Distinguished

Italian Consulate General in Shanghai

Visa Section

Host declaration

I, the undersigned (name and surname)………………………………………………...

Born (DD/MM/YYYY)…………………in……………………………………………
nationality…………………………..resident in (city and province)…………………..
………………………………………………………………………………………….
address………………………………………………..n………c.a.p…………………..
telephone……………………………….Email...............................................................
Occupation ………………………………………………………………….

As owner/renter (choose according to the case) of the apartement, aware of the

consequencies as per article 12 of the Leglislative Decree 25 July 1998, n. 286 (Testo
Unico sull’Immigrazione)

with this letter I state that I will host/rent to:

(choose the option according to the case)

the foreign citizen, Mr/Ms (name and surname)…..…………………………………...

born
(DD/MM/YYYY)……………………..in……………………………………………
nationality………………………………resident in…. ……………………………….
Address:…………………………………………………………………...n…………..
Telephone………………………………..Email.............................................................

From (DD/MM/YYYY) ……………………………. to

(DD/MM/YYYY)……………………………
In the room/apartment (choose according to the case) located in: city and
province:...............................................address………………………………………
…………………………………………………………………………………………
n.................................... cap.........................................
 I am aware of and consent to the following: the collection of the data required by this
application form are mandatory for the examination of the visa application and the data
will be supplied to the relevant authorities of the Member States and processed by thos
authorities, for the purposes of a decision on the visa application.
Such data will be enteres into, and stored in the Visa Information System (VIS) for a
maximum period of five years, during which it will be accessible to the visa authorities
competent for carrying out checks on visas at external borders and within the Member
States, immigration and asylum authorities in the Member States for the purposes of
verifying wheter the conditions for the legal entry into, stay and residence on teh territory
of the Member States are fulfilles, or identifying persons who do no longer fulfill these
conditions, or examining an asylum application and of determining responsibility for such
examination.
Under certain conditions the data will be also available to designated authorities of the
Member States and to Europol for the purpose of the prevention, detection and
investigation of terrorist offences and of other serious criminal offences.
I am aware that the authorities of the Member State responsible for the processing of the
data, following the article 41 par. 4 of the Reg. CE 767/2008 are the Ministry of the Foreign
Affairs and the Interior Ministry.
I am aware that I have the right to obtain in any of the Member States notification of the
data relating to me recorded in the VIS and of the Member State which transmitted the
data, and to request that data relating to me which are inaccurate be corrected and that
data relating to me processing 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.
The national supervisory authority of whom at the art. 41 par. 1 of the Reg. CE n. 767/08 is
the guarant for the protection of personal date in Piazza Monte Citorio n. 121 00186
ROMA.
I declar that to the best of my knloledge all particulars supplied by me are correct and
complete. I am aware that any false statements will lead to render me liable to porsecution,
as established by the art. 76 del D.P.R. 445/2000.

(Place) (date) (Signature of the declarant)

Please, enclose copy of ID or of the signatory person, in validity and with both data
and signature pages.
In case signatory person is a non- EU citizen, please also provide copy of a residence
permit (Permesso di Soggiorno) valid at least until the end of the indicated period of
stay. Applications for a residence permit or for its extension are not accepted.

Please, note that the declaration must be filled in all its parts.