Application for a Regular Residence Permit without a ... · without a Regular Provisional Residence...

IND5007_M35A/11B

Applicationfor a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay

Nederlandse versieDit aanvraagformulier is ook verkrijgbaar in het Nederlands. Bel met 0900 1234561 (€ 0.10 p.m. plus de kosten voor het bellen met uw mobiele telefoon). Vanuit het buitenland belt u +31 20 8893045. Of kijk op: www.ind.nl om dit formulier aan te vragen of te downloaden.

Please read the explanation on this page and the next carefully before you fill in the form.

Why this form? You can use this form to submit an application for a Dutch Regular Residence Permit (VVR). You can only use this form if one of the following situations applies to you:• YoudonothaveordonotneedaRegularProvisionalResidence

Permit (MVV); or • YouhaveanMVVforaspecificpurposeofstay,butyouwanttoapply

for a residence permit for a another purpose of stay; or • Youwanttochangeyourresidencepermitforaspecificpurposeof

stay into a residence permit for a another purpose of stay; or • Yourpersonalsituationhaschangedandyoumustsubmitanew

application; or • Thesituationofyoursponsorhaschangedandyoumustsubmita

new application. Inallothercases,itisnotpossibletousethisformtosubmitan application. On page 3 of this form you can read which form you must use to submit your application. NB.IfyouwanttostayintheNetherlandsasascientificresearchworkerwithinthemeaningofDirective2005/71/EC,thencontacttheresearchinstitute.Theinstitutemustsubmittheapplicationonyourbehalf.

How to fill in this form Fill in one form for each person for whom an application is being submitted.Theformconsistsof19pagesand21appendices. Tickunder6(page7)theboxstatingthepurposeofstayforwhichyouare submitting an application for a residence permit. Which appendices youhavetofillindependsonyoursituation.Thishasbeenindicatedin the questions and on the appendices. Do not submit this form until

youhavefilledinthisformcompletelyandcollectedalltherequiredevidenceanddocuments,sodonotsubmititinparts.Ifyourapplicationis not complete it cannot be assessed properly. Non-payment or overdue payment and the submission of an incomplete application may slow down the handling of the application. You can only tick one purpose of stay on each application form.

Minor children Ifyouaretheparentorlegalrepresentativeofaminorchild,youcanalsofillinthisformonbehalfofhim/her.Wheretheformrefersto‘you’or‘theapplicant’,thechildismeant.Fillinoneformforeachchild. Please answer all questions on behalf of the child. If the child is 12 years ofageorolder,thenheorshemustsigntheformhimself/herself.Ifthechildisyoungerthan12yearsofage,youdonothavetofillinpoint3,the‘AntecedentsDeclaration’.

NB. It is possible that the minor child has Dutch nationality by operation oflaw,anddoesnotneedaresidencepermitatall.Thismaybethecasein the following situations: • Atthetimethechildwasborn,thechild’sfatherwaslivinginthe

Netherlandsandhisfather’sfatherormotherwaslivinginthe Netherlands when he was born himself; or

• Atthetimethechildwasborn,thechild’smotherwaslivingintheNetherlandsandhermother’sfatherormotherwaslivingintheNetherlands when she was born herself.

For more information you can contact the migration/immigration desk orthePopulationAffairsDepartmentinthemunicipalityofyourplaceofresidence.

Have you been staying with your spouse or partner or registered partner foraperiodofthreeyearsorlonger?Haveyouhad,foraperiodofthreeyearsorlonger,aresidencepermittostaywithapersonwhoispermittedto stay in the Netherlands permanently or with a Dutch national? In that case,youmayqualifyforaresidencepermitforthepurposeofcontinuedresidence.Theadvantageofaresidencepermitforcontinuedresidenceisthattheextensionoftheperiodofvalidityofthisresidencepermit

– Signature of the foreign national (the applicant)

Name

City/Town and date

Signature

I have filled in this form truthfully. I know that, for the purpose of implementing the Aliens Act 2000, the personal data filled in will be processed and passed on to the institutions that require these details for this purpose. I will immediately inform the IND of any changes in the situation that relates to the residence permit.

|City/Town Day month year

| Number

| | I submit this form and of appendices/documents in evidence

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doesnotdependonyourfamilysituation.Theresidencepermitforcontinuedresidenceisthereforealsocalledan‘independent’residencepermit.

How to submit this application Beforeyousubmittheapplication,call09001234561(€0.10perminute plus any additional costs charged by your operator if you are calling from a mobile phone) to make an appointment with the IND deskinyourregion.TheINDemployeewilltellyouwhichinformationyou must bring with you to the appointment. Each person submitting an application must be present when the application is being submitted. You must bring the originals of all the required evidence and documents withyou.TheINDverifiesthesedocumentsandmakescopiesofthem,afterwhichtheINDwillreturnalloriginaldocumentstoyou.Thecopieswill be added to your application.

IND desks TheINDhasdesksinZwolle,Utrecht,Rijswijk,DenHaag,Rotterdam,Eindhoven,DenBosch,Amsterdam,andHoofddorp.Thesearethecities/towns where you must submit your application. Please visit www.ind.nl for the nearest IND desk.

What will happen with your application? Once you have submitted your application at one of the IND desks andyouhavepaidtheapplicationcosts(fees),yourapplicationwillbe assessed by the IND. If your application is not complete it cannot be assessed properly. Non-payment or overdue payment and the submission of an incomplete application may slow down the handling oftheapplication.Accordingtothelaw,theINDmustmakeadecisionon your application within 6 months. You will receive a written notice when the handling of your application has been completed. When your applicationisgranted,youwillreceivealetterwithinformationaboutwhere you can pick up your residence document.

Period of validity of the residence permit YoucanusethisformtosubmitanapplicationforaTemporaryVVR. TheTemporaryVVRisvalidforoneyear,unlessitbecomesevidentwithin that year that you no longer meet the conditions that apply to the purpose of stay you have stated in this application. You must also use this form if you currently have a VVR for study purposes and you want to make use of the so-called orientation year for highly skilled migrants. You can only apply for a VVR for one purpose of stay.

Application costs (charges) Applyingforaresidencepermitcostsmoney.Thesecostsmustbepaidthemomentyousubmittheapplication.Thecostsdependonthepurposeofstayforwhichyousubmitanapplication.Thisformdoesnotincludeanyinformationaboutthecostsorapossibleexemptionfrompayingcharges.Ifyouwanttobeinformedofthecostsinadvance,please visit www.ind.nl or call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile phone) or +31 20 8893045 from outside the Netherlands. If the assessment of your application establishes that you do not qualify for the requested residence permit the money will not be refunded.

Other forms • DoyoualreadyhaveavalidMVVanddoyouwanttoapplyfora

residence permit for the same purpose? In that case use the form ‘ApplicationforaResidencePermitwithanMVV’.

• DoyouhaveBulgarianorRomaniannationality?OrareyouafamilymemberofapersonwithanationalityfromanEU/EEAMemberStateorSwitzerland?Inthosecases,youmay,ifyouwishtodoso,apply foracertificateoflawfulresidenceonthebasisofEULawinsteadofapplyingforaVVR.Inthatcase,donotusethisform,butusetheform‘ApplicationforVerificationagainstEULaw’(certificateoflawful residence).

• AreyouanationaloftheUnionorafamilymemberofanationaloftheUnionandhaveyoustayedintheNetherlandsforacontinuousperiodof5yearsormore?Inthatcase,usetheform‘ApplicationforaPermanentResidencePermitfornationalsoftheUnionandtheir FamilyMembers’.Youcanalsousethisformifyouareanationalofthe

Unionwho,afterhavingworkedasanemployeeoronaself-employedbasis,hasretiredorhastakenearlyretirement,whohasbecome permanentlyunfitforwork,orwhohasworkedasafrontierworker.

• Doyouwanttoextendyourcurrentresidencepermit?Inthatcase,usetheform‘ApplicationforanExtensionoftheResidencePermit’.

• Underspecificconditionsitispossibleforformerlyprivilegedforeignnationals,foreignnationalswhoremigratedwithapplicationof Article8oftheDutchRemigrationAct,andadultindividualswhoqualifyforre-entry,asreferredtoinArticle3.92oftheDutchAliensDecree,toapplyforaPermanentVVR.Inthatcase,usetheform ‘Aanvraag of wijziging verblijfsvergunning regulier voor onbepaalde tijd’.

• Ifyouwanttobeconsideredforaresidencepermitforreasonsthatarebasedonasylum-relatedgrounds,youcannotusethisform.YoumustapplyforasylumattheApplicationCentreinTerApel.Formoreinformationaboutthis,call09001234561(€0.10perminuteplusany additional costs charged by your operator if you are calling from a mobile phone) or +31 20 8893045 from outside the Netherlands.

NB.IfyouwanttostayintheNetherlandsforstudypurposes,the following applies: If you want to attend a higher education course and youdonothaveaprovisionalresidencepermit,thendonotusethisform,butcontacttheeducationalinstitution.Theeducational institution must submit the application on your behalf.

New passport photo, signature, and Appendix ‘Photo Card’ ThisformmustbeaccompaniedbyaPhotoCard,whichisnecessaryformaking your residence permit. Please place your colour passport photo andyoursignatureonthisPhotoCard.Thepassportphotowillbeplacedon a chip on the residence permit. Your signature will also be included on the residence permit.

Requirements of the colour passport photoYourcolourpassportphoto,whichyoumustplaceontheenclosedPhotoCard,mustmeetthefollowingrequirements:• Yourpassportphotomaynothavebeenusedforaresidencepermit

before and it must bear a clear resemblance.• Inaddition,yourpassportphotomustmeettheDutchpassport

requirements.Youcanfindtheserequirementsat www.paspoortinformatie.nl/nederlands/reisdocumenten/pasfoto.

Ifyourpassportphotodoesnotmeettheserequirements,itwillnotbepossibletomakearesidencepermitandissueittoyou.Soitisimpor-tantthatyousendalongaproperpassportphoto.Alwayshaveanewpas-sport photo made by a professional photographer who is familiar with the applicable requirements for passport photos in the Netherlands.

Signature requirementEach person from 12 years or older must place his/her signature on the Photo Card himself/herself.

Bring the Photo Card along when you are submitting your application.

Border-crossing documentWhenyouaregoingtosubmityourapplication,youmustalsobringalongyourborder-crossingdocument(e.g.yourpassport).Astickerwillbeaffixedtothisdocumentandacopywillbemadeofit.Thiscopywillbe added to your application.

Foreign documents AnyofficialforeigndocumentsaboutpersonsthatarerequiredfortheapplicationmusthavebeenlegalisedorprovidedwithanApostillestampbythecompetentauthoritiesoftheissuingcountry.Thismayrelatetodocumentssuchasbirthcertificates,certificatesofunmarriedstatus(notolderthan6months),marriagecertificates,andcourtdecisionsregardingadoptionandguardianship.Thismaytakeagreatdealoftime.We therefore advice you to have the relevant documents legalised or providedwithanApostillestampinthecountryoforiginseveralmonthsbefore submitting the application. For more information about legalisationorApostillerequirementsfordocumentsforeachcountryandanyexceptionstothis,pleasecalltheMinistryofForeignAffairsat(+31)(0)703484844orvisitwww.minbuza.nl/en/Services.

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for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of StayImmigrationandNaturalisationServiceMinistry of the Interior and Kingdom Relations

Application

IND5007_M35A/11B

Language of the documents to be enclosed AlldocumentsmusthavebeendrawnupinDutch,English,French,orGerman.Isthisnotthecase?Ifthisisnotthecase,youmusthaveyour documents translated by a translator who has been sworn in asatranslatorbytheDutchcourt.Submitthetranslation(s)andthedocument(s) together with the application to the IND. If you do not have the document(s) translated in the Netherlands by a translator who hasbeensworninasatranslatorbytheDutchcourt,butabroad,notonlythedocument,butalsothetranslationmusthavebeenlegalisedorprovidedwithanApostillestampbythecompetentauthoritiesoftheissuing country.

Work permit Ifyouwanttoworkasanemployee,youwilloftenneedaworkpermit.Forfurtherinformationabouttheworkpermit,pleasecontactUWVWERKbedrijf (which is the work placement division of the Netherlands EmployeesInsuranceAgency)(www.werk.nl).

Tuberculosis Ifyouwanttobeconsideredforaresidencepermit,youmustfirsttakeatuberculosistestand,ifnecessary,undergotreatment.YoumustprovethiswithanoriginalrecentTuberculosisTestReferenceFormfilledinandsignedbytheDutchMunicipalHealthService(GGD)ifyouare applyingforaresidencepermitforthefirsttime.ThisobligationdoesnotapplytoforeignnationalswhohavethenationalityofanEU/EEAcountry,Australia,Canada,Israel,Japan,Monaco,NewZealand,Surinam,UnitedStatesofAmerica,andSwitzerland.YouarealsonotobligedtoundergoaTBtestifyouhaveoneofthefollowingdocuments:AnEC

1 Details of the foreign national (the applicant)

> Tick the situation that applies to you.

1.1 V-number

1.2 Citizen Service Number (BSN) (if known)

1.3 Name

1.4 Gender

1.5 Home address

1.6 Date of birth

1.7 Place of birth

1.8 Country of birth

1.9 Nationality

1.10 Civil status

1.11 Contact

1.12 Do you have an EC residence permit for long-term residents in another Member State?

residencepermitforlong-termresidentsissuedbyanotherEUMemberStateorifyouareafamilymemberofthelong-termresidentandyouhavealreadybeenadmittedtoanotherEUMemberStateasafamilymember of the long-term resident.

Dutch Personal Data Protection Act UndertheDutchPersonalDataProtectionAct,theINDisobligedtoinform you that the IND is the organisation that processes the data includedinyourapplication.TheINDdoesthistoestablishwhetheryouqualifyforanasylumresidencepermit.TheMinisterforImmigrationandAsylumisresponsibleforthis.Ifyouhaveanyquestionsaboutthisdataprocessing,youcanaskthesequestionsinalettertotheIND, Postbus1200,2280GERijswijk,theNetherlands.Youcanalsosendarequest to the same address asking the IND for an overview of the data processedaboutyou.Withreferencetothisoverview,youmayasktheINDtocorrect,supplement,delete,orblockyourpersonaldata.

More information Please call the IND for more information about this application form oraboutyoursituation.TheINDcanbereachedat09001234561onworking days from 9 a.m. to 5 p.m. (€ 0.10 p/m plus the costs of your mobiletelephone),or+31208893045fromoutsidetheNetherlands, or visit www.ind.nl. You can also go to one of the IND desks. If you want toknowwherethenearestINDdeskis,pleasevisitwww.ind.nlorcall 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile phone) or +31 20 889 3045 from outside the Netherlands.

I am submitting this application (for the maximum period of validity) for myself / my child / the child that I legally represent:

a. n An initial residence permit

b. n Change of the purpose of stay of the residence permit (together with the extension of the validity of the residence permit)

n Yes n No

Surname as it appears in your passport or on your identity papers First names

| |

n Male n Female

Street Number

|

Postal code City/Town

|Day month year

|

|

|

|Telephone number E-mail

|

n Yes n No

(The V-number can be found in previous correspondence from the IND or on your previous residence permit )

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3 Antecedents Declaration

3.1 Tick the situation that applies to you. You only have to fill in this declaration if you (the applicant) are 12 years of age or older.

NB. If you do not fill in this Antecedents Declaration truthfully, this may have consequences for your residence status.

2 Details of the sponsor

2.1 Citizen Service Number (BSN) (if known)

2.2 Name

2.3 Gender

2.4 Home address

2.5 Date of birth

2.6 Place of birth


2.8 Nationality

2.9 Civil status

2.10 Contact

2.11 Residence status

> Fill in only in cases of work/study

2.12 Name of the organisation

2.13 Contact person

a. n I declare the following: – I have never been sentenced to a term of imprisonment - nor have I received a custodial order - for

committing a crime; – I have never been sentenced to perform unpaid work for the benefit of the general public or to

perform community service for committing a crime; – I have never received an unconditional fine for committing a crime; – I have never accepted an out-of-court settlement for committing a crime; – I have never received a punishment order for committing a crime; – I am currently not involved in criminal proceedings for committing a crime; – I have never been responsible for one of the following categories of acts as referred to in Article

1F of the Convention on Refugees of 1951: a crime against peace, a war crime, or a crime against humanity, a serious non-political crime (e.g. murder or an act of terrorism), or acts contrary to the purposes and principles of the United Nations (e.g. acts of terrorism); and

– I am familiar with the fact that a sentence for committing a crime may result in a refusal of a residence application or a termination of residence.

b. n I cannot declare the above for the following reasons:

|

Fill in the required data concerning the sponsor. The sponsor is the person with whom you want to stay or the organisation that will pay for your stay in the Netherlands. If you want to stay in the Netherlands, for example to work, or in preparation of a study, or to attend a course, please fill in the data of the organisation by whom you will be employed or where you will attend a course, and its contact person.


| |

n Male n Female

Street Number

|


|Day month year

|

|

|

|Telephone number E-mail

|

n Dutch nationality n Awaiting the outcome of an application for a residence permit

n None n Privileged n Residence permit

|

|

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Application

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5 Exemption from the Obligation to Have an MVV, and Special Situations

You will usually be required to have a Provisional Residence Permit (MVV) to be able to apply for a Dutch residence permit. You must apply for an MVV in the country of permanent residence. This is your country of origin, or the country where you have been permitted to stay for a period longer than 3 months on the basis of a residence permit. You may enter the Netherlands with a valid MVV. Once in the Netherlands you can use this MVV to apply for a residence permit for the same purpose of stay. In some cases, you do not require a Provisional Residence Permit. The relevant situations are listed and explained below: Please read all the situations before ticking the situation that applies best to you. If your situation is not listed below, you will probably require an MVV.

n I have a valid residence permitThe period of validity is stated on your residence permit. Your application must be accompanied by copies of the front and back of your residence permit.

n I have a nationality that is exempt from the MVV requirement Persons having the nationality of one of the following countries do not require an MVV to apply for a residence permit: Australia, Austria, Belgium, Bulgaria, Canada, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Greece, Germany, Hungary, Iceland, Ireland, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Monaco, New Zealand, Norway, Poland, Portugal, Romania, Slovenia, Slovakia, Spain, South Korea, Sweden, United Kingdom, United States of America, and Vatican City.

n The period of validity of my residence permit has expired The period of validity is stated on your residence permit. If you have not been able to extend or change your residence permit within 2 years from expiry of the document, you must state the reason for this in a separate letter. Only in cases where this was caused by circumstances beyond your control will it not be necessary for you to have an MVV. You must accompany you application by this letter together with as many pieces of evidence and documents as possible to substantiate your story.

n I cannot apply for an MVV in my country of origin for health reasons If, for medical reasons, it is not safe for you to travel to your country of origin, you do not have to apply for an MVV. You must prove this with the following evidence and documents:– The Appendix ‘Declaration on Your Medical Situation’ filled in completely

and signed by your doctor. This declaration may not be older than 1 month. Any changes in your medical situation that may be relevant to taking a decision must be declared in a new medical declaration.

– The Appendix ‘Medical Information Disclosure Consent Form’ filled in completely and signed by you. If several doctors are in charge of your treatment, the consent to contact these doctors must be given separately for each doctor. Your consent must be given with respect to the contact with the doctor(s) in charge of your treatment in the Netherlands as well as the doctor(s) in charge of your treatment in the country of origin;

n I am submitting an application for a residence permit for re-entryA residence permit for re-entry is for former Dutch nationals and foreign nationals who had a residence permit in the Netherlands in the past for many years. If you want to qualify for a residence permit for the purpose of re-entry, you are usually exempt from the MVV requirement. The situations in which you may submit an application for a residence permit for the purpose of re-entry are stated below. For each situation, an indication is given as to whether or not you are exempt from the MVV requirement.– You are a former Dutch national and you were born and raised in the

Netherlands. There is no general exemption form the MVV requirement in this case. It is, however, very probable that you will be exempt from the MVV requirement after all, because you were a lawful resident of the Netherlands as a Dutch national before you were 19 years of age for a period of 5 consecutive years, and you did not change your main residence to a country outside the Netherlands. For more information about this, call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile phone) or +31 20 8893045 from outside the Netherlands).

