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EMBASSY OF THE REPUBLIC OF CYPRUS

FOR EMBASSY USE ONLY APPLICATION FOR VISA
S / M T /B /F/O PV: CY / SCH ‫ﺍﺳﺘﻤﺎﺭﺓ ﻁﻠﺐ ﺗﺄﺷﻴﺮﺓ‬
Val:

F: S:
Photo
ER / E / U OWN / IN-C / IN-P / HOT ‫ﺻﻭﺭﺓ‬

Note:

This application form is free

‫ﻫﺫﻩ ﺍﻻﺳﺗﻣﺎﺭﺓ ﻣﺟﺎﻧﻳﺔ‬

1.Surname(s) (as on travelling document) / ‫ﺍﻟﺷﻬﺭﺓ‬

2. First name(s) (as on travelling document) / ‫ﺍﻻﺳﻡ‬

3. Date of birth (dd/mm/yyyy) / ‫ﺗﺎﺭﻳﺦ ﺍﻟﻭﻻﺩﺓ‬ 4. (a) Country of birth / ‫ﺑﻠﺩ ﺍﻟﻭﻻﺩﺓ‬

(b) Place of Birth / ‫ﻣﺣﻝ ﺍﻟﻭﻻﺩﺓ‬

5. Current Nationality/Nationalities / ‫ ﺍﻟﺟﻧﺳﻳﺎﺕ‬/ ‫ﺍﻟﺟﻧﺳﻳﺔ‬ 6. Nationality at Birth if different from current / ‫ﺍﻟﺟﻧﺳﻳﺔ ﻋﻧﺩ ﺍﻟﻭﻻﺩﺓ ﺇﺫﺍ ﻛﺎﻧﺕ ﻣﺧﺗﻠﻔﺔ ﻋﻥ ﺍﻟﺣﺎﻟﻳﺔ‬

8. (a) Mother’s Maiden Name & Surname / ‫ﺍﺳﻡ ﺍﻷﻡ ﻭﺍﻟﺷﻬﺭﺓ‬

7. (a) Father’s Name & Surname / ‫ﺍﺳﻢ ﺍﻷﺏ ﻭﺍﻟﺷﻬﺭﺓ‬

(b) Father’s Nationality / ‫ﺟﻧﺳﻳﺔ ﺍﻷﺏ‬ (b) Mother’s Nationality / ‫ﺟﻧﺳﻳﺔ ﺍﻷﻡ‬

9. Sex / ‫ﺍﻟﺟﻧﺱ‬ 10. Marital status / ‫ﺍﻟﺣﺎﻟﺔ ﺍﻟﺷﺧﺿﻳﺔ‬

Male / ‫ﺫﻛﺭ‬ Single / ‫ﺃﻋﺯﺏ‬

Married / ‫ﻣﺗﺄﻫﻝ‬
Female / ‫ﺍﻧﺛﻰ‬
Other / ‫( ﻏﻳﺭ ﺫﻟﻙ‬Please Specify) (‫ )ﺍﻟﺭﺟﺎء ﺍﻟﺗﺣﺩﻳﺩ‬:

11. (a) Spouse’s Name & Maiden Surname / ‫ﺍﺳﻡ‬ 12. (a) Spouse’s Nationality / (‫ﺟﻧﺳﻳﺔ ﺍﻟﺯﻭﺝ)ﺓ‬
‫ﺍﻟﺯﻭﺝ)ﺓ( ﻭﺍﻟﺷﻬﺭﺓ‬

(b) Spouse ’s Country & Place of Birth / (‫ﺑﻠﺩ ﻭﻣﺣﻝ ﻭﻻﺩﺓ ﺍﻟﺯﻭﺝ)ﺓ‬
(b) Spouse’s Date of Birth / (‫ﺗﺎﺭﻳﺦ ﻭﻻﺩﺓ ﺍﻟﺯﻭﺝ)ﺓ‬

14. Children’s Date of Birth /‫ﺗﺎﺭﻳﺦ ﻭﻻﺩﺓ ﺍﻷﻭﻻﺩ‬

13. Children’s Names / ‫ﺍﺳﻤﺎء ﺍﻷﻭﻻﺩ‬

1- 1-

2- 2-

3- 3-

4- 4-

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15. (a) Current occupation / ‫ﺍﻟﻣﻬﻧﺔ ﺍﻟﺣﺎﻟﻳﺔ‬ 16. Employer ‘s details / ‫ﺻﺎﺣﺏ ﺍﻟﻌﻣﻝ‬

(a) Name / ‫ﺍﻻﺳﻡ‬

(b) Address / ‫ﺍﻟﻌﻧﻭﺍﻥ‬

(b) Monthly Salary / ‫ﺍﻟﺭﺍﺗﺏ ﺍﻟﺷﻬﺭﻱ‬

(c) Telephone & Email / ‫ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ ﻭﺍﻟﺑﺭﻳﺩ‬

17. Residence in a country other than the country of 18. Residence Permit / ‫ﺗﺻﺭﻳﺢ ﺍﻹﻗﺎﻣﺔ‬
current nationality / ‫ﺍﻹﻗﺎﻣﺔ ﻓﻲ ﺑﻠﺩ ﻏﻳﺭ ﺑﻠﺩ ﺍﻟﺟﻧﺳﻳﺔ ﺍﻟﺣﺎﻟﻲ‬
(a) Country of Issue / ‫ﺑﻠﺩ ﺍﻹﺻﺩﺍﺭ‬
NO / ‫ﻛﻼ‬
(b) Date of Issue / ‫ﺗﺎﺭﻳﺦ ﺍﻹﺻﺩﺍﺭ‬

YES (Residence Permit or Equivalent) / ‫ﻧﻌﻡ )ﺗﺻﺭﻳﺢ‬ (c) Valid Until / ‫ﺻﺎﻟﺢ ﻟﻐﺎﻳﺔ‬
(‫ﺍﻹﻗﺎﻣﺔ ﺃﻭ ﻣﺎ ﻳﻌﺎﺩﻟﻬﺎ‬

19. Type of passport / ‫ﻧﻭﻉ ﺟﻭﺍﺯ ﺍﻟﺳﻔﺭ‬

National Passport / ‫ﺟﻭﺍﺯ ﺳﻔﺭ ﻋﺎﺩﻱ‬

Service Passport / ‫ﺟﻭﺍﺯ ﺳﻔﺭ ﺧﺎﺹ‬

Travel document (1951 Convention) / ‫ﻭﺛﻳﻘﺔ ﺳﻔﺭ‬

Diplomatic Passport / ‫ﺟﻭﺍﺯ ﺳﻔﺭ ﺩﺑﻠﻭﻣﺎﺳﻲ‬

Other travel document (please specify) / ‫ﻏﻳﺭ ﺫﻟﻙ )ﺍﻟﺭﺟﺎء ﺍﻟﺗﺣﺩﻳﺩ‬

21. Issued by (country) / ‫ﺑﻠﺩ ﺍﻹﺻﺩﺍﺭ‬

20. Number of Passport/Travel Doc / ‫ﺭﻗﻡ ﺟﻭﺍﺯ ﺍﻟﺳﻔﺭ ﺃﻭ‬
‫ﻭﺛﻳﻘﺔ ﺍﻟﺳﻔﺭ‬

22. Date of Issue / ‫ﺗﺎﺭﻳﺦ ﺍﻹﺻﺩﺍﺭ‬

23. Valid Until / ‫ﺻﺎﻟﺢ ﻟﻐﺎﻳﺔ‬

24. Main destination in Cyprus / ‫ﻭﺟﻬﺔ ﺍﻟﺳﻔﺭ ﺃﻷﺳﺎﺳﻳﺔ ﻓﻲ ﻗﺑﺭﺹ‬

25. Number of entries requested / ‫ﻋﺩﺩ ﻣﺭﺍﺕ ﺍﻟﺩﺧﻭﻝ ﺍﻟﻣﻁﻠﻭﺑﺔ‬

26. Purpose of travel / ‫ﺍﻟﻐﺭﺽ ﻣﻥ ﺍﻟﺳﻔﺭ‬
Single entry / ‫ﻣﺭﺓ ﻭﺍﺣﺩﺓ‬
Tourism / ‫ﺳﻳﺎﺣﺔ‬
Multiple entries / ‫ﻣﺭﺍﺕ ﻣﺗﻌﺩﺩﺓ‬
Business / ‫ﻋﻣﻝ‬

Other (please specify) :

