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