THE APPLICANT SHALL APPEAR IN PERSON AT CONSULAR POST IN TEHRAN ON 2013/11/12 12-13 HOURS
Application for Schengen Visa
FOTO
361941
This application is free FOR OFFICIAL USE ONLY
1. Surname (Family name) (x) NIKNAM
Date of application:
2. Surname at birth (Former family name(s)) (x) NIKNAM
3. First name(s) (Given name(s)) (x)
Visa application number:
AMIN
4. Date of birth (day-monthyear) 1979/06/17
5. Place of birth
7. Current nationality
ABADAN
IRAN
Nationality at birth, if different:
6. Country of birth IRAN
8. Sex □X Male
IRAN
9. Marital status □ Single □X Married □ Separated □ Widow(er) □ Other (please specify)
□ Female
□ Divorced
10. In the case of minors: Surname, first name, address (if different from applicant’s) and nationality of parental authority/legal guardian
1819570894
13. Number of travel document T25523881
□ Service passport
14. Date of issue
15. Valid until
2012/11/27
2017/11/28
17. Applican’ts home address and e -mail address
IRAN - AHWAZ -AKHAR ESFALT-DAGHAGHELE STR - NO107
□ Official passport □ Special
16. Issued by IRAN
Telephone number(s) 00986115530063
18. Residence in a country other than the country of current nationality □X Não □ Yes. Residence permit or equivalent……………..................................No ...................... Valid until * 19. Current ocupation BANKER
Name: □ Other File handled by:
Supporting documents: □ Travel document □ Means of subsistence □ Invitation □ Means of transport □ TMI □ Other:
11. National identify number, where applicable
12. Type of travel document: □X Ordinary passport □ Diplomatic passport passport □ Other travel document (please specify):
Application lodge at □ Embassy/consulate □ CAC □ em Prestadores de serviços □ em Intermediários comerciais □ na fronteira
Visa decision: □ Refused □ Issued: □A □C □ LVT □ Valid: From Until Number of entries: □ 1 □ 2 □ Multiple Number of days: