7form to fill https://secure2.e-konsulat.gov.pl/placowki/221/wiza-krajowa-formularz-bez-rejestracji

Form to fill for Visa

all fields required

Personal data

article Passport data Passport data 12. Type of travel document Ordinary passport Diplomatic passport Service passport Official passport Special passport Other travel document (please specify): Other travel document type 13. Travel document’s number (series and number) 14. Date of issue (year-month-day) 15. Valid until (year-month-day) 16. Issued by people 10.In the case of minors: Surname, first name, address (if different from applicant’s) and nationality of parental authority/legal guardian does not apply Guardian details 1 10.In the case of minors: Surname, first name, address (if different from applicant’s) and nationality of parental authority/legal guardian Nationality

First name Surname State

State/province Place Postal code Address home Contact details 17. Applicant’s home address and e-mail address Contact details State

State/province Place Postal code Address Icon information Current email address. Other e-mail addresses than the one provided in the VISA Application Form shall not be used when contacting an applicant. E-mail Phone area code arrow_drop_down Phone number cases Other data Other data 18. Residence in a country other than the country of current nationality No Yes. Residence permit or equivalent Number Expiry date indefinitely emergencystar 19. Current occupation

emergencystar 20. Employer and employer’s address and phone number. For students, name and address of school Employer School Name State

State/province Place Postal code Address Phone area code arrow_drop_down Phone E-mail Fax area code arrow_drop_down Number of fax 21. Main purpose(s) of the journey: Tourism Business Visit to family or friends Cultural Sports Official visit Medical reason Study other (please specify) Another purpose of the trip public Travel data Travel data 22. Destination country

23. Member State of first entry

24. Number of entries requested Single entry Two entries Multiple entries Visa requested for days (>90) 26. National visas issued during the past five years No Yes. Date(s) of validity to: from: 27. Fingerprints collected previously for the purpose of applying for a Schengen visa No Yes 28. Entry permit for the final country of destination, where applicable does not apply 29. Intended date of arrival to the Republic of Poland (year-month-day) 30. Intended date of departure from the Republic of Poland (year-month-day) contact_page Data of receiving person emergencystar 31, 32. Surname and first name of the inviting person(s) in the the Republic of Poland. If not applicable, name of hotel(s) or temporary accommodation(s) in the the Republic of Poland. Data of receiving person Is the inviter a company/organization? Type Person Company Name First name Surname Country

Place Postal code 34. Address House number Flat number E-mail address Phone area code arrow_drop_down Phone number emergencystar 32. Name and address of the inviting company/organization Data of receiving person Name Country

Place Postal code 34. Address House number Flat number Surname and name, business address, business telephone number and business e-mail address of the contact person in the company/organization: First name Surname Place Postal code 34. Address House number Flat number Phone area code arrow_drop_down Phone number E-mail address Company/organization phone number Phone area code arrow_drop_down Phone number credit_card Data of person covering expenses emergencystar 33. Cost of travelling and living during the applicant’s stay is covered Data of person covering expenses by the applicant himself/herself By a sponsor (host, company, organisation), please specify referred to in field 31 or 32 other (please specify) 36. Means of support during your stay Cash Travellers cheques Credit cards Accommodation Prepaid transport All expenses covered during the stay Other: Travel and/or health insurance. Valid until: work Data of the document authorizing you to work 34. Information on the work permit, certificate of entry of the application in the register of seasonal work applications, declaration of entrusting work to a foreigner or exemption from the obligation to have a work permit Data of the document authorizing you to work does not apply Type of the document entitling you to work

Document number entitling you to work Date of issue (year-month-day) Valid until (year-month-day) Issued by

euro EU citizen data 35. Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens. EU citizen data does not apply Surname First name Date of birth Nationality

Number of passport (series and number) Relationship: spouse child grandchild dependent ascendant assignment Applicant's data Applicant's data I am aware that the visa fee is not refunded if the visa is refused. Applicable in case a multiple entry national visa is applied for (cf. Field No 24): I am aware of the need to have an adequate travel health insurance in the meaning of regulations on health care benefits financed out of public funds or travel health insurance for my first stay and any subsequent visits to the territory of the Republic of Poland. I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that the submission of an application and/or supplementary documents containing untrue personal data or false information, declaration of untruth or the suppression of truth, forgery or tampering with a document with the intent of passing it off as genuine or the use of such a document as genuine will lead to my application being rejected or to the annulment of a national visa already granted, and may also render me liable to prosecution under Polish law. I undertake to leave the territory of the Republic of Poland not later than the last day of the national visa’s validity. I am aware that possession of a visa is only one of the prerequisites for entry into the territory of the Republic of Poland. The 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 the Law on Aliens and am refused entry. The prerequisites for entry will be checked again on entry into the territory of the Republic of Poland. I am aware that a granted national visa may be revoked if I no longer meet the requirement for its issuance. I hereby give consent for my personal data in the e-Konsulat registration form to be processed, in accordance with art. 6 sec. 1 lit. a Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46 / EC (GDPR), by the Ministry Spraw Zagranicznych, with its seat in Warsaw, Al. J. Ch. Szucha 23. At the same time, I declare that I have read the information posted on the website https://secure.e-konsulat.gov.pl/rodo being the implementation of the information obligation specified in Art. 13 of the GDPR regarding the processing of my personal data, and I am aware of all my rights referred to in art. 15 - 19 GDPR. Icon information * Questions marked with * may be omitted by family members of EU or EEA citizens (spouse, child, or dependent ascendant). Family members of EU or EEA citizens have to present documents proving this relationship. BannerOtwarcie w nowej karcie Terms and conditionsGDPRAccessibility declaration