Application for Bulgarian Visa
/this application form is free/ / STAMP OF EMBASSY OR CONSULATE
PHOTO
  1. 1. SURNAME (FAMILY NAME)
  2. SLIEPTSOV
/ FOR VISA ISSUING AUTHORITY USE ONLY
2. EARLIER FAMILY NAMES / SURNAMES AT BIRTH
SLIEPTSOV
3. FIRST NAME
OLEKSANDR / Date of application:
4. DATE OF BIRTH
1968.12.10 / 5. NATIONAL ID-NUMBER (if any)
2518102279 / File handled by:
6. PLACE AND COUNTRY OF BIRTH Zhitomir, Ukraine
7. CITIZENSHIPS
Ukrainian / 8. PREVIOUS CITIZENSHIP
(citizenship at birth) Ukrainian / Supporting documents:
9. SEX
□Male □ Female / 10. MARITAL STATUS:
□Married □ Separated □ Divorced
□ Widow(er) □ Other / □ Valid passport
□ Financial means
□ Invitation
□ Means of transport
□ Health insurance
□ Other
11. FATHER’S NAMES
Fedor / 12. MOTHER’S NAMES
Vera
13. TYPE OF TRANSPORT:
□National passport □ Diplomatic passport □ Service passport
□ Travel document (1951 Geneva Convention)
□ Alien's passport □ Seaman’s passport □ Other travel document (please specify)
14. NUMBER OF PASSPORT
EP832262 / 15. ISSUED BY
8099
16. DATE OF ISSUE
13.03.2013 / 17. VALID UNTIL
13.03.2023
18. IF YOU RESIDE IN A COUNTRY OTHER THAN YOUR COUNTRY OF ORIGIN, DO YOU HAVE PERMISSION TO RETURN TO THAT COUNTRY?
□No □ Yes (number and validity of permission) / Visa:
19. CURRENT OCCUPATION Sports coaches / □ Refused
□ Granted
Characteristics of Visa:
□ LTV
□ A
□ B
□ C
□ D
□ D+C
20. EMPLOYER AND EMPLOYER’S ADDRESS AND TELEPHONE NUMBER
(for students: name and address of school) Federation Taekwon-Do ITF of Ukraine
7/9 Arteleriysky Lane, 03113 Kyiv, Ukraine Tel:+380 44453 42 29, +380453 44 42 30
21. FINAL COUNTRY OF DESTINATION
Bulgaria / 22. TYPE OF VISA:
□ Airport transit
□ Transit
□ Short stay
□ Long stay / 23. VISA:
□ Individual □Group
24. NUMBER OF ENTRIES REQUESTED
□ Single entry □ Two entries □ Multiple entries / 25. DURATION OF STAY
Visa is requested for: 14days / Number of entries:
26. OTHER BULGARIAN VISAS (issued during the past three years) AND THEIR PERIOD OF VALIDITY 22.07.11 – 21.01.12,
04.06.12 – 04.12.12 / □ 1 □ 2
□ Multiple
27. IN THE CASE OF TRANSIT, DO YOU HAVE AN ENTRY PERMIT FOR THE FINAL COUNTRY OF DESTINATION?
□ No □ Yes, valid until: Issuing authority: / Valid from......
To......
Valid for: ....days
28. TRAVELS ABROAD IN THE PAST FIVE YEARS
2003 – Slovakia, 2008 – Croatia, 2011 – Estonia, 2011 – Bulgaria, 2012 – Bulgaria,
2012 – Estonia, 2013 –Slovenia / FOR VISA ISSUING AUTHORITY USE ONLY
29. PURPOSE OF TRAVEL
□ Tourism □ Business □ Private visit □ Cultural/Sports □ Official
□ Medical reasons □ Other (please specify):......
30. DATE OF ARRIVAL
13.07.2013 / 31. DATE OF DEPARTURE
22.07.2013
32. BORDER OF FIRST ENTRY OR TRANSIT ROUTE
Romania / 33. MEANS OF TRANSPORT
Train
34. DETAILS OF HOST PERSON, ORGANIZATION, OR HOTEL
Bulgarian Taekwon-Do ITF Federation, President: Mr. MarioBogdanov
Name of person/Name of organization or hotel
Blagoevgrad 2700, “Dimitar Talev” Str. #5, Bulgaria / Telephone and telefax
+35973833480
Full address
PrincessSofiaHotel, 131 Maria Luisa Blvd. 1202 Sofia, Bulgaria / Е-mail address


35. WHO IS PAYING YOUR TRAVELLING AND LIVING EXPENSES DURING YOUR STAY?
□ Myself □ Host person □ Host organization
(State who and how and present corresponding documentation)......
……………………………………………………………………………………………………
36. MEANS OF SUPPORT DURING YOUR STAY
□ Cash □ Traveller’s cheques □ Credit cards □ Guaranteed accommodation
□ Other:...... □ Travel and/or health insurance. Valid/and until:......
37. SPOUSE’S FAMILY NAME
Serbina / 38. SPOUSE’S PREVIOUS FAMILY NAMES
Shastun
39. SPOUSE’S FIRST NAME
Diana / 40. SPOUSE’S DATE OF BIRTH
1963.02.16 / 41. SPOUSE’S PLACE OF BIRTH
Chernovtsy, Ukraine
42. CHILDREN
Middle name and family name First namе Date of birth
1.
2.
3.
43. PERSONAL DATA OF THE EU OR EEA CITIZEN YOU DEPEND ON
(This question should be answered only by family members of EU and EEA citizens.)
Middle name and family name / First name
Date of birth / Citizenship / Number of passport
Family relationship:...... of an EU or EEA citizen
44. I consent to the following: any data which appear on this application form, my photograph and, if applicable, my fingerprints, will be supplied to the relevant authorities and processed by those authorities for the purposes of the examination of the visa application and a decision on it. Such data, as well as my photograph and my fingerprints, will be entered into and stored in databases..
I declare that the particulars above are correct. I am aware that I incur criminal liability under Bulgarian legislation for making false statements, as well as that this may lead to my application being rejected or to the annulment of a visa already granted.
I undertake to leave the territory of the Republic of Bulgaria upon the expiry of the visa, if granted.
I have been informed that the possession of a visa is not the only condition for entry into the territory of the Republic of Bulgaria.
45. APPLICANT’S HOME ADDRESS
28-b ave.Svobody, 14, Kyiv, Ukraine / 46. TELEPHONE NUMBER
+380503564582
47. PLACE AND DATE
Kyiv 12.06.2013 / 48. SIGNATURE