Applicationfor Schengen Visa PHOTO

This application form is frcc

FOR OFFICIAL USE

1Surnume (1amily namc) () ONLY

Bhat Datc of application

2 Surnamc at birth (lomer famiy name() ()

Bhat Applicaton number

3 First name(s) (Gncn namc(s) () Appl1cabon lodged at

Sharan Oinbassy/consulate
Service provider
4. Datc of brth (day-monh-ycar) 5. 1Placc of birtlh : Bargaloe 7. Current nationality: od n Commercal
intermcdary
National1ty at brth, if different: N Border (Name)
6. Country of birth
In dia
1446 Other nationalities
OOther

Iile handled by

Supporing documents
Travel documcnt
S. Sex 9. Marital Status
Marricd ORegistered Partnership OSeparatcd Dvorced Wdow(er) Mcans of
OSingle subs1stence
Nale D'emale DOther (plcase spec1fy)
InvitatIon

name, address, if d1fferent from applicant's, telephone

10 Parcntal authornty (in case of minors) / legal guardian (surname, first Means of transport
n0, c-ma1l address, and naionalty):
Other
Bhat NO. 65
20
Ruulhna temple, bang aloe -560o
Visa dec1son:
nee DRefuscd
Issued

|11. Natonal sdentity number, where applicablc :

IRNI4TI SOH9
Valid
12 Type of traved document
Ord1nary passport Diplomaticpassport Service passport Dofficialpassport Spccial passport lrom
Unul
DOther travel document (please spec1fy)

14. Date of issue : 15. Vald until 16. Issucd by (country) :

13. Number of ravcl document
t|12|102b Lndia Number of entries
176AC O02O Muluple
Untcd
'uropcan Unon, 11EA or Swiss (Conlcderaton cZCn or is a
17. Personal data of the lamily member who is a
Number of daus

Kingdom cizen beneficary ol the w1thdrawal agreement, if applicable

|irst names (s) (iven namc())
Surname (l'amily name)

kapoo Number of travel document or lD card

Date of brth (day-month-year): Nationality

Andian 3
 ot SwSs Confederaton cizen, or ith United K1ngdom ctizen beneficary of the withdrval
18 'amh relstionship with sn Furopean Unon, 1EA
ajrroemn, if appcabl
ocher
Ds Dhild Dgrandchild Ddpendent ascendant Regstered Partncrsh1p

19 Apphcant's hom nddrcss and c-mal addrcss: Telephonc no.

NO 6, nd ain q4246 1890|

chann a sandia, Borgalst
560003
20 RexIdence In a countr othber than the country of
current nibonal1ty

No Vald untl
Yes Resndence nermt or equnalent
21.Current occupaton

implogd
22 Emplorer and employer's address and telephone number. 'or students,
name and address of cducatonal cstabl1shmcnt

Nineleaps5
23 Purpose(s) of the journcy
Busness JVIsitung family or friends Cultural Sports Oficial vist
Tounsm
Medical reasons DSudy Arport trans1t D
Other (please specify)

24 Addtonal informauon on purposc of stay

tunctien
State of first cntcy
25 Memnber State of main dest1nation (and other Mcmber States of destinauon, if26. Mcmber
applhcabic):

Calitosna, los Ageley Cal'fona

27. Number of entries rcquested
Single entry Two entries Muliple entries
Intended date of arrval of the frst intended stay in the Schengen area:
Intended date of departure from the Schengen arca after the first intended stay :

|28. Fingerprintscollected preyously for the purpose of applying for a Schengen visa : No Yes.
Date, if knuwn Visa sucker numbcr, if known.

|29. Entry permit for the final country of dest1naton, where applicable
Issucd by. 4ot..ot.. Ihda ....Vald trom. .untl.
30 Surnane and frst namc of the nviting prson(s) in the Menbr Statc(s) If not appicable, namu ot hotcl(s) or temporary accommodaton()n hc
Mcmber Statc(s)
 / Temporary accommodation(s) Tclcphorne no.
|Address and c-mail address of inviting person(s) 7 hotcl(s)

· Com Bellview t|41S 190 15

wwhinglon
*31. Name and address of inviting company / organisation :
no Wain skeet
Bentou?)la 2
walmat
Asingto n |Telephone no. of company /
company /organisation
Surnamc, hrst namc, addrcss, tclephonc no., and c-ail address of contact person in organisat1on

*32. Cost of ravclling and living during the app1cant's stay is covered :

by thc applicant himself/hcrsclf by a sponsor (host, company, organisauon),

Please spec1fy :
referred to in ficld 30 or 31
Mcans of support other (please specify):
Cash
Traveller's cheques
Credit Card
Mcans of support
Prc-paid accommodation Cash
Pre-paid transport Accommodation provided
DOther (please spccify) All expenses covercd during the stay
Pre-paid transport
DOcher (pleasc specily) :
 not refunded if the visa is refusd.
|Iam awvare that the visa fee is

Appl1cable in casc a multiple-cntry visa is applicd for : territory of Member States.

Iam aware of the nccd to have an adcquate travel
mcdical insurancc for my first stay and any subscquent visits to the

if applicable, the
form and the taking of my photograph and, application
the collection of the data requircd by this application data
Iam aware of and conscnt to the following :examination concerning me which appear on the visa form,
of the visa application, and any personal
tngot
tak1 lingerpnnts aare mandatory for the author1ties of the Member States and processed by those authorities, for the purposes
to the relevant
las my fingerprints and my photograph will be suppl1ed
of a decision on my visa application. to annul, revoke or cxtend a vIsa Issued will be cntercd
into, and
my applicaton or a decision whether
|Such data as well as data concerning the decision taken on the vIsa urhorities and the authoritics
period of five vears, during which it will be accessible toauthor1tics in the Member Status for th
storcd in the Visa Information Systcm (VIS) for a maximum borders and within the Membur Statcs, immgraton and asylum
compctent for carry ing out checks on vIsas at Cxternal Member Statcs are fulfillcd, of idenufy1ng persons
entry into, stay and residence on the territory of the
|purposes of verifying whethcr the cond1tions for the legalesamining an asylum appicaton and of determin1ng responsib1lity for such examinaton Under certain
who do not or who no longer fulfil these conditons, of of the prevention, detecton and
of the Member States and to iuropol for the purposc
cond1tions the data will be also available to des1gnated authorities processing thc data (
investigation of terrorist offences and of other serious criminalaloffences. The authority of the Member State is rusponsible for
of the Member State which
Statcs notification of the data rclating to me recorded in the VIS and
|lam aware that Ihave thc rght to obtain in any of the Mcmber inaccurate be corrected and that data relhting to me processed unlawfully be deleted. At my
transmitted the data, and to request that data relating to me which are of the manner in which I may exercise my right to check the personal data concerning me
me
Cxpress request, thc authority examining my application wil informaccording of that
to the national law of the State concerned. T'he nauonal supervisorv authority
and have them corrected or deleted, including the related remedies 3 Place de Fontenoy - TSA 80715 - 75334 PARIS CEDEX 07 | will hear claims
Libertés -
Member State |Commission Nationale de l'Informatiquc ct des
concerning the protcction of pcrsonal data.
by me are correct and complete. I am aware that any false statements will lead to my application
|Ideclare that to the best of my knowledge all particulars supplcd
and may also render me liable to prosccuion under the law of the Member Statc
which deals with the
bcing rcjcctcd or to the annul1nent of a visa already granted
application.
if grantcd. Ihave been informed that possCSSIOn of a visa Is only one of the
Iundertke to lcavc the territory of thc Member States before the expiry of the visa, that a visa has been granted to me does not mean that Iwill be enutled to
prercquisites for entry into the Europcan territory of the Member States The mere fact there fore
|compensation if Ifail to comply with the relevant provisions of Article G(1) of Regulation (EC) No 399/2016 (Schengen Borders CCode) and Iam
checked again on entry into the Buropean territory of the Member States
refused entry. The prercquisites for entry will be

Phce and date Signarure (for minors, signature of parental authority /gal guardan)

Bargalae Biad
I4|6 24
bencficary uf the withdcawal agrecment, should not complte boxcs 21, 22, 30,
Iamily members of I:U, EEA, Swiss Confcderation, or United K1ngdom citizcn
31 and 32 (marked with an "). travel docunment.
(s) The data in boNes 1to 3 must correspond to the data on the