(also serves to inform applicants pursuant to Section 54 (2) 7 in conjunction with Section 53 of the Residence Act)

Please fill in the following form to confirm whether you fulfil the entry requirements.
This form is used by all applicants and by no means indicates that certain countries
or you personally are considered suspect.

Your answers could have consequences with regard to the visa application process
and/or the curtailment of a future stay in Germany.

A foreigner can be expelled from Germany if he or she, in response to questions designed to dispel any doubts regarding entry or continued residence, fails to reveal previous stays in Germany or other states, or knowingly furnishes the German mission abroad with false or incomplete information, or no information at all, on key
points regarding links with persons or organisations suspected of supporting terrorism or of posing a threat to the liberal democratic order or the security of the Federal
Republic of Germany.

Please answer the following questions:

1. Have you been to the Federal Republic of Germany or another European Union
country within the past three years? (Airport transits need not be mentioned.)
 No
Yes

If yes, please state where you have been (main destination), giving the dates
(month/year) and purpose of each visit:

2. Have you been to any of the following countries or regions within the past three
years? (Airport transits need not be mentioned.)
 Afghanistan
 Algeria
 Bahrain
 Egypt
 Indonesia
 Iran
 Iraq
 Yemen
 Jordan
 Kashmir
 Qatar
 Kuwait
 Lebanon
 Libya
 Mali
 Morocco
 Mauritania
 Niger
 Nigeria
 Northern Caucasus (Chechnya, Dagestan, Ingushetia, North Ossetia, Karachai-Cherkessiya, Kabardino-Balkaria)
 North Korea
 Oman
 Pakistan
 Palestine
 Philippines
 Saudi Arabia
 Somalia
 Sri Lanka
 Sudan
 South Sudan
 Syria
 Tunisia
 Uzbekistan
 United Arab Emirates

Please mark the appropriate box for each of the following statements:

3. I have never visited another country (including Germany) using another identity or
nationality.
 True
 False – please give Details

4. I have no identity documents under another identity.
 True
 False – please give Details

5. I am not and never have been a member of a non-state armed group; I do not
have and have never had any contact with such a group.
 True
 False – please give Details

6. I have never, in my home state or another country, been charged with or convicted
of membership of a non-state armed group.
 True
 False – please give Details

7. I have never visited a non-state camp for the purpose of paramilitary or military
training. I have never tried to attend such a camp nor have I ever been asked to go to
such a training camp.
 True
 False – please give Details

8. I have never planned or conducted terrorist activities or been involved in the plan-
ning or conduct of such activities.
 True
 False – please give Details

In signing this document, you certify that you have been informed of the legal consequences of furnishing false or incomplete information in the visa application process.
_______________________
Place, date, signature

Information provided to applicants pursuant to Section 54 (2) 8 in conjunction
with Section 53 of the Residence Act

A foreigner can be expelled if he or she has furnished false or incomplete information
in order to gain a German residence permit or a Schengen visa.

The applicant is obliged to provide all information to the best of his or her knowledge
and belief. If he or she refuses to provide data or knowingly furnishes false or incom-plete information, the visa application may be refused or, if a visa has already been issued, the applicant may be expelled from Germany. In signing this document, the applicant certifies that, before submitting the application, he or she was informed of
the legal consequences of refusing to provide data or furnishing false or incomplete
information in the visa application process.
_______________________
Place, date, signature