Surname (Family name)
Surname at birth (Former family name(s))
First name(s) (Given name(s))
Date of birth (day-month-year)
Place of birth
Country of birth
Current nationality
Nationality at birth, if different:
In the case of minors: Surname, first name, address (if different from applicant’s) and nationality of parental authory/legal guardian
National identity number, where applicable
Type of travel document
Official passport
Number of travel document
Date of issue
Valid until
Issued by
Applicant’s home address, e-mail address
Telephone number(s)
Residence in a country other than the country of current nationality
Current occupation
Employer and employer’s address and telephone number. For students, name and address of educational establishment.
Member State(s) of destination
Member State of first entry
Number of entries requested