Questionnaire for third-country nationals for enrolment with

Questionnaire for third-country nationals
for enrolment with EasyPASS-RTP
1 Introduction
The following questionnaire is to be completed in order to enrol with the German Registered Traveler
Program EasyPASS-RTP.
2 Personal Data
2.1 Surname: (Name as stated in your passport!)
2.2 Given name: (All names as stated in your passport!)
2.3
2.4
2.5
2.6
2.7
2.8
2.9
Title:
Date of birth (DD.MM.YYYY):
Place of birth:
Country of birth:
Maiden name:
Sex:
Nationality: (Please state all nationalities!)
3 D
etails regarding your travel document
3.1 Type of travel document:
3.2 ID Number:
3.3 Valid till:
3.4 Type of travel document:
3.5 ID Number:
3.6 Valid till:
4 C
riminal record
4.1 A criminal record or other conflicts with the law usually make participation in a Registered
Travellers Program (RTP) difficult.
4.2 Are there any criminal or civil proceedings pending?
If you answered with a „Yes“ in parts 4.2 or 4.3,
YesNo
4.3 Do you have previous convictions?
YesNo
you receive the opportunity to provide information for
clarification to set the record straight and be able to
participate in this program. Please be aware that your
answers will be verified.
4.4 If you answered with a „Yes“ in parts 4.2 or 4.3, please state the reasons:
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5 T
ravel behaviour
5.1 Which German airports are you currently using?
5.2 Average number of flights to and from Germany a year?
To Germany:
From Germany:
6 F
urther details for compliance with the Community Code on the rules governing the
movement of persons across borders in accordance with article 6 of the Regulation
(EU) 2016/399 (Schengen Borders Code)1
6.1 What is your main reason for travelling to Germany?
Tourism
Business trip
Visit family/friends
Official visits
Health issues
Other (please explain)
6.2 Where do you usually stay overnight while in Germany?
Hotel
Family
Friends
Other (please explain)
6.3 By which means do you finance your stays in Germany?
Money in cash
Credit card(s)
My stay is paid by my company/inviting person, e.g.
6.4 Did you conclude a travel health insurance that is valid for the Schengen area?
YesNo
6.5 Have you been removed, deported, banished from or refused entry to Germany or any other
country of the Schengen area within the past 10 years?
YesNo
If you answered this question with „Yes“, state the legal ground for this measure
(otherwise leave a space):
1
The specifications you made concerning Part 6 will not exempt you from answering further questions when actually crossing the border.
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This expulsion measure was a
Removal
Deportation
Banishment
Refusal
from an authority of
the Federal Republic of Germany,
another Schengen country.
Please elaborate on the reasons for being returned:
By signing this document I confirm that the information provided is truthful to the best of my knowledge.
I have taken note of the information provided about the Registered Travelers Program EasyPASS-RTP.
Place, Date
Signature
Interne Vermerke (nicht durch die Antragstellerin/den Antragsteller auszufüllen)
Behörde/Dienststelle
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Declaration of consent for third-country Nationals
for enrolment with EasyPASS-RTP
n I will
voluntarily participate in the Registered Traveler Program, herein after called EasyPASS-RTP, as described
in more detail in the accompanying information.
n I am aware that my personal data from my valid, machine-readable travel document (eMRTD) and the information
from the attached questionnaire will be stored and used in the process.
n The MRTD-data stored in an EasyPASS-RTP database will be used exclusively to enable me to cross the border
from and to Non-Schengen-Area using the semi automated border control system EasyPASS on the airports
where it is implemented. A query of this data in another context of police tasks does not occur.
n I agree to a regular review of my personal data in the police information system (always enclosed with the entry
and exit).
n I can countermand my participation any time with immediate effect and without giving any reason, without any
incurring resulting disadvantages.
n Note: In accordance with Article 8, paragraph 3 of Regulation (EU) 2016/399 (Schengen Borders Code)
nationals of third countries are subject to a thorough check at the Schengen external border, which will be
conducted upon entry and exit.
Privacy Agreement on Data Protection
n Responsible
for the collection, processing and use of data is the Federal Police Headquarters,
Heinrich-Mann-Allee 103, 14473 Potsdam, e-mail: [email protected], which also ensures the
necessary data security.
n The personal data of the applicant/participant in the EasyPASS-RTP process are only used by the Federal Police
and only to carry out the necessary measures in this procedure. For the process unneeded data will be deleted
immediately.
n No personal data will be transmitted to other agencies.
n The request by the authorities of the partner countries in the context of registration for their RTP, if a person is
registered in EasyPASS-RTP, shall be answered with yes or no.
n As soon as an individual participation or the proceeding is terminated, all data stored in the context of
EasyPASS-RTP will be deleted immediately or rendered anonymous in such a manner that a reference to the
person is no longer possible.
Appendix: Information EasyPASS-RTP
With my signature, I certify that I have read the foregoing and the attached Appendix for information and declare my
explicit consent to the type and extent of data use stated above.
Place, Date
Signature
Interne Vermerke (nicht durch die Antragstellerin/den Antragsteller auszufüllen)
Behörde/Dienststelle
Dateneingabe und -speicherung über Web-Anwendung EasyPASS
Datum, Uhrzeit
Name, Amtsbezeichnung, Unterschrift
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