Dpartement fdral de justice et police DFJP
Office fdral des migrations ODM
Domaine de direction Immigration et Intgration
Division Entre et admission
( )
Application for a long stay visa (visa D)
A. / APPLICANT
1. / Surname (Family name)
RSERVE L'USAGE
EXCLUSIF DU SERVICE
Date d'introduction de la
demande:
2. / Surname at birth
3. / First name(s) (given names)
Numro de la demande de
visa :
4. (- - )/ Date of birth (day-month-year)
Demande dpose :
l'ambassade/consulat
au canton
5. / Place of birth
Responsable du dossier:
6. / Country of birth
7. / Current nationality(ies)
( ) / Nationality at birth (if different)
8. / Sex
/ Male
/ Female
Documents justificatifs:
Document de voyage
Attestation de
l'employeur / de l'cole
Documents d'tat civil
Moyens de subsistance
Autres:
Assurance d'autorisation
de sjour
9. / Marital status
/ Single
/ Married
/ Separated
/ Divorced
/ Registered partnership
/ Widow(er)
( )
/ Other (please specify)
Visa D:
Dlivr
Refus
Valable:
10. \ / Father's surname and first name; place and country of birth
du
au
11. \ / Mother's surname and first name; place and country of birth
Nombre d'entres :
1 2 Multiples
12.
/ ) ( : / In the
case of minors: Surname, first name, address (if different from applicants) and nationality of parental
authority/legal guardian
13. / Type of travel document
/ Ordinary passport
/ Official passport
/ Diplomatic passport
/ Special passport
/ Service passport
( ) / Other travel document (please specify)
14. / Number of travel document
15. / Date of issue
16. / Valid until
17. / Applicants home address
/ Telephone number(s)
18. / Residence in a country other than the country of current nationality
/ No
:.
Yes. Residence permit or equivalent No.
Valid until
19. / Current occupation
20. . / Employer and employers address
and telephone number. For students, name and address of educational institution
B. / PURPOSE OF STAY
21. / Purpose of the stay in Switzerland
/ Employment
/ Family reunion
- / Studies - Education
/ Medical reasons
( ) / Other (please specify)
22. / Duration of the intended stay
/ Indicate number of months
23. / Intended date of arrival
24. / Probable adress in Switzerland
25. / Number of entries requested
/ Single entry
/ Multiple entries
/ Two entries
26. / Previous stays in Switzerland
/ No
.
Yes. From
to
27. :
/ In case of family reunion: relationship with the family
member in Switzerland
/ Child
/ Spouse
/ Dependent ascendant
/ Grandchild
/ Surname
/ First name(s)
/ Date of birth
/ Nationality
: / If the family member is non-Swiss citizen:
indicate type and number of the residence permit
/ Address of the family member
28. / Name and address of employer educational facility - medical facility in Switzerland
29. / Description of the job - education - medical treatment
in Switzerland
30.
/ Travel expenses and costs of living during the applicant's stay are covered
/ by the applicant himself/herself
( )/ by a sponsor (host, company, organisation), please specify
( )
I agree, if deemed necessary, to submit my personal biometric identifiers (fingerprints and photograph) for identification purposes.
.
I declare that to the best of my knowledge the above particulars are correct and complete.
/ Place and date
/ Signature
