Application for National Visa

This application is free PHOTO

STAMP

Al-LAMI
1. Surname (Family name) (x) For official use only

2. Surname at birth (Former family name(s)) (x) Dátum prijatia žiadosti:

3. First name(s) (Given name(s)) (x) MUSTAFA ALI REBAT Číslo žiadosti:

4. Date of birth (day-month- 5. Place of birth 7. Current nationality Žiadosť podaná:

year) AL BASRAH
6. Country of birth
IRAQI
Nationality at birth, if different
□ na veľvyslanectve/konzuláte
□ v spoločnom vízovom centre
07_10_1994 IRAQ
□ u poskytovateľa služieb
□ u sprostredkovateľského subjektu
8. Sex 9. Marital status □ na hraniciach
□ Male □ Female □ Single □ Married □ Separated □ Divorced
□ Widow(er) □ Other (please specify) Názov:

10. In the case of minors: Surname, first name, address (if different from applicant's) and nationality of □ iné
parental authority/legal guardian
Spis vybavuje:

11. National identity number, where applicable Sprievodné doklady:

□ cestovný doklad
12. Type of travel document □ prostriedky na pokrytie nákladov
□ Ordinary passport □ Diplomatic passport □ Service passport □ Official passport spojených s pobytom
□ Special passport □ Other travel document (please specify): □ pozvanie
□ dopravný prostriedok
13. Number of travel document 14. Date of issue 15. Valid until 16. Issued by □ cestovné zdravotné poistenie
□ iné:
A8539666 20_10_2014 18_10_2022 AL BASRAH
17. Applicant's home address and e-mail address Telephone number(s) Rozhodnutie o víze:
Hay Al-Khadra, Al Basra , Iraq D vízum
email: [email protected] 00964 7716079425 □ zamietnuté
18. Residence in a country other than the country of current nationality □ udelené:
□ No □ Yes. Residence permit of equivalent ……………………………………..
□ Platnosť:
No…………………………….. Valid until …………………………….. Od
*19. Current occupation STUDENT Do

* 20. Employer and employer’s address and telephone number. For students, name and address of Počet vstupov:
educational establishment. □ 1 □ 2 □ viac
University of Kerbala and its address is Freaha, University of Kerbala,
P.O.Box 1125, Kerbala, Iraq. Počet dní:

21. Main purpose(s) of the journey:

□ Permission to reside in the Slovak Republic obtained Iné záznamy:
□ Other (please specify) □ vízum zrušené

22. Member State(s) of destination 23. Member State of first entry in Schengen □ vízum odvolané
THE SLOVAK REPUBLIC THE SLOVAK REPUBLIC
24. Number of entries 25. Duration of the intended stay in SK
□ Single entry □ Two entries Indicate number of days
□ Multiple entries More than 90 days
* The fields marked with * shall not be filled in by family members of EU, EEA or CH citizens (spouse, child or dependent ascendant)
while exercising their right to free movement. Family members of EU, EEA or CH citizens shall present documents to prove this
relationship and fill in fields No 34 and 35.
(x) Fields 1-3 shall be filled in accordance with the data in the travel document.
26. Schengen/national visas issued during the past three years
□ No
□ Yes. Date(s) of validity from ……………………………… to …………………………………….

27. Fingerprints collected previously for the purpose of applying for a Schengen/national visa
□ No □ Yes.
Date, if known
28. Work permit issued, where applicable

Issued by ……………………………………… on ……………………………………………………

29. Intended date of arrival in SK 30. Intended date of departure from SK

Once I finish the high education
* 31. Surname and first name of the inviting person(s) in SK. If not applicable, name of hotel(s) of
temporary accommodation(s) in SK

