2008.11.14 formular viza ds
DESCRIPTION
forTRANSCRIPT
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Operator de date cu caracter personal notificat sub numrul 5285
Solicitare de viz
Application for Visa
Formular gratuit/This application form is free
TIP DE VIZA: DS
1. Numele/Surname(s) (family name(s))
FOR EMBASSY / CONSULATE USE ONLY
2. Numele la natere/ Surname(s) at birth (earlier family name(s))
Data solicitrii :
3. Prenume/First names (given names)
4. Data naterii/Date of birth (day-month-year)
5. CNP/ ID-number Document procesat de :
6. Locul i ara naterii/ Place and country of birth 7. Cetenia prezent/Current nationality/ies 8. Cetenia la natere/Original nationality (nationality at birth)
9. Sexul/Sex
Brbtesc/Male Femeiesc/Female 10. Statut civil/Marital status :
Celibatar/Single Cstorit/Married Separat/Separated Divorat/Divorced Vduv()/Widow(er) Altele/Other
11. Prenumele tatlui/Fathers name 12. Prenumele mamei/Mothers name
13. Document de cltorie/Type of passport:
Paaport diplomatic/Diplomatic passport
Paaport de serviciu/Service passport
Documente doveditoare:
Paaport valabil
Nota verbala
14. Nr. de paaport/Number of passport
15. Emis de/Issued by
16. Data emiterii/Date of issue (day-month-year)
17. Valabil pn la/Valid until (day-month-year)
Viza :
Refuzat Acordat
18 Funcia ocupat n prezent/ Current occupation
19. Nr. de intrri solicitate/No. of entries requested Unic intrare/Single entry Dou intrri/Two entries Multiple intrri/Multiple entries
20.Durata ederii/ Duration of stay
Tipul de viz : DS
Nr. de intrri:
1 2 Multiple
FOTOGRAFIE 3/4
TAMPILA AMBASADEI/CONSULATULUI
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21. Indicati misiunea diplomatica sau oficiul consular din Romania /Indicate diplomatic mission or consular office from Romania
22. ederi anterioare n Romnia/Previous stays in Romania.
Valabil de la ................................................... La ...................................................
FOR EMBASSY / CONSULATE USE ONLY
23. Data sosirii/ Date of arrival (day-month-year)
24. Punctul de intrare/Border of first entry
25. Mijloc de transport/Means of transport
26. Numele soului(soiei)/Spouses family name
27. Numele la natere al soului(soiei)/ Spouses family name at birth
28. Prenumele soului(soiei)/ Spouses first name
29.Data de natere a soului (soiei)/ Spouses date of birth (day-month-year)
30. Locul de natere al soului(soiei)/ Spouses place of birth
31. Copii (se vor completa solicitri separate pentru cei care dein paaport individual)/Children (Applications must be submitted separately for each passport) Nume/Name Prenume/First name Data naterii/Date of birth
1 ....................................................................................................................................................................................................................................... 2 ....................................................................................................................................................................................................................................... 3 .......................................................................................................................................................................................................................................
32. Date cu caracter personal prelucrate n conformitate cu dispoziiile Legii nr. 677/2001. Acest document este destinat numai pentru uzul instituiilor abilitate de lege i nu poate fi dat publicitii. Operaiunile exercitate fr drept de legtur cu acest document (multiplicarea, difuzarea, adaptarea, copletarea, extragerea, utilizarea, dezvluirea) ctre teri prin transmiterea sub orice form, sunt pedepsite de legea romn i intr sub incidena Legii nr.677/2001. Am luat la cunotin urmtoarele: toate datele personale cu privire la subsemnatul(a) care apar n prezentul formular vor fi puse la dispoziia autoritilor romne competente i procesate de ctre acestea, dup caz, n scopul lurii unei decizii cu privire la prezenta solicitare de viz. Aceste date pot fi introduse i stocate n bazele de date accesibile autoritilor romne competente. Urmare solicitrii exprese a subsemnatului, autoritile consulare menite s proceseze prezenta solicitare m vor informa cu privire la la modalitatea n care mi pot exercita dreptul de a verifica datele personale furnizate, de a dispune modificarea sau ndeprtarea lor, dac se dovedesc incorecte, n conformitate cu prevederile legislaiei n vigoare n Romnia. Declar c, dup tiina mea, toate datele furnizate sunt corecte i complete. Declar c am cunotin de faptul c orice date false furnizate conduc la respingerea prezentei solicitri sau la anularea vizei emise n baza acestora i pot duce la declanarea urmririi mele penale n conformitate cu legea romn. M oblig s prsesc teritoriul Romniei la expirarea vizei ce mi-a fost acordat. Am fost informat c deinerea vizei nu reprezint dect una dintre condiiile de ndeplinit pentru intrarea n Romnia. Simpla eliberare a vizei nu presupune faptul c sunt ndreptit() la primirea unor compensaii dac nu ndeplinesc condiiile prevzute la Capitolul II (Dispoziii generale privind intrarea, ederea i ieirea strinilor) al OUG 194/2002 i mi este refuzat intrarea n Romnia. ndeplinirea condiiilor de intrare va fi supus verificrii la momentul intrrii pe teritoriul Romniei.// Sunt de acord cu prelocrarea datelor preyentate in conformitate cu Legea 677/2001. Personal data, processed according to the provisions of Law n 677/2001. The present document is destined to the exclusive use of the institutions with competences attributed by law and cannot be made public. All types of unauthorized operations in relation to this document (such as its multiplication, distribution, adaptation, completion, data extraction, use, public display), with a view to its distribution towards third parties concerned, will be punished by Romanian law and will be subject to Law n
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677/2001. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form will be supplied to the relevant authorities in Romania and processed by those authorities, if necessary, for the purposes of a decision on my visa application. Such data may be input into, and stored in, databases accessible to the relevant authorities in Romania. At my express request, the consular authority processing 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 altered or deleted, in particular, should they be inaccurate, in accordance with the national law of the state concerned. 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 Romanian law which deals with the application. I undertake to leave the territory of Romania upon 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 Schengen 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 Chapter II (General provisions regarding entry, stay and exit of aliens) of GEO no.194/2002 and am thus refused entry. The prerequisites for entry will be checked again on entry into the territory of Romania. I agree with processing of data presented in according with Law no. 677/2001 33. Adresa de domiciliu a solicitantului/Applicants home address
34. Nr.de tel./Phone no. 35. Dat la (locul i data)/Place and date (day-month-year)
36. Semntura (pentru minori, semntura reprezentantului legal)/Signature (for minors, signature of custodian/guardian)