(‫ﻏﻳﺭ ﺫﻟﻙ )ﺍﻟﺭﺟﺎء ﺍﻟﺗﺣﺩﻳﺩ‬

27. Date of Arrival in Cyprus / ‫ﺗﺎﺭﻳﺦ ﺍﻟﻭﺻﻭﻝ ﺇﻟﻰ ﻗﺑﺭﺹ‬ 28. Date of Departure from Cyprus / 29. Duration of Stay in Cyprus (No. of
‫ﺗﺎﺭﻳﺦ ﺍﻟﻣﻐﺎﺩﺭﺓ ﻣﻥ ﻗﺑﺭﺹ‬ Days) / (‫ﻣﺩﺓ ﺍﻹﻗﺎﻣﺔ ﻓﻲ ﻗﺑﺭﺹ )ﻋﺩﺩ ﺍﻷﻳﺎﻡ‬

30. Previous CYPRUS VISA or SCHENGEN VISA issued during the past three years /
‫ ﺷﻧﻐﻥ ﺗﻡ ﺍﻟﺣﺻﻭﻝ ﻋﻠﻳﻬﺎ ﺧﻼﻝ ﺍﻟﺳﻧﻭﺍﺕ ﺍﻟﺛﻼﺙ ﺍﻷﺧﻳﺭﺓ ﻭﺗﺎﺭﻳﺦ ﺍﻟﺻﻼﺣﻳﺔ‬/ ‫ﺗﺄﺷﻳﺭﺍﺕ ﻗﺑﺭﺹ‬

(a) Cyprus Visa / ‫ﺗﺄﺷﻳﺭﺍﺕ ﻗﺑﺭﺹ‬ YES / ‫ﻧﻌﻡ‬ NO / ‫ﻛﻼ‬

Multiple / ‫ﻣﺗﻌﺩﺩﺓ‬ Single / ‫ﻭﺍﺣﺩﺓ‬

(b) Schengen Visa / ‫ ﺷﻧﻐﻥ ﺗﺄﺷﻳﺭﺍﺕ‬YES / ‫ﻧﻌﻡ‬ NO / ‫ﻛﻼ‬

Multiple / ‫ﻣﺗﻌﺩﺩﺓ‬ Single / ‫ﻭﺍﺣﺩﺓ‬

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31. Accommodation in Cyprus / ‫ﺍﻹﻗﺎﻣﺔ ﻓﻲ ﻗﺑﺭﺹ‬

(a) Own a house / ‫( ﻣﻧﺯﻝ ﻣﻠﻙ‬Copy of Title Deeds/Contract Attached / ‫ ﺍﻟﻌﻘﺩ ﺍﻟﻣﺭﻓﻖ‬/ ‫) ﻧﺳﺧﺔ ﻣﻥ ﺻﻙ ﺍﻟﻣﻠﻛﻳﺔ‬

(b) Inviting person / ‫( ﺩﻋﻭﺓ ﺷﺧﺹ‬Assumption of Responsibility Letter Attached / ‫) ﻣﺭﻓﻖ ﺭﺳﺎﻟﺔ ﺍﻓﺗﺭﺍﺽ ﺍﻟﻣﺳﺅﻭﻟﻳﺔ‬

(c) Inviting company / ‫ ( ﺩﻋﻭﺓ ﺷﺭﻛﺔ‬Invitation Letter & Reservation Attached / ‫) ﻣﺭﻓﻖ ﺭﺳﺎﻟﺔ ﺍﻟﺩﻋﻭﺓ ﻭﺍﻟﺣﺟﺯ‬