4 Tuberculosis

The countries that are members of the European Union (EU) are the following: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Greece, Germany, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovenia, Slovakia, Spain, Sweden, and the United Kingdom.The countries that are members of the European Economic Area (EEA) are the following: Liechtenstein, Norway, and Iceland.

If you want to be considered for a residence permit, you must first take a tuberculosis test and, if necessary, undergo treatment. If you are applying for a residence permit for the first time, you must prove that you have taken this test by means of the Tuberculosis Test Reference Form. Several nationalities are exempt from this obligation (see the explanation on the back/page 2 of this form). Tick the situation below that applies to you. If you – as a foster child or as an adopted child – have passed a TB examination in the country of origin and this is evidenced by a recent medical declaration to be submitted along with the application, you do not have to undergo a TB test.

a. n I do not have to undergo a TB test, because I have the nationality of one of the following countries: Australia, Canada, Israel, Japan, Monaco, New Zealand, Surinam, Switzerland, United States of America, the EU/EEA countries.

b. n I do not have to undergo a TB test, because I have a valid EC residence permit for long-term residents issued by another EU Member State, or I am a family member of a long-term resident and I have already been admitted to another EU Member State as a family member of the long-term resident.

c. n I do not have to undergo a TB test, for I was born in the Netherlands and I have not moved my main residence outside the Netherlands since my birth.

d. n I have already undergone a TB test in connection with my first application for a residence permit, and my new application concerns a continuation of that residence.

e. n I have another nationality and n I have already undergone a TB test in the Netherlands: You must accompany your application by an original recent TB Test

Reference Form. This form proves that you have undergone a TB test, but the form may not be older than 6 months; n I have not yet undergone a TB test in the Netherlands: Your application must be accompanied by a signed ‘Declaration of

Intent to Undergo a TB Test’ showing that you are prepared to undergo a TB test. Use the Appendix ‘Declaration of Intent to Undergo a TB test’ for this purpose. You must then make an appointment for this test. You can make an appointment with the Municipal Health Service (GGD) in the region where you are staying (visit www.ggd.nl for more information). Use the Appendix ‘TB Test Reference Form’ for this purpose.

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– You are a former Dutch national and you were born outside the Netherlands. There is no general exemption form the MVV requirement in this case. It is, however, possible that you will be exempted from the MVV requirement for another reason, for example, because you have the nationality of one of the countries to which the MVV requirement does not apply. For more information about this, call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile phone) or +31 20 8893045 from outside the Netherlands).

You do not require an MVV in the following situations:– You are of age and you were a lawful resident of the Netherlands for at

least 10 years when you were between 4 and 19 years of age and you are submitting the application for the purpose of re-entry before you have reached the age of 23 years;

– You are of age or you were a lawful resident of the Netherlands for a period of at least 5 consecutive years before you turned 19 years of age and the Netherlands is the most appropriate country of residence for you;

– You are a minor, your accommodation and representation in the Netherlands have been arranged, and you were a lawful resident of the Netherlands (or as a Dutch national) from the age of 4 years for a period of 10 years;

– You are a minor, your accommodation and representation in the Netherlands has been arranged, and you were a lawful resident of the Netherlands (or as a Dutch national) for a period of 5 years before submitting the application and the Netherlands is the most appropriate country of residence for you;

– You are a former Dutch national and you renounced your Dutch nationality to be able to rely on the provisions of the Dutch Remigration Act;

– You qualify for re-entry on the basis of Article 8 of the Dutch Remigration Act;– You are a former Dutch national and you lost your Dutch nationality because

it was withdrawn because you did not renounce your original nationality;– You are a former Dutch national because you renounced your Dutch

nationality yourself because it would otherwise have been withdrawn because of the failure to renounce your original nationality;

– You have submitted an application to the District Court in The Hague to establish your Dutch nationality and the Minister of Security and Justice does not consider this application utterly unfounded.

– You lived outside the Netherlands due to imprisonment or military service.

n I am staying as a family member with someone who has a privileged status. My family member himself/herself qualifies for a permanent residence permit.

If you are staying - as a family member - with someone with a privileged status and you currently also have a privileged status, you do not require an MVV. This only applies if the family member with whom you are staying submitted an application for a permanent residence permit at the same time as you did. Employees of a foreign diplomatic or consular post or an international treaty organisation, for example, have a privileged status.

n I have worked on a Dutch sea-going vessel or in a mining installation on the continental shelf for 7 years or more.

If you can prove that you have worked on a Dutch sea-going vessel or in a mining installation on the continental shelf for 7 years or more, you do not require an MVV. You must accompany this application by the relevant evidence. n I have Turkish nationality and I have worked legally in the Netherlands

during the past year If you have Turkish nationality and you have worked legally in the Netherlands during the past year, you do not require an MVV, on the basis of an international treaty. This treaty only applies if you want to continue to work as an employee in the Netherlands and you want to apply for a residence permit for this purpose.

n I am a family member or a former family member of a Turkish employee and I lived with this Turkish employee.

If you have lived legally in the Netherlands as a family member of a Turkish employee for three years, you do not require an MVV, on the basis of an international treaty.

n I have Turkish nationality and I want to work in the Netherlands on a self-employed basis

If you have Turkish nationality and you want to work in the Netherlands on a self-employed basis, the MVV requirement will not be enforced against you in advance if you immediately submit a business plan along with your application to work on a self-employed basis, and it is evident that you have sufficient personal experience and that your profession or business has added value to the Dutch economy. If during the handling of your application it becomes evident that you meet all conditions of admission concerning work on a self-employed basis, you do not require an MVV on the basis of an international treaty.

n I was born in the Netherlands, I am 12 years of age or younger and I did not change my main residence to a country outside the Netherlands

A child of 12 years of age or younger that was born in the Netherlands and is part of the family of the sponsor (who also did not change the main residence to a country outside the Netherlands) does not require an MVV. The parent(s) must have been (a) lawful resident(s) in the Netherlands.

n I am a victim or witness reporting human traffickingIf you are a victim or witness reporting human trafficking, you must report to the police. On the basis of this report, you can obtain a residence permit. You are not obliged to submit a separate application for this purpose. You do not require an MVV in this case.

n I have an EC residence permit for long-term residents that was issued by another Member State or I am the principal person’s spouse or partner or registered partner or minor child, and I was admitted to the other Member State as a family member of the long-term resident

If you have an EC residence permit for a long-term resident in another Member State of the EU or if you are the spouse or partner or registered partner or minor child of a person who has an EC residence permit for long-term residents and you formed a family with that person in the other Member State, you do not require an MVV.

n I am the child of someone with an EC residence permit for long-term residents in another Member State. I am unmarried, and of age. I was also admitted to the other Member State as a family member of the long-term resident because I am not capable of supporting myself for health reasons.

If you are the unmarried adult child of someone who has the EC residence permit for long-term residents and you were admitted to the other Member State as a family member of the long-term resident and you are not capable of supporting yourself, in that case your application must be accompanied by evidence of this.

n I cannot leave the NetherlandsIf you cannot leave the Netherlands through no fault of your own, because you do not have a valid border-crossing document and it is not possible for you to obtain replacement documents for valid reasons, you do not require an MVV. Under 20, ‘Residence permit due to absence of all guilt’ on page 16, you will find a list of documents and supplementary evidence by which you must prove this.

n I am a minor child and I have been a lawful resident of the Netherlands for a period of at least 3 years.

You do not require an MVV in the following cases:• youareaminor;and• youhavebeenalawfulresidentoftheNetherlandsforaperiodofatleast

3 years; and • yougotoschool;and• youintendtostaywithaparentwhoisalawfulresidentoftheNetherlands.

n I want to stay with a family member with an asylum residence permit, but my nationality is different from that of this family member

You do not require an MVV in the following cases:• Youaresubmittingtherequestforfamilyreunificationwithinthreemonths

after your family member who is staying in the Netherlands has been granted an asylum residence permit;

• Youcannotstayinacountrywithwhichyouhavespecialties(e.g.yourcountry of origin).

n I cannot leave the Netherlands because this is contrary to Article 8 of the European Convention on Human Rights

If you are of the opinion that you cannot leave the Netherlands because the family life that you have in the Netherlands must be protected by Article 8 of the ECHR, you must accompany this application by evidence showing the ties with the family member who is staying in the Netherlands / the family members who are staying in the Netherlands. You must also set out clearly in which way you give content to this family life. You must also submit evidence showing that you and your family members are capable of supporting yourselves (e.g. by means of an employment agreement, salary slips, etc.). If either you or your family members do not have any means of existence, you must submit evidence showing what you and your family members have undertaken to earn an income or evidence showing that you are unfit for work or that you are exempt from the obligation to seek work.

n OtherYou want to apply for a Dutch residence permit and you do not have a valid or correct MVV. Only if there are special and individual circumstances will you possibly be able to obtain a residence permit without an MVV. This only applies if you cannot be expected to apply for an MVV in your country of origin or a country of permanent residence outside the Netherlands. Explain in a separate letter why this is not possible for you. You must accompany your application by this letter together with as many pieces of evidence and documents as possible to substantiate your reasons.

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6 Purpose of Stay in the Netherlands

Please state the main purpose of your stay in respect of which you are applying for a residence permit. Tick the most important purpose of stay and follow the instruction stated there.

n To stay with a spouse or partner or registered partner or family member or relative

If you want to stay with a spouse or partner or registered partner or family member or relative who lives in the Netherlands> Go to 7 on page 8 and follow the instruction written below this purpose of stay.

n To work as an employee or as a trainee or for the purpose of work experience

If you want to work as an employee or as a trainee or for the purpose of work experience for a Netherlands-based company> Go to 8 on page 12 and follow the instruction written below this purpose of stay.

n To work on a self-employed basis If you want to practise a profession or operate a business in the Netherlands on a self-employed basis> Go to 9 on page 13 and follow the instruction written below this purpose of stay.

n To search for a job as a highly skilled migrant or to start an innovative business after having finished your study, and to make use of the orientation year

> Go to 10 on page 14 and follow the instruction written below this purpose of stay.

n To work on the basis of an international treaty > Go to 11 on page 14 and follow the instruction written below this purpose of stay.

n If you have an EC residence permit for long-term residents issued by another EU Member State

If you have an EC residence permit for long-term residents issued by another EU Member State, you can stay in the Netherlands for the following purposes of stay: To work as an employee> Go to 8 on page 12 and follow the instruction written below this purpose of stay. To work on a self-employed basis> Go to 9 on page 13 and follow the instruction written below this purpose of stay. For study purposes > Go to 13 on page 15 and follow the instruction written below this purpose of stay. For other reasons (other than employment, study or vocational training course)> Go to 12 on page 15 for purpose of stay ‘economically non-active’, and follow the

instruction written below this purpose of stay If none of the above-mentioned purposes of stay apply, but another purpose mentioned in this form applies, follow the instruction written below this purpose of stay.

n For study purposes > Go to 13 on page 15 and follow the instruction written below this purpose of stay.

n For Exchange Purposes If you want to become acquainted with the Dutch society and culture through the ‘Working Holiday Scheme’, the ‘Working Holiday Program’, or through a private organisation> Go to 14 on page 15 and follow the instruction written below this purpose of stay.

n As an au pair If you want to stay in a host family as an au pair to become acquainted with the Dutch society and culture> Go to 15 on page 15 and follow the instruction written below this purpose of stay.

n On religious or ideological grounds If you want to stay in the Netherlands with a religious or ideological organisation> Go to 16 on page 16 and follow the instruction written below this purpose of stay.

n Re-entry If you have lived in the Netherlands earlier, as a Dutch national or with a residence permit> Go to 17 on page 16 and follow the instruction written below this purpose of stay.

n For Medical Reasons If you want to stay in the Netherlands because you must undergo medical treatment here> Go to 18 on page 17 and follow the instruction written below this purpose of stay.

n As a victim or witness reporting human trafficking> Go to 19 on page 17 and follow the instruction written below this purpose of stay.

n Through no fault or action of your own > Go to 20 on page 18 and follow the instruction written below this purpose of stay.

n Continued residence You may qualify for continued residence in the following cases:– You have Turkish nationality and - before submitting the application for

continