Documente Academic
Documente Profesional
Documente Cultură
Formular Viza Tip ABC
Formular Viza Tip ABC
Solicitare de viz
Application for Visa
Formular gratuit/This application form is free/
TIP DE VIZA: A; B; C
FOR EMBASSY /
CONSULATE USE
ONLY
Document procesat de :
5. CNP/ ID- /
8.
10.
Sexul/Sex /
Brbtesc/Male/
Documente doveditoare:
Cstorit/Married//
Separat/Separated/
Mijloace financiare
Invitaie
Mijloace de transport
Bilet de calatorie
Asigurare de sntate
Dovada asigurarii
conditiilor de cazare
Exceptii: (se va completa
Celibatar/Single//
Femeiesc/Female/
Paaport valabil
Divorat/Divorced/ ()
Vduv()/Widow(er)/ (- /-)
in functie de documentele
prezentate de solicitant, in
conformitate cu art.40 din
O.U.G.194/2002))
Altele/Other/
18.
Dac avei domiciliul n alt stat dect cel de origine, v este permis s v rentoarcei n acest stat/If you reside in a country
other than your country of origin, have you permission to return to that country? / ... ,
...?
Nu/No/
*19.
*20.
22.
23.
Viz/Visa/
Individual/Individual/
Colectiv/Collective
Viza :
Refuzat
Acordat
Tipul de viz :
A
B
C
Nr. de intrri:
1
2
Multiple
( )
Misiune (C/M)/Official/
Afaceri (C/A)/Business/
Turism (C/TU)/Tourism/
*30.
*31.
*33.
*32.
*34.
Denumirea firmei romne de contact i a persoanei responsabile n cadrul acesteia. n absen, denumirea hotelului sau
adresa temporar n Romnia/ Name of host or company in Romania and contact person in host company. If not applicable,
give name of hotel or temporary address in Romania./
. , .
Nume/Name/
e-mail/e-mail address/
*35.
Cine suport cheltuielile de deplasare i de edere n Romnia/Who is paying for your cost of travelling and for your costs
of living during your stay?/ ,
Subsemnatul/Myself/
Persoan fizic romn/Host person(s)/
Persoan juridic romn(numii cine i anexai documente doveditoare)/Host company. (State who and how and present
corresponding documentation)/ :(
) : .......................................................................................................................................................................................
...............................................................................................................................................................................................................
....................
*36. Modaliti de ntreinere n Romnia/Means of support during your stay /
Cash/
Cecuri de cltorie/Travellers' cheques/
Cri de credit/Credit cards/
Cazare pltit/Accommodation /
Altele/Other:
Asigurare medical valabil pn la/Travel and/or health insurance. Valid until: ,
......................................................................................................................................
37.
39.
42.
Prenumele soului(soiei)/
Spouses first name /
/
40.
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 /
1 ............................................................................................................................................................................................................
.
2 ............................................................................................................................................................................................................
.
3 ............................................................................................................................................................................................................
.
43.
Datele persoanale ale ceteanului romn n ntreinerea cruia v gsii. Rubric de completat doar de ctre cei aflai n
44.
Daca aveti alte rude in Romania?/If you have any relatives in Romania?/
?
45.
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 accord cu prelucrarea datelor prezentate n conformitate cu Legea 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.
() : , ,
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.
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II- ( , ) 194/2002
.
.
, 677/2001.
48.
(*) Rubricile nsoite de (*) nu trebuie completate de membrii familiei resortisanilor UE sau SEE (so, soie, copil sau
ascendent dependent). Membrii familiei resortisanilor UE sau SEE trebuie sa prezinte documentele care dovedesc relaia de
rudenie.
(*) The questions marked with (*) do not have to be answered by family members of EU or EEA citizens (spouse, child or
dependant ascendant). Family members of EU or EEA citizens have to present documents to prove this relationship.
(*) (*)
( , , ).
.