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Application for Schengen Visa
Photo
This application form is free
1.
Surname(s) (family name(s))
LIU
2. Surname(s)
at birth (earlier family name(s))
3. First names
HAIWEI
4. Date of
birth
(year-month-day)
1968-01-03
6.
Place and country of birth
NEI MONGGOL
CHINA
7. Current
nationality/ ties
CHINESE
9. Sex
8. Original
nationality (nationality at birth)
Stamp Embassy or
Consulate
F
OR EMBASSY
/
CONSULATE USE
ONLY
Date application :
File handled by :
Supporting documents:
5. ID-number
(optional)
154517
CHINESE
10. Marital status :
Male
Female
11. Father’s
name
LIU ZHIZHANG
13.
Type of passport:
Single
Married
Separated
Divorced
Widow(er) Other
12. Mother’s name
LI LIHUA
O
Valid passport
O
Financial
means
O
Invitation
O
Means of transport
O
Health
insurance
O
Other
Visa :
National
passport
Diplomatic passport
Service passport
Travel document (1951
Convention)
Alien’s passport
Seaman’s
passport
Other travel
document (please specify):
14. Number of
passport
P. 6773124
15.
Issued by
THE MINISTRY OF FOREIGN
AFFAIRS
16. Date
of issue
2006-11-07
17.
Valid until
2011-11-07
18. If you reside in a
country other than your country of origin, have
you permission to return to that
country?
No
Yes, (number and validity)
* 19. Current
occupation
PROJECT MANAGER
12 FUXING AVENUE,BENJING,ONE
+86-10-63936703
21. Main
destination
BELGIUM
24. Number of entries requested
22. Type of Visa :
Airport transit
Short stay
23. Visa :
Individual
Collective
O
Refused
O
Granted
O
LTV
O
A
* 20.
Employer and employer’s address and telephone
number. For students, name and address of
school.
Characteristics of
Visa:
Transit
Long stay
Single entry
Two entries
25. Duration of stay
Multiple entries
Visa is requested for: 30 days
O
B
O
C
O
D
O
D + C
26. Other visas (issued
during the past three years) and their period of
validity
27. In the case of transit, have you an entry
permit for the final country of destination?
Number of
entries
:
O
1
O
2
O
Multiple
Valid
from
To
Valid for :
No
Yes , valid until:
Issuing authority:
*
28. Previous stays in
this or other Schengen states
BELGIUM,
2007
* The questions marked with * do
not have to be answered by family members of EU or
EEA citizens (spouse, child or
dependent ascendant). Family members
of EU or EEA citizens have to present documents to
prove this relationship.
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