(d) Hotel / ‫( ﻓﻧﺩﻕ‬Reservation Attached /‫) ﻣﺭﻓﻖ ﺍﻟﺣﺟﺯ‬

32. Inviting Person, Inviting Company, Hotel in Cyprus / ‫ ﻓﻧﺩﻕ ﻓﻲ ﻗﺑﺭﺹ‬،‫ ﺩﻋﻭﺓ ﺷﺭﻛﺔ‬،‫ﺩﻋﻮﺓ ﺷﺧﺹ‬
(a) Name / ‫ﺍﻻﺳﻡ‬

(b) Address / ‫ﺍﻟﻌﻧﻭﺍﻥ‬

(c) Telephone & Email / ‫ﺭﻗﻡ ﺍﻟﻬﺎﺗﻑ ﻭﺍﻟﺑﺭﻳﺩ ﺍﻻﻛﺗﺭﻭﻧﻲ‬

(d) City - Town / ‫ ﺍﻟﺑﻠﺩﺓ‬- ‫ﺍﻟﻣﺩﻳﻧﺔ‬

33. Personal data of the family member who is an EU, CH or EEA if applicable / ‫ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ ﻷﺣﺪ ﺍﻻﻗﺎﺭﺏ ﻣﻦ ﻣﻮﺍﻁﻨﻲ ﺍﻻﺗﺤﺎﺩ ﺍﻻﻭﺭﻭﺑﻲ ﺃﻭ ﺩﻭﻝ‬
‫ﺍﻟﻤﺠﻤﻮﻋﺔ ﺍﻻﻗﺘﺼﺎﺩﻳﺔ ﺍﻻﻭﺭﻭﺑﻴﺔ ﺃﻭ ﺍﻻﺗﺤﺎﺩ ﺍﻟﻜﻮﻧﻔﺪﺭﺍﻟﻲ ﺍﻟﺴﻮﻳﺴﺮﻱ‬

(a) Name & Surname / ‫ﺍﻻﺳﻡ ﻭﺍﻟﺷﻬﺭﺓ‬

(b) Date of Birth / ‫ﺗﺎﺭﻳﺦ ﺍﻟﻭﻻﺩﺓ‬

(c) Nationality / ‫ﺍﻟﺟﻧﺳﻳﺔ‬

(d) Number of passport / ‫ﺭﻗﻢ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ‬

(e) Family relationship / ‫ﺍﻟﺻﻠﺔ‬

(f) Not applicable / ‫ﻻ ﻳﻧﻁﺑﻖ‬

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 34. I am aware of and consent to the following: any personal data concerning me which appear on this visa application form may be
supplied to the relevant authorities in the Schengen States and processed by those authorities, if necessary, for the purposes of a decision
on my visa application.
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 Republic of Cyprus which deals with the application.
I undertake to leave the territory of the Republic of Cyprus upon 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 territory of the Republic of Cyprus. 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 Cyprus legislation and am thus refused entry. The prerequisites for entry will be checked again on entry into the Republic of
Cyprus.

