Italian embassy Harmonised application form Application for Schengen Visa This application form is free PHOTO Family members of EU, EEA or CH citizens shall not fillin fields no.21, 22, 30, 31 and 32 (marked with’) Fields 1 3 shall be filed in in accordance with the data in the travel document. 7, Suman Harel FOR OFFICAL USE ONLY 7 Surname at birt Hairej Date of application Z Name vise application number: Mohammed Date of bith & Piace ofbiah \appicaton Todged al 1981.0531 Fl Jadia rcintessyiconsulate IDI service provicer &. Comty of birth 7 Current nationality 7. Nationality at birt, Faiferent —[] Commercial intermedia Mar MOROCCO Mar. MOROCCO Map - Morocco IED sorter ase 3 Marital stats ICD other Male Married 70, Holder of parental responsibiliy in case of minors)/ Legal guardian 70, Surname 7D. Wane Fis handled by 70, dares (i aMTerent Wom Whe apHCAnTS| 7D, PRONE Supporng Gosumens 70 Ema 70, Nationaliy IC travet documents ICameans of supcort ID ssvaton pi [itcans ot tanspot Dorner iss decision: IL Retused issued No logo is roquired for Norway, lealand, Lisehtonetein and Switzerland, 177, National Identity Number, where applicable 72, Travel document type ORDINARY PASSPORT - os Oe lov vatie 5, Number of Travel Document Peans3675 74, Date of issue 2022.02.07 76, ssued by MAR - MOROCCO 77, Personal data ofthe family member whe is an EU, EtAor CH citizen irapplicable 77, Surname (Family name) 77 Name 77, Date of birth 77, Nationality atbinth, # diferent 77, Murnber of Travel Document 7a Family constraint with an EU, EEA or CH ciizen ‘Applicant's home address 70, Adare 201-519 Rue De Crops 75, POSTAL CODE 79, Phone rae Hoe 19 4363408149 75, County 73. Cy CAN - CANADA veraun 73 Email Hairosimo@g mail om 20, Residence in a courity other than the country of current nationality 20, Residence parmitor equivalent Permanent Resient Card 20, vatigum 20, Wamiber 2024-11-07 11-0851.2765 =2i. Other purpose(s) ofthe journey 7 "2p, Employer and employers address and telephone number For aluGenis, name and adress of educational establishment: ‘Transion Sewices Corseis 2a, Adare 41205 Boulevard Lebourgnouf Bureau 2, POSTAL CODE aK 264 2, City auevec 2, Country CAN - CANADA 23, Phone 4198263003 7. Fax 22, Ema Admin @t ransitionse © Tunber fens Io: D2 A iutpte number or caysZi, Purpose(syoF he journey: Tourism 24, Addiforal information on purpose of stay Transit 2g, Member State of main destnalion (and other 25, Member State offirst ety ‘Member States of destination, if applicable} ESP SPAIN may 27, Number of enbies required Mattie 27, nfended date of arival ofthe frat intended stay in the Schengen area By, Iniended date of departure Wom the Schengen area affer the frat iniended stay 2020-1224 27, Daralion ofthe Tniended say oF wansl 14 wicate The number of days 25, Fingerprints Collected previously for the purpose of applying fora Schengen visa No 26, Date, known 26, Visa sticker number, Wnown "a, Entry permit or the Binal Country OF destination, where applicable Passued by 25, Van BoTaformations about te viling person(s). Irnot applicable, name of Horels) ar temporary accommodation(s) i The Member State(s) Tap, Surmane of he Taviing person “ao, Namie ofthe Taviing person Date oF bith oF fe inviting] “30, Province Of he inviting person pereon S30, AIGESS OF He THVTETG PaTSOT "30, POSTAL CODE of ie THVEINg PETSON "30, Phone ofthe iviting person | "30, Fax ofthe inviting person "50, Cily of the inviting person 730, Emall of the tnviing person Tao ving company Hotel Planet 3p, Province of We TVG Compa “0, Phone of the tiring Company RM-Roma 034958232 =30, Cify of he mviting company 330, Fax of the inviting company Rome "3p, Adress ofthe inviting company 350, POSTAL CODE of the inviting company Via Miazzo 3 .Stazione Termini antes, 30, Email ofthe tnviing Company =a Namie "aH, Adress =H, POSTAL CODE aH, Province Ta PRONE Far “Email TOnEECEDETSOR Th COMPARY | OFGNTATION WT SPBUCABTET =H, Summamne 3H Namie Ty Adaress Ta Prone Fa =H Ena "3, The applicants travel and subsistence expenses ate charged Oneself "az, Neans of support Means AulonomousTam aware atthe visa fee isnot refunded ithe visa is refused Applicable incase 2 multiple enty vsais applied for. | am aware ofthe need tohave an adequate travel medical incurance formy fst stay and any subsequent visits tothe territory of Member States. 