Dpartement fdral de justice et police DFJP

Office fdral des migrations ODM

Domaine de direction Immigration et Intgration
Division Entre et admission

( )
Application for a long stay visa (visa D)

A. / APPLICANT
1. / Surname (Family name)

RSERVE L'USAGE
EXCLUSIF DU SERVICE

Date d'introduction de la
demande:

2. / Surname at birth
3. / First name(s) (given names)

Numro de la demande de
visa :

4. (- - )/ Date of birth (day-month-year)

Demande dpose :
l'ambassade/consulat
au canton

5. / Place of birth

Responsable du dossier:

6. / Country of birth
7. / Current nationality(ies)
( ) / Nationality at birth (if different)
8. / Sex
/ Male

/ Female

Documents justificatifs:
Document de voyage
Attestation de
l'employeur / de l'cole
Documents d'tat civil
Moyens de subsistance
Autres:
Assurance d'autorisation
de sjour

9. / Marital status

/ Single
/ Married
/ Separated
/ Divorced

/ Registered partnership
/ Widow(er)

( )
/ Other (please specify)

Visa D:
Dlivr
Refus
Valable:

10. \ / Father's surname and first name; place and country of birth

du
au

11. \ / Mother's surname and first name; place and country of birth
Nombre d'entres :
1 2 Multiples

12.
/ ) ( : / In the
case of minors: Surname, first name, address (if different from applicants) and nationality of parental
authority/legal guardian

13. / Type of travel document

/ Ordinary passport

/ Official passport

/ Diplomatic passport

/ Special passport
/ Service passport
( ) / Other travel document (please specify)

14. / Number of travel document

15. / Date of issue

16. / Valid until

17. / Applicants home address

/ Telephone number(s)
18. / Residence in a country other than the country of current nationality

/ No

:.
Yes. Residence permit or equivalent No.

Valid until

19. / Current occupation

20. . / Employer and employers address
and telephone number. For students, name and address of educational institution

B. / PURPOSE OF STAY
21. / Purpose of the stay in Switzerland

/ Employment

/ Family reunion
- / Studies - Education
/ Medical reasons
( ) / Other (please specify)

22. / Duration of the intended stay

/ Indicate number of months
23. / Intended date of arrival
24. / Probable adress in Switzerland

25. / Number of entries requested

/ Single entry
/ Multiple entries

/ Two entries

26. / Previous stays in Switzerland

/ No

.
Yes. From

to

27. :
/ In case of family reunion: relationship with the family
member in Switzerland
/ Child
/ Spouse
/ Dependent ascendant

/ Grandchild

/ Surname

/ First name(s)

/ Date of birth

/ Nationality

: / If the family member is non-Swiss citizen:

indicate type and number of the residence permit
/ Address of the family member

28. / Name and address of employer educational facility - medical facility in Switzerland

29. / Description of the job - education - medical treatment

in Switzerland

30.

/ Travel expenses and costs of living during the applicant's stay are covered

/ by the applicant himself/herself

( )/ by a sponsor (host, company, organisation), please specify

( )
I agree, if deemed necessary, to submit my personal biometric identifiers (fingerprints and photograph) for identification purposes.
.
I declare that to the best of my knowledge the above particulars are correct and complete.
/ Place and date

/ Signature