‫ ﺃﻱ ﺑﻴﺎﻧﺎﺕ ﺷﺨﺼﻴﺔ ﺗﺨﺼﻨﻲ ﺗﻈﻬﺮ ﻋﻠﻰ ﺍﺳﺘﻤﺎﺭﺓ ﻁﻠﺐ ﺍﻟﺘﺄﺷﻴﺮﺓ ﺳﻮﻑ ﺗﻘﺪﻡ ﺍﻟﻰ ﺍﻟﺴﻠﻄﺎﺕ ﺍﻟﻤﺨﺘﺼﺔ ﻓﻲ ﺍﻟﺠﻤﻬﻮﺭﻳﺔ ﺍﻟﻘﺒﺮﺻﻴﺔ ﻭﻣﻦ ﺛﻢ ﻳﻌﻤﻞ ﺑﻬﺎ ﻟﺪﻯ ﺍﻟﺴﻠﻄﺎﺕ‬:‫ﺍﻧﻨﻲ ﻋﻠﻰ ﻋﻠﻢ ﻭﻣﻮﺍﻓﻘﺔ ﻋﻠﻰ ﺍﻻﺗﻲ‬
‫ ﺍﻧﺎ ﺍﻗﺮ ﺑﺄﻥ ﺟﻤﻴﻊ ﺍﻟﻤﺴﺘﻨﺪﺍﺕ‬.‫ ﺭﺑﻤﺎ ﻳﺘﻢ ﺗﺰﻭﻳﺪ ﻫﺬﻩ ﺍﻟﺒﻴﺎﻧﺎﺕ ﻓﻲ ﻗﺎﻋﺪﺓ ﻣﻌﻠﻮﻣﺎﺕ ﻭﺗﺨﺰﻳﻨﻬﺎ ﻓﻲ ﺍﻟﺔ ﺣﺎﺳﺒﺔ ﻣﻤﺎﺛﻠﺔ ﺑﺴﺎﻁﺎﺕ ﺍﻟﺠﻤﻬﻮﺭﻳﺔ ﺍﻟﻘﺒﺮﺻﻴﺔ‬. ‫ﺍﻟﻘﺒﺮﺻﻴﺔ ﺑﻐﺮﺽ ﺍﺧﺬ ﻗﺮﺍﺭ ﺑﺸﺄﻥ ﻁﻠﺒﻲ ﻟﻠﺘﺄﺷﻴﺮﺓ‬
.‫ ﺍﺗﺎ ﺃﺗﻌﻬﺪ ﺑﺘﺮﻙ ﺃﺭﺍﺿﻲ ﺍﻟﺠﻤﻬﻮﺭﻳﺔ ﺍﻟﻘﺒﺮﺻﻴﺔ ﻋﻨﺪ ﺍﻧﺘﻬﺎء ﻣﺪﺓ ﺍﻟﺘﺄﺷﻴﺮﺓ ﻓﻲ ﺣﺎﻝ ﻣﻨﺤﺖ ﻟﻲ‬.‫ﺍﻟﻤﻘﺪﻣﺔ ﻛﺎﻣﻠﺔ ﻭﺻﺤﻴﺤﺔ ﺍﻟﻰ ﺣﺪ ﻋﻠﻤﻲ‬
‫ ﺍﻟﺤﻘﻴﻘﺔ ﺍﻟﻤﻄﻠﻘﺔ ﺍﻥ ﻣﻨﺤﻲ ﻟﻠﺘﺎﺷﻴﺮﺓ ﻻ ﻳﺨﻮﻟﻨﻲ ﺣﻖ ﺍﻟﺘﻌﻮﻳﺾ ﻓﻲ ﺣﺎﻟﺔ ﻋﺪﻡ ﺍﺳﺘﺠﺎﺑﺘﻲ‬.‫ﻟﻘﺪ ﺗﻤﺖ ﺍﻓﺎﺩﺗﻲ ﺑﺄﻥ ﺍﻟﺤﺼﻮﻝ ﻋﻠﻰ ﺍﻟﺘﺄﺷﻴﺮﺓ ﻭﺍﺣﺪﺓ ﻣﻦ ﺍﻟﻤﺘﻄﻠﺒﺎﺕ ﺍﻻﺳﺎﺳﻴﺔ ﻟﺪﺧﻮﻝ ﺍﺭﺍﺿﻲ ﺍﻟﺠﻤﻬﻮﺭﻳﺔ ﺍﻟﻘﺒﺮﺻﻴﺔ‬
.‫ﻟﻠﺘﺪﺍﺑﻴﺮ ﺍﻻﺣﺘﻴﺎﻁﻴﺔ ﺍﻟﻤﻨﺎﺳﺒﺔ ﻭﺭﻓﺾ ﺩﺧﻮﻟﻲ‬
.‫ﺍﻥ ﺍﻟﻤﺘﻄﻠﺒﺎﺕ ﺍﻟﻤﺴﺒﻘﺔ ﻟﻠﺪﺧﻮﻝ ﺳﻮﻑ ﺗﺮﺍﺟﻊ ﻣﺮﺓ ﺍﺧﺮﻯ ﻋﻨﺪ ﺍﻟﺪﺧﻮﻝ ﺍﻟﻰ ﺍﺭﺍﺿﻲ ﺍﻟﺠﻤﻬﻮﺭﻳﺔ ﺍﻟﻘﺒﺮﺻﻴﺔ‬

35. Applicant’s home address / ‫ﻋﻨﻮﺍﻥ ﺳﻜﻦ ﻣﻘﺪﻡ ﻁﻠﺐ ﺍﻟﺘﺄﺷﻴﺮﺓ‬ 36. Telephone number & email/ ‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ ﻭﺍﻟﺒﺮﻳﺪ ﺍﻻﻟﻜﺘﺮﻭﻧﻲ‬

37. Place and date / ‫ﺍﻟﻤﻜﺎﻥ ﻭﺍﻟﺘﺎﺭﻳﺦ‬ 38. Signature (for minors, signature of custodian / guardian)
(‫ ﺍﻣﻀﺎء ﺍﻟﻮﺻﻲ‬:‫ﺍﻻﻣﻀﺎء )ﻟﻠﻘﺎﺻﺮﻳﻦ‬