1am aware of and consent tothe folowing: the collation of the data roquirod by thiaapplistion form and the taking of my photograph ard, ¥ applicable, ‘he taking offingerprin's, are mandatory for the examination ofthe application: and any personal data concerning me which appear onthe appiization form, as well as my fingerprints ané my photograph will be supplied to the relevant authoriies ofthe Member Stales and processed by those authorities, for he Purposes of a decision on my apolication. Such data as wel as daia concerning the decision taken on my appication ora decision whether fo annul evoke of extend a visa issued Wil be enfered into, and stored inthe Visa Information Sysiem (VIS) fora maximum petod of fe years, Curing which itil be accessible t the visa authorifes andthe autherii's competent for caring out checks on visas at extemal borders and within fre Member States, immigration and asylum authorities nthe Memer States fr the purposes of varying whether the concitions fr fhe legal entry info, stay and rescence on the leritery ofthe Member States ae fulflled, of identifying persons who do not or iho ne longer Tufl these conaitons, of examining an asylum application and of determining respensbilly fer such examination. Under certain cendtions the cata wi be also avaiable to designated authariies of he Member Stas (for itay te Ministry of ntenor and the Police authoriy) endo Europdl for he purpese of he prevention. detection and investigation of {errors offences and of ofier scious ciiminal offences. The Ministry of Foreign Affairs and Inlrmational Cooperalion - MAECI (Piazzale dela Farresina | 00135 Rema) wnnvesterit tel, 0039 06 36911 (evitehbcard), through the Diplomate Representation or Consulate where the viea application has been lodged, isthe authority responsible for processing the data Tam aware Fall have the ight bs oblain, in any ofthe ManbarStsles_nalfcaton ofthe Gala reatng fe me recarded inthe VIS ana ofthe Member See \hich transmitted the data, and fo request thai data relating to me which are inaccurate be corrected and that data relating fo me processed unlavully be deleted, At my express request, he autnorty examining my application (or the Diplomatic Representations or Consulates please visit vanesteriite hip:istoperitaia. ester will inform me ofthe mannerin which Imay exercise my right o check the personal data conceming me and nave them Ccotected of deleted, including the related remedies accordhg io the national law ofthe Member State concerned The lll National supervisory ‘compatent authority onthe protection of preanal data isthe MAECI Dats Protection Officer /DPO (email: cpd@estat it carted emai: rpd@oert este it) orthe Itaian Data Protection Auhorty (Piazza Venezia 11, 00187 ROMA: tel. 0039 06 696771 (switchboard): emai: garante@apdait pec: protocollo@zec gpdp.i). [declare that fo the test of my kncwledge al particulars supplies by me are correct and complete. | am aware that any false ‘Statements vill ea to my application being rejected orto the annulment of a visa aiready granted and may also render me lable to prosecution under the Taw ofthe Member State which ceals win fie appication. | undertake to leave the ferrfory ortne Member States before the expiry of he vis, rgranted. | havo bocn irformed that possession of vaa a eny one of the preroquicite for onty into the European teriery of the Momber Statco. Tho more fact that a visa has been granted to me does noi mean tha | will be enfiled fo compensation i fat to comply wi the relevant provisions cf Article 6(1) of Regulation (EU) No 2016/398 (Schengen Boréers Cade) and lam therefore refused entry. The prerequsites for enry willbe checked again on enty into the European territory of the Member Sites. a Pace and Gale i, Signature (or minors, signature Of parental alaiylegal guaraianyAppendix for Application for Schengen Visa Please co also bring this page when applying for a visa. It cor your entries in a machine-readable format.