Formulari i aplikimit

Applicant's personal data

Family name:
Name at birth/former family name(s):
First name(s):
Date of birth (dd.mm.yyyy):
Place of birth:
Country of birth:
Sex:
Marital status:
Current nationality:
Former nationality:

Parents of the applicant

Family name of father:
First name(s) of father:
Nationality of father:
Father's date of birth:
Father's place of birth:
Father's place of residence:
Family name of mother:
First name(s) of mother:
Nationality of mother:
Mother's date of birth:
Mother's place of birth:
Mother's place of residence:
Occupation
Occupation learned:

Current address and contact details

Street:
House number:
Other address information:
Postal code:
Town/city:
Country:
Telephone/mobile number:
Email:

Identification papers
Type of travel document:
Travel document number:
Date of issue (dd.mm.yyyy):
Valid until (dd.mm.yyyy):
Issuing state:
Issued by:
Issued in:

Travel data and purpose

Purpose of stay in the Federal Republic of Germany:
If applicable, intended employment:
From (dd.mm.yyyy):
To (dd.mm.yyyy):
I intend to stay for no longer than 12 months in the Federal territory and apply for a visa that
covers the entire duration of my stay:

Educational establishment/company/organization
Type of reference Educational establishment/company/organisation
Name of the educational establishment, company or organisation:
Organisation's place of business, town/city:
Organisation's place of business, country:
Organisation's objectives/area of activity:
Name of the register of the organisation:
Location of register:
Register number:
Family name of contact person:
First name(s) of contact person:
Sex:
Date of birth (dd.mm.yyyy):
Nationality:
Street:
House number:
Postal code:
Town/city:
Country:
Telephone/mobile number:
Email:

Means of support and details regarding the stay

What are your means of support in the Federal Republic of Germany?
Has a formal declaration of commitment been completed?
Formal declaration of commitment - authority:
Formal declaration of commitment - date (dd.mm.yyyy):
Intended place of stay in the Federal Republic of Germany:
Street (if known):
House number (if known):
Postal code:
Town/city:
How will you be accommodated?
Do you intend to retain your permanent residence outside the Federal Republic of Germany?
Do family members intend to accompany you?
Do you have health insurance (for a longer stay) for the Federal Republic of Germany?

Have you ever been to the Federal Republic of Germany before?

Have you ever been convicted?

Have you ever been expelled or deported from the Federal Republic of Germany, had an
application for a residence permit rejected, or been refused entry into the Federal Republic of
Germany?
Do you suffer from any of the following diseases?
Smallpox, poliomyelitis, types of influenza not common in humans (e.g. "bird flu", "swine flu"),
acute pandemic influenza, severe acute respiratory syndrome (SARS), cholera, pneumonic
plague, yellow fever, viral haemorrhagic fever (e.g. Ebola, Lassa, Marburg)