1
PORTUGAL
APPLICATION FOR NATIONAL VISA
(Residence and Temporary Stay)
This application form is free
Fields 1-3 shall be filled in in accordance with the data in the travel document.
1. Surname (Family name):
FOR OFFICIAL USE ONLY
Date of application:
Application number:
2. Surname at birth (Former family name(s)):
3. First name(s) (Given name(s)):
4. Date of birth
(day-month-year):
5. Place of birth:
6. Country of birth:
7. Current nationality:
Nationality at birth, if different:
Other nationalities:
APPLICATION LODGED AT:
☐ Embassy/Consulate /
Vice-Consulate
☐ Service provider
☐ Commercial intermediary
☐ Other:
8. Sex
☐ Male
☐ Female
9. Civil status:
☐ Single ☐ Married ☐ Registered Partnership ☐ Separated
☐ Divorced ☐ Widow(er) ☐ Other (please specify):
10. Parental authority (in case of minors) /legal guardian (surname, first name, address, if different
from applicant’s, telephone no., e-mail address, and nationality):
File handled by:
11. National identity number, where applicable:
Supporting documents:
☐ Travel document
☐ Means of subsistence
☐ Invitation
☐ TMI
☐ Means of transport
☐ Other:
Visa decision:
☐ Refused
☐ Issued:
☐ E ☐ D
Valid:
From:
Until:
12. Type of travel document: ☐ Ordinary passport ☐ Other travel document (please specify):
13. Number of travel
document:
14. Date of issue:
15. Valid until:
16. Issued by
(country):
17. Personal data of the family member who is an EU, EEA or CH citizen if applicable – NOT
APPLICABLE
18. Family relationship with an EU, EEA or CH citizen if applicable:
NOT APPLICABLE
19. Applicant's home address and e-mail address:
Telephone no.:
PHOTO
2
20. Residence in a country other than the country of current nationality:
☐ No ☐ Yes. Residence permit or equivalent ………………… No. ……………………..
Valid until……………
Number of entries:
☐ 2 ☐ Multiple
Number of days:
*21. Current occupation:
*22. Employer and employer’s address and telephone number. For students, name and address of
educational establishment:
23. Purpose(s) of the journey:
☐ Study ☐Training ☐ Work ☐ Familiar Regrouping ☐ Youth mobility ☐ Medical reason/medical
escort ☐ Retired/Religious ☐ Internship/Volunteering ☐ Other (please specify):
24. Additional information on purpose of stay:
25. Member State of main destination (and other
Member States of destination, if applicable):
PORTUGAL
26. Member State of first entry:
27. Number of entries requested:
☐ Two entries (residency) ☐ Multiple entries (temporary stay)
Intended date of arrival of the first intended stay in Portugal:
Intended date of departure from Portugal after the first intended stay:
28. Fingerprints collected previously for the purpose of applying for a Schengen visa
NOT APPLICABLE
29. Entry permit for the final country of destination, where applicable: NOT APPLICABLE
*30. Surname and first name of the inviting person(s) in the Member State(s). If not applicable, name
of hotel(s) or temporary accommodation(s) in the Member State(s):
Address and e-mail address of inviting
person(s)/hotel(s)/temporary accommodation(s):
Telephone no.:
*31. Name and address of inviting company/organisation:
Surname, first name, address, telephone no., and
e-mail address of contact person in
company/organisation:
Telephone no. of company/organisation:
*32. Cost of travelling and living during the applicant’s stay is covered:
3
☐ by the applicant himself/herself
Means of support:
☐ Cash
☐ Traveller’s cheques
☐ Credit card
☐ Pre-paid accommodation
☐ Pre-paid transport
☐ Other (please specify):
☐ by a sponsor (host, company,
organisation), please specify:
…. ☐ referred to in field 30 or 31 ……. ☐
other (please specify):
Means of support:
☐ Cash
☐ Accommodation provided
☐ All expenses covered during the stay
☐ Pre-paid transport
☐ Other (please specify)
I am aware that the visa fee is not refunded if the visa is refused.
Applicable in case a multiple entry visa is applied for:
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 Member
States.
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 application; and any personal data concerning me
which appear on the 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 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 (VIS) 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 Member States for the purposes of verifying whether the conditions for the legal entry into, stay
and residence on the territory of the 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 Member States and to Europol for the purpose of the prevention, detection and investigation of
terrorist offences and of other serious criminal offences. The authority of the Member State responsible for processing the data is: Direção
Geral dos Assuntos Consulares e Comunidades Portuguesas (DGACCP).
I am aware that I have the right to obtain, in any of the Member States, notification of the data relating to me recorded in the VIS and of the
Member State which transmitted the data, 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 Member State concerned. The national supervisory authority of that Member State is the Comissão
Nacional de Proteção de Dados (CNPD), contact details: Rua de São Bento nº. 148 – 3º, 1200-821 Lisboa, (www.cnpd.pt)] will hear claims
concerning the protection of personal data.
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
Portuguese law.
I undertake to leave Portugal 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 Portugal. 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 national legislation applicable – Law n.º 23/07 of 4/07 amended by the Law n.º 102/17 of 28/08 and I am therefore
refused entry. The prerequisites for entry will be checked again on entry into Portuguese territory.
Place and date:
Signature:
(signature of parental authority/legal guardian, if applicable):
