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APPLICATION FOR CROATIAN
VISA
This application form is free

1. Surname(s) / Family name(s)2. Surname(s) at birth
3. First name(s)Isključivo zaslužbenu uporabu(x)Datum podnošenja zahtjeva

(x)

(x)

Broj zahtjeva u HVIS-u

4. Date of birth(day-month-year)

5. Place of birth

7. Current nationality
Nationality at birth, if different

6. Country of birth
8. SexZahtjev podnesen u
DM/KU
Zajednički centar za
podnošenje zahtjevaPružatelj usluga

9. Marital statusMaleSingleMarried

SeparatedFemaleOther (please specify)

DivorcedWidow(er)Komercijalni posrednik
Granični prijelaz
Naziv

10. If the application is lodged by a legal guardian: surname(s), name(s), address (if different fromapplicant’s) and nationality of a legal guardian
Ostalo11. National identity number (where applicable)
Zahtjev obradio/obradila

12. Type of travel document
Ordinary passport

Diplomatic passport

Service passport

Special passport
Priložena dokumentacija

Other travel document (please specify)
13. Number of travel document

14. Date of issue

15. Valid until

17. Applicant’s home address, e-mail address

16. Issued byTelephone number(s)18. Residence in a country other than the country of current nationality

Putna isprava
Sredstva zauzdržavanje
Poziv
Prijevozno sredstvo
Putno zdravstveno
osiguranje
OstaloNo
Yes. Residence permit or equivalent

No

Valid until

Odluka o vizi
Odbijena*19. Current occupation

Izdana*20. Employer and employer’s address and telephone number. For students, name and address ofeducational establishment(*)

ACVrijedi
od .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
do .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

21. Main purpose of travel
Tourism

Business

Broj ulazaka

Visiting friends/family

CulturalSports

Jedan
Više

Official visit

Medical reasons

StudyTransit

Other (please specify)(x) Fields 1 – 3 shall be filled in accordance with the data in the travel document.

Airport transit

Broj danaDva22. Country of final destination

23. Border of first entry

24. Number of entry requested

25. Duration of the intended stay or transit (indicatenumber of days)

Single entry

Two entriesMultiple entries

26. Visa(s) issued during past three years
NoYes. Country and validity:
Country

Valid from

untilCountry

Valid from

untilCountry

Valid fromuntil

27. Fingerprints collected previously for the purpose of visa application
No

Yes. Date (if known)

28. Entry permit for the final country of destination, where applicable
Issued by
29. Intended date of arrival in the Republic ofCroatia

Valid fromuntil

30. Intended date of departure from the Republic ofCroatia*31. Surname and first name of the inviting person(s) in the Republic of Croatia. If not applicable, name ofhotel(s) or temporary accomodation(s) in the Republic of Croatia.

Address and e-mail address from the inviting person(s) / hotel(s) /temporary accommodation(s)Telephone and telefax*32. Name and address of inviting company/organisation

Telephone and telefax

Surname, first name, address, telephone, telefax and e-mail address of a contact person incompany/organisation*33. Cost of travelling and living during the stay is covered by

the applicant himself/herself

a host / company /organisation (please specify)
referred to in field 31 / 32 .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. ..

Means of support
Cashother (please specify) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. ..
Means of support

Traveller’s cheques

CashCredit card(s)Accommodation provided

Prepaid accommodation

All expenses covered during the stayPrepaid transport

Prepaid transport

Other (please specify)

Other (please specify)(*)The fields marked with * shall not be filled in by family members of EU, EEA and CH citizens (spouse, child, or dependent ascendant) while exercising
their right of free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields number 34and 35.

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

Number of travel document or ID card

35. Family relationship with an EU, EEA or CH citizen
spousechild

36. Place and dategrandchilddependent ascendant

37. Signature (for minors and persons deprived of legal capacity,
signature of a legal guardian)

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 Republic ofCroatia.

I am aware of and consent to the following: the collection of the data required by this application form and the taking of my photographand, 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 therelevant authorities of the Republic of Croatia 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 annual, revoke or extend a visa
issued will be entered into, and stored in the Visa Information System of the Republic of Croatia (HVIS) for a maximum period of fiveyears. During that time all data will be accessible to the visa authorities and the authorities competent for carrying out checks on visas
at external borders and within the Republic of Croatia, immigration and asylum authorities in the Republic of Croatia for the purposesof verifying whether the conditions for the legal entry into, stay, and residence on the territory of the Republic of Croatia are fulfilled, ofidentifying 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 also be available to designated authorities of the Republic ofCroatia and to Europol for the purpose of prevention, detection and investigation of terrorist offences and other serious criminaloffences. The authority responsible for processing the data is the Ministry for Foreign and European Affairs of the Republic of Croatia.
I am aware that I have the right to obtain notification of the data relating to me recorded in the HVIS 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, theauthority examining my application will inform me of the manner in which I may exercise my right to check, correct or delete if
inaccurate or illegally processed, any personal data concerning me in HVIS, as well as of the legal remedies according to the law.
Claims concerning personal data protection are dealt by the Croatian Personal Data Protection Agency.
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 toprosecution under the law of the Republic of Croatia.
I undertake to leave the territory of the Republic of Croatia before the expiry of the visa, if granted. I have been informed thatpossession of a visa is only one of the prerequisites for entry into the Republic of Croatia. 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 the Aliens Act of theRepublic of Croatia (Official Gazette, No. 130/11, 74/13 and 69/17) and I am therefore refused entry. The prerequisites for entry will
be checked again on entry into the territory of the Republic of Croatia.

Place and date

Signature (for minors and persons deprived of legal capacity, signature of alegal guardian)