To the Visa Officer in the Embassy of Italy in Dublin
Exercising the right to rectify or cancel personal data inserted into the Visa Information System (VIS) (in applicaton of art. 7 of the Privacy Code, art. 38 of the VIS Regulations)
the undersigned (name and surname)
…………………………………………………………………………………………………………………..,……………………………………………………….
Nationality ……………………………………………… born in ……………………………………………….. on ……………………………………….
who obtained an entry visa for Italy on ……………………………….. (sticker number ………………………………….)
or
who has requested a visa for Italy with visa application n. …………………………………………….…….
with the present form requests
the CORRECTION of his/her own incorrect data or the CANCELLATION of the data registered illegitimately in the Visa Information System (VIS) for the following reasons:
…………………………………………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………………………………………
Awaiting a kind reply he/she requests to be informed via one of the following means:
□ Postal address ………………………………………………………………………………………………………………........................................
□ Telephone:…………………………………………………………………..…… □ Fax:……………………………………………………………………….
□ E-mail:………………………………………………………………………………………………….……………………………………………………………….
Date, Signature
____________________________
Attachments:
1) Copy of a valid identity document
2) Copy of a proxy to represent the applicant