Address and e-mail address of inviting person(s)/hotel(s)/temporary Telephone and telefax

accommodation(s) telephone:
+421 917 470 507
Studenkom domove Jura Hronca, Bernopecence
Telefax:
ul.1, 811 07 Bratislava Slovensko
+421 2 57 29 45 37
[email protected]
*32. Name and address of inviting company/organisation Telephone and telefax of
Slovak University of Technology in Bratislava company/organisation
t:+421 917 470 507
Address:Vazovova 5 , 812 43 ,Bratislava
fax:+421 2 57 29 45 37
Surname, first name, address, telephone, telefax, and e-mail address of contact person in
company/organisation
Dr. Laura Gressnerova, M.A.manager for concept and development
of education _ Institute of Lifelong Learning/Slovak University of Technology
Vazovova 5, 812 43 Bratislava, Slovak Republic: E-mail:[email protected]
Web: www.stuba.sk
*33. Cost of travelling and living during the applicant's stay is covered
□ by applicant himself/herself □ by a sponsor (host, company, organisation),
please specify ..........................…….……….
Means of support □ referred to in filed 31 or 32
□ Cash □ Other (please specify)
□ Traveller’s cheques
□ Credit card
□ Prepaid accommodation Means of support
□ Prepaid transport □ Cash
□ Other (please specify) □ Accommodation provided
□ All expenses covered
□ Prepaid transport
□ Other (please specify)
34. Personal data of the family member who is an EU, EEA or CH citizen
Surname First name(s)

Date of birth Nationality Number of travel document of ID card

35. Family relationship with an EU, EEA or CH citizen

□ spouse □ child □ grandchild □ dependant ascendant
36. Place and date 37. Signature (for minors, signature of parental
authority/legal guardian)
I am aware that the visa fee is not refunded if visa is refuse.

Applicable in case a multiple-entry visa is applied for (cf. field No 24):

I am aware of the need to have an adequate travel medical insurance for my first stay and any subsequent visits to the territory of the
Slovak Republic.

I am aware of and consent to the following: the collection of the data required by this application form and the taking of my photograph
and, if applicable, the taking of fingerprints, are mandatory for the examination of the visa application; and any personal data concerning
me which appear on the visa application form, as well as my fingerprints and my photograph will be supplied to the relevant authorities of
the Member States and processed by those authorities, for the purposes of a decision on my visa application.

Such data as well as data concerning the decision taken on my application or a decision whether to annul, revoke or extend a visa issued
will be entered into, and stored in the visa information system for a maximum period of five years, during which it will be accessible to the
visa authorities and the authorities competent for carrying out checks on visas at external borders and within the Member States,
immigration and asylum authorities in the Slovak Republic and in the Schengen Member States for the purposes of verifying whether the
conditions for the legal entry into, stay and residence on the territory of the Slovak Republic and of the Schengen Member States are
fulfilled, of identifying persons who do not or who no longer fulfil these conditions, of examining an asylum application and of
determining responsibility for such examination. Under certain conditions the data will be also available to designated authorities of the
Schengen Member States and to Europol for the purpose of the prevention, detection and investigation of terrorist offences and of other
serious criminal offences. The authorities of the Slovak Republic responsible for processing the data are: Ministry of Foreign Affairs of the
Slovak Republic, Hlboká cesta 2, 833 36 Bratislava 36 and Ministry of Interior of the Slovak Republic, Border and Alien Police Bureau,
Vajnorská 25, 812 72 Bratislava 3.

I am aware that I have the right to obtain notification of the data relating to me recorded in the visa information system and to request that
data relating to me which are inaccurate be corrected and that data relating to me processed unlawfully be deleted. At my express request,
the authority examining 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 corrected or deleted, including the related remedies according to the national law of the Slovak Republic.
The national supervisory authority that will hear claims concerning the protection of personal data is: The Office for Personal Data
Protection of the Slovak Republic, Odborárske námestie 3, 817 60 Bratislava 15.

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
law of the Slovak Republic.

I undertake to leave the territory of the Slovak Republic before 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 Slovak Republic or the European territory of the Schengen Member 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 Article 5(1) of Regulation (EC) No 562/2006 (Schengen Borders Code) and I am therefore refused entry. The prerequisites for entry will
be checked again on entry into the Slovak Republic or the European territory of Schengen Member States.

Place and date Signature

(for minors, signature of parental authority/legal guardian)