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APPLICATION FOR CROATIAN

VISA
This application form is free

(x) Isključivo za
1. Surname(s) / Family name(s)
službenu uporabu
Datum podnošenja zahtjeva
(x)
2. Surname(s) at birth

(x)
3. First name(s) Broj zahtjeva u HVIS-u

4. Date of birth 5. Place of birth 7. Current nationality

(day-month-year)
Nationality at birth, if different Zahtjev podnesen u
6. Country of birth
DM/KU
Zajednički centar za
8. Sex 9. Marital status podnošenje zahtjeva
Pružatelj usluga
Male Single Married Separated Divorced Widow(er) Komercijalni posrednik
Granični prijelaz
Female Other (please specify)
Naziv
10. If the application is lodged by a legal guardian: surname(s), name(s), address (if different from
applicant’s) and nationality of a legal guardian
Ostalo

11. National identity number (where applicable)

Zahtjev obradio/obradila
12. Type of travel document

Ordinary passport Diplomatic passport Service passport Special passport

Priložena dokumentacija
Other travel document (please specify) Putna isprava
13. Number of travel document 14. Date of issue 15. Valid until 16. Issued by Sredstva za
uzdržavanje
Poziv
17. Applicant’s home address, e-mail address Telephone number(s) Prijevozno sredstvo
Putno zdravstveno
osiguranje
18. Residence in a country other than the country of current nationality Ostalo

No
Yes. Residence permit or equivalent No Valid until Odluka o vizi
*19. Current occupation Odbijena
Izdana
A C
*20. Employer and employer’s address and telephone number. For students, name and address of
(*)
educational establishment Vrijedi
od .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

do .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..

21. Main purpose of travel Broj ulazaka

Jedan Dva
Tourism Business Visiting friends/family Cultural Sports
Više
Official visit Medical reasons Study Transit Airport transit Broj dana

Other (please specify)

(x) Fields 1 – 3 shall be filled in accordance with the data in the travel document.
 22. Country of final destination 23. Border of first entry

25. Duration of the intended stay or transit (indicate

24. Number of entry requested
number of days)

Single entry Two entries Multiple entries

26. Visa(s) issued during past three years

No

Yes. Country and validity:

Country Valid from until

Country Valid from until
Country Valid from until

27. Fingerprints collected previously for the purpose of visa application

No Yes. Date (if known)
28. Entry permit for the final country of destination, where applicable
Issued by Valid from until
29. Intended date of arrival in the Republic of 30. Intended date of departure from the Republic of
Croatia Croatia

*31. Surname and first name of the inviting person(s) in the Republic of Croatia. If not applicable, name of
hotel(s) or temporary accomodation(s) in the Republic of Croatia.

Address and e-mail address from the inviting person(s) / hotel(s) / Telephone and telefax
temporary accommodation(s)

*32. Name and address of inviting company/organisation Telephone and telefax

Surname, first name, address, telephone, telefax and e-mail address of a contact person in
company/organisation

*33. Cost of travelling and living during the stay is covered by

the applicant himself/herself a host / company /organisation (please specify)

referred to in field 31 / 32 .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. .. ..
Means of support other (please specify) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .... .. ..
Cash Means of support
Traveller’s cheques Cash
Credit card(s) Accommodation provided
Prepaid accommodation All expenses covered during the stay
Prepaid transport Prepaid transport
Other (please specify) Other (please specify)

(*)The fields marked with * shall not be filled in by family members of EU, EEA and CH citizens (spouse, child, or dependent ascendant) while exercising
their right of free movement. Family members of EU, EEA or CH citizens shall present documents to prove this relationship and fill in fields number 34
and 35.
 34. Personal data of the family member who is an EU, EEA or CH citizen
Surname First name

Date of birth Nationality Number of travel document or ID card

35. Family relationship with an EU, EEA or CH citizen

spouse child grandchild dependent ascendant

36. Place and date 37. Signature (for minors and persons deprived of legal capacity,
signature of a legal guardian)

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

Applicable in case a multiple-entry visa is applied for (cf. field No. 24):

I am aware of the need to have an adequate travel medical insurance for my first stay and any subsequent visits to the Republic of
Croatia.

I am aware of and consent to the following: the collection of the data required by this application form and the taking of my photograph
and, if applicable, the taking of fingerprints, are mandatory for the examination of the visa application; and any personal data
concerning me which appear on the visa application form, as well as my fingerprints and my photograph will be supplied to the
relevant authorities of the Republic of Croatia and processed by those authorities, for the purposes of a decision on my visa
application.

Such data, as well as data concerning the decision taken on my application or a decision whether to annual, revoke or extend a visa
issued will be entered into, and stored in the Visa Information System of the Republic of Croatia (HVIS) for a maximum period of five
years. During that time all data will be accessible to the visa authorities and the authorities competent for carrying out checks on visas
at external borders and within the Republic of Croatia, immigration and asylum authorities in the Republic of Croatia for the purposes
of verifying whether the conditions for the legal entry into, stay, and residence on the territory of the Republic of Croatia 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. Under certain conditions the data will also be available to designated authorities of the Republic of
Croatia and to Europol for the purpose of prevention, detection and investigation of terrorist offences and other serious criminal
offences. The authority responsible for processing the data is the Ministry for Foreign and European Affairs of the Republic of Croatia.

I am aware that I have the right to obtain notification of the data relating to me recorded in the HVIS and to request that data relating
to me which are inaccurate be corrected and that data relating to me processed unlawfully be deleted. At my express request, the
authority examining my application will inform me of the manner in which I may exercise my right to check, correct or delete if
inaccurate or illegally processed, any personal data concerning me in HVIS, as well as of the legal remedies according to the law.
Claims concerning personal data protection are dealt by the Croatian Personal Data Protection Agency.

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 Croatia.

I undertake to leave the territory of the Republic of Croatia before 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 Republic of Croatia. 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 the Aliens Act of the
Republic of Croatia (Official Gazette, No. 130/11, 74/13 and 69/17) and I am therefore refused entry. The prerequisites for entry will
be checked again on entry into the territory of the Republic of Croatia.

Place and date Signature (for minors and persons deprived of legal capacity, signature of a
legal guardian)