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Checklist Medical Treatment Visa
| DOCUMENTS TO BE SUBMITTED ( A4 size only) | Original | Copy |
1. Application form Fully completed in German, English or Indonesian language version through e-application VIDEX https://videx.diplo.de, printed out and signed by the applicant | 1 | 0 |
| 2. Contact Consent Form | 1 | 0 |
3. Passport:
| 1 | 1 |
4. Recent photograph: Photograph requirements as follows:
Sample chart: https://www.bundesdruckerei.de/system/files/dokumente/pdf/Sample-Photos-For-ID-Documents.pdf | 1 | 0 |
5. Travel health insurance
List of companies in Indonesia providing travel insurances that comply with the Schengen Visa Code requirements:
| 0 | 1 |
6. Travel Itinerary including
| 0 | 1 |
| 0 | 1 |
7. Medical documents For patient:
| 0 | 1 |
| 1 | 1 |
For escort:
| 1 | 0 |
| 0 | 1 |
8. Proof of the current employment situation of the applicant in Indonesia
| 1 | 1 |
| 1 | 1 |
| 1 | 1 |
| 0 | 1 |
9. Proof of financial means of the applicant in Indonesia: e.g. personal bank or savings account statements of at least the past 3 months, personal property, assets etc.
| 1 | 1 |
10. Funding of the trip (only required, if costs aren’t born solely by the applicant) Funds provided by parents/ family member: Bank account statements of the last three months or saving account as well as written declaration of sponsorship and proof of kinship (for example birth certificate or family card). OR | 1 | 1 |
Funds provided by the host: Formal obligation (Verpflichtungserklärung) of the host under the terms of §§ 66–68 of the German Immigration Act (Aufenthaltsgesetz). The formal obligation (Verpflichtungserklärung) has to be declared at the local immigration office inGermany. | 1 | 1 |
| 11. Proof of marital status / family status: Up to date family card (kartu keluarga), not older than 6 months | 1 | 1 |
12. Children below 18 years of age. Both parents/legal custodians have to appear in person for the child`s visa application and submit the following documents:
If one parent / legal custodian is residing abroad, he / she can give the consent to the child’s visa application at a German Embassy/ Consulate General in the country of his / her residence. If one parent/ legal custodian is residing in Indonesia and unable to be present at the time of application, they can provide a consent letter (notarized and with apostille). | 1 | 1 |
The Embassy might request additional documents during the process
REMARKS to be filled in by VFS staff (please tick what is relevant):
Applicant has
□ NO Schengen Visa □ Previous Schengen & National Visa (please attach copies)
Applicant travels
□ alone
□ with family member/s
□ with a group as …………………..(please specify e.g. colleague, friends,...)
Applicant’s documents are □ complete □ NOT complete
Due to incomplete documents,
□ Applicant has been informed of option to withdraw application as to avoid refusal.
□ Applicant wishes to submit application.
Other remarks: …………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………
SIGNATURES and AGREEMENT
a) For Visa Applicant: I HAVE READ AND AGREED TO THE ABOVE FOR THE VISA APPLICATION.
b) For VFS Staff: APPLICANT HAS BEEN INFORMED OF THE ABOVE. THE REMARKS HAVE BEEN COMPLETED TOGETHER WITH APPLICANT.
…………………………………………… ……………………………………………
City and Date (Signature of Applicant)
…………………………………………… ……………………………………………
City and Date (Signature VFS Staff)