Harmonised application form (1) Application for Schengen Visa This application form is free. Photo 1 Surname (Family name) (x) For official use only BRYZHUK . 2 Surname at birth (Former family name(s)) (x) Date of application: BRYZHUK 3 First name(s) (Given name(s)) (x) Visa application number: OLEH 4 Date of birth (day-month-year) 5 18.11.1981 7 Place of birth BERDYCHIV 6 Current nationality Nationality at birth, if different: UKRAINE Country of birth UKRAINE 8 Sex 9 Male Marital status Single Female Married Separated Divorced Widow(er) Application lodged at Embassy/consulate CAC Service provider Commercial intermediary Border Other (please specify) Name: 10 In the case of minors: Surname, first name, address (if different from applicant’s) and nationality of parental authory/legal guardian Other 11 National identity number, where applicable File handled by: BH568280 12 Type of travel document Diplomatic passport Ordinary passport Service passport Official passport Special passport Other travel document (please specify) 13 Number of travel document 14 Date of issue 15 Valid until 16 Issued by ER636199 13.05.2024 1814 13.05.2014 17 Applicant’s home address, e-mail address Telephone number(s) 8 BEREZNEVIY PROV. 13300 BERDYCHIV UKRAINE Oleh.81@mail.ru 0674126331 Supporting documents: Travel document Means of subsistence Invitation Means of transport TMI Other: Visa decision: Refused Issued: 18 Residence in a country other than the country of current nationality A No Yes. Residence permit or equivalent No C Valid until LTV *19 Current occupation MANAGER - Valid *20 Employer and employer’s address and telephone number. For students, name and address of educational establishment. GERMES SEKURITI 6A SOBORNA BERDYCHIV 13300 UKRAINE 0679006040 From Until 21 Main purpose(s) of the journey: Tourism Business Visiting family or friends Cultural Transit Airport transit Other (Please specify) Official visit Medical reasons EC 109 Study SAESON WORK (1) No logo is required for Norway, Iceland and Switzerland. Sports Number of entries: 1 2 Multiple Number of days: 22 Member State(s) of destination 23 Member State of first entry Finland POLAND 25 Duration of the intended stay or transit Indicate number of days 24 Number of entries requested Two entries Single entry 90 Multiple entries 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 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 visa No Yes Date, if known 28 Entry permit for the final country of destination, where applicable Issued by Valid from until 29 Intended date of arrival in the Schengen area 30 Intended date of departure from the Schengen area 01.07.2014 31.12.2014 *31 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) ASIKAINEN JUHA Address and e-mail address of inviting person(s)/hotel(s)/temporary Telephone and telefax accommodation(s) 17 KIURUSAARENTIE 58520 HIUKKAJOKI FINLAND *32 Name and address of inviting company/organisation 0409111585 Telephone and telefax of company/organisation Surname, first name, address, telephone, telefax and e-mail address of contact person in company/organisation ASIKAINEN JUHA 17 KIURUSAARENTIE 58520HIUKKAJOKI FINLAND 0409111585 Juble@mbnet.fi *33 Cost of travelling and living during the applicant’s stay is covered by the applicant himself/herself by a sponsor (host, company, organisation), please specify referred to in field 31 or 32 Means of support Cash Traveller’s cheques other (please specify) Means of support Credit card Cash Prepaid accommodation Accommodation provided Prepaid transport All expences covered during the stay Other (please specify) 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 or ID card 35 Family relationship with an EU, EEA or CH citizen spouce child 36 Place and date grandchild dependent ascendant 37 Signature (for minors, signature of parental authority/legal guardian) 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 (cf. field No. 24): I am aware of the need to have an adequate travel medical insurance for my first stay and 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 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 annual, revoke or extend a visa issued will be entered into, and stored in the Visa Information System (VIS) (1) 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 Ministry for Foreign Affaires of Finland, PO Box 176, 00023 Government, Finland, e-mail: visas.passports@formin.fi 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 State concerned. The national supervisory authority of that Member State (Office of the Data Protection Ombudsman, PO Box 315, 00181 Helsinki, Finland, e-mail: tietosuoja@om.fi) 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 any may also render me liable to prosecution under the law of the Member State which deals with the application. I undertake to leave the territory of the Member States 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 European territory of the Member States. The mere fact that a visa has been granded 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 therfore refused entry. The prerequisites for entry will be checked again on entry into the European territory of the Member States. Place and date (1) In so far as the VIS is operational Signature (for minors, signature of parental authority/legal guardian) ADDITIONAL INFORMATION RefNo : F011253 Personal Information Passport Information Contact Information Occupation Travel Information Inviting Party Travel Costs APPLICANT NAME : OLEH BRYZHUK.