Bulgaria. If not applicable, name of hotel(s) ortemporary accommodation(s) in the Republic of Bulgaria

Address and e-mail address of inviting person(s)/hotel(s)/temporaryaccommodation(s)Telephone and telefax

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*32. Name and address of inviting company/organisation

Telephone and telefax of company/organisation

Surname, first name, address, telephone, telefax, and e-mail address of contact person in company/organisation*33. 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 31 or 32…….□ other (please specify)

Means of support□ Cash□ Traveller's cheques□ Credit card□ Pre-paid accommodation□ Pre-paid transport□ Other (please specify)

Means of support□ Cash□ Accommodation provided□ All expenses covered during the stay
□ Pre-paid transport□ Other (please specify)

34. Personal data of the family member who is an EU, EEA or CH citizen

Surname

Date of birthFirst name(s)Nationality

Number of travel
document or ID card

35. Family relationship with an EU, EEA or CH citizen□ spouse ……………..□ child ……□ grandchild ………………□ dependent ascendant

36. Place and date

37. Signature (for minors, signature of parental authority/legal guardian)

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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 (cf. field no 24):
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 the Republic ofBulgaria.

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; and 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 theRepublic of Bulgaria 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) 1 for a maximum period of five years, during which it will be accessible tothe visa authorities and the authorities competent for carrying out checks on visas at borders of the Republic of Bulgaria, immigration andasylum authorities in the Republic of Bulgaria for the purposes of verifying whether the conditions for the legal entry into, stay and residence
on the territory of the Republic of Bulgaria are fulfilled, of identifying persons who do not or who no longer fulfil these conditions, ofexamining an asylum application and of determining responsibility for such examination. Under certain conditions the data will be alsoavailable to designated authorities of the Republic of Bulgaria and to Europol for the purpose of the prevention, detection and investigationof terrorist offences and of other serious criminal offences. The competent authority of the Republic of Bulgaria responsible for processing
the data is MFA.
I am aware that I have the right to obtain in the Republic of Bulgaria notification of the data relating to me recorded in the VIS and of theMember State which transmitted the data, and to request that data relating to me which are inaccurate be corrected and that data relating tome 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 Republic of Bulgaria. The National Supervisory Authority, which will help me and indicate how toexercise these rights, is the Commission for Personal Data Protection.
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 willlead to my application being rejected or to the annulment of a visa already granted and may also render me liable to prosecution under thelaw of the Republic of Bulgaria.
I undertake to leave the territory of the Republic of Bulgaria before the expiry of the visa, if granted. I have been informed that possession ofa visa is only one of the prerequisites for entry into the Republic of Bulgaria. The mere fact that a visa has been granted to me does not meanthat I will be entitled to compensation if I fail to comply with the relevant provisions of Article 5(1) of Regulation (EC) No 562/2006(Schengen Borders Code) and I am therefore refused entry. The prerequisites for entry will be checked again on entry into the territory of theRepublic of Bulgaria.

Place and date1

Signature(for minors, signature of parental authority/legal guardian):Insofar as the VIS is operational.

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