REPUBLIC OF MALTA PHOTO

Application Form for Long-Stay (D) Visa 3.50cm x 4.50cm

This application form is free

Family members of the EU, EEA, or CH citizens or of UK nationals who are Withdrawal Agreement beneficiaries shall
not fill in fields no.21,22,30,31 and 32 (marked with*).

Fields 1-3 shall be filled in in accordance with the data in the travel document.

1. Surname (Family name): N/A FOR OFFICIAL USE ONLY

Date of application:
2. Surname at birth (Former family name(s)): N/A Application number:

3. First name(s) (Given name(s)): THOMAS Application lodged at:

□Embassy/consulate
4. Date of birth (day-month-year): 5. Place of birth: 7.Current nationality: □ Service provider
22-05-1998 INDIAN
BAJWARA KALAN, PUNJAB Nationality □ Commercial
at birth, intermediary
6. Country of birth: if different: N/A
□ Border (Name):
INDIA
Other nationalities: ………………
□ Other:
N/A
8. Sex: File handled by:
9. Civil status:

□ Single Supporting documents:

□ Male □ Travel document
□ Married □ Means of subsistence
□ Female □ Invitation
□ Registered Partnership
□ TMI
□ Separated □ Means of transport
□ Other:
□ Divorced
Visa decision:
□ Widow(er)
□ Refused
□ Other (please specify): □ Issued:

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):
N/A
□ Valid:
From:
11. National identity number, where applicable:
Until:
739235832177
12. Type of travel document: Number of entries:
□ 1 □ 2 □ Multiple

□ Ordinary passport
Number of days:
□ Diplomatic passport
□ Service passport
□ Official passport
□ Special passport □ Other travel document (please specify):
13. Number of travel 14. Date of issue: 15. Valid until: 16. Issued by
document: 25-05-2018 24-05-2028 (country):
S2478897 REPUBLIC OF
INDIA

17. Personal data of the family member who is an EU, EEA, or CH citizen or a UK national who is
a Withdrawal Agreement beneficiary, if applicable: N/A

Surname (Family name): First name(s) (Given name(s)):

Date of birth (day month year): Nationality: Number of travel document or

ID card:

18. Family relationship with an EU, EEA or CH citizen or a UK national who is a Withdrawal
Agreement beneficiary, if applicable:

□ spouse
□ child
□ grandchild
□ dependent ascendant
□ Registered Partnership
□ other

19. Applicant's home address and e-mail Telephone no.:

address:
VPO BAJWARA KALAN, HOSHIARPUR
PIN:146023, PUNJAB, INDIA +91-9914786590

EMAIL :-
[email protected]

20. Residence in a country other than the country of current nationality:

□ No
□ Yes. Residence permit or equivalent ………………… No. …………………….. Valid
until……………

*21. Current occupation:

ADMINSITRATIVE ASSISTANT
* 22. Employer and employer’s address and telephone number. For students, name and address of
educational establishment:
TARGET IELTS ACADEMY 1ST FLOOR GURU NANAK COMPLEX, HOSHIARPUR
146001,PUNJAB, INDIA
+91-9653378800, [email protected]
23. Purpose(s) of the journey:
□ Tourism
□ Business s
□ Visiting family or friends
□ Cultural
□ Sports
□ Official visit
□ Medical reasons
□ Study
□ Airport transit
□ Other (please specify):
24. Additional information on purpose of stay:

FOR HIGHER EDUCATION IN MALTA

25. Member State of main destination (and other 26. Member State of first entry:
Member States of destination, if applicable): MALTA
MALTA

27. Number of entries requested:

□ Single entry
□ Two entries
□ Multiple entries

Intended date of arrival of the first intended stay in the Schengen area: 16-05-2024

Intended date of departure from the Schengen area after the first intended stay:
15-05-2025

28. Fingerprints collected previously for the purpose of applying for a Schengen visa:

□ No
□ Yes
Date, if known …………………….. Visa sticker number, if known
…………………………………………………………

29. Entry permit for the final country of destination, where applicable:

Issued by ………………………………..

Valid from ……………………until ……………………

* 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):
VELLA ZARB
Address and e mail address of inviting Telephone no:
person(s)/hotel(s)/temporary accommodation(s):
52, Palazzo Spadafora FL-1, Triq II Kbira, +356 99682198
Malta
[email protected]

*31. Name and address of inviting company/organisation:

GATEWAY INSTITUTE OF LEARNING
7/9- TRIQ DUN GEJTANU MANNARINO,BIRKIRKANA BKR9080,MALTA
Surname, first name, address, telephone no, and Telephone no of company/organisation:
e mail address of contact person in +356- 27032850 , +356- 99682198
company/organisation:
Douglas Stevenson,7/9 - Triq Gejtanu
Mannarino Birkirkara BKR9080 ,Malta
+356- 27032850 , +356- 99682198
[email protected]
*32. Cost of travelling and living during the applicant’s stay is covered:

YES
□ by the applicant himself/herself □ by a sponsor (host, company, organisation),
Means of support: please specify:
□ Cash ……. □ referred to in field 30 or 31 /
□ Traveller’s cheques ……. □ other (please specify): /
□ Credit card Means of support:
□ Pre-paid accommodation □ Cash
□ Pre-paid transport □ Accommodation provided
□ Other (please specify): □ All expenses covered during the stay
□ Prepaid transport
EURO 10040 □ Other (please specify):

I am aware that the visa fee is not refunded if the visa is refused.
YES

I am aware of the need to submit all requested documentation in line with the applicable checklist,
depending on the purpose of my travel. YES
I am aware of and consent to the following:
- the collection of the data required by this application form and YES
- 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 in Malta and processed 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 the National Visa
Information System (N-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 the external
borders, immigration and asylum authorities in Malta for the purposes of verifying whether the
conditions for the legal entry into, stay and residence on the territory of Malta 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.

Personal data will be processed in accordance with the General Data Protection Regulation EU
2016/679.

I am aware that I have the right:

- to obtain a notification of the data relating to me recorded in the N-VIS; YES
- to know to which authorities within Malta my data has been transmitted, and
- to request that data relating to me which is inaccurate, be corrected and in case such data is processed
unlawfully, be deleted.
- that 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 laws of Malta.

The Office of the Information and Data Protection Commissioner (IDPC) 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 applicable laws of
Malta.
Place and date: Signature:
(Signature of parental authority/legal guardian, if
PUNJAB,INDIA applicable):

DATE:- 28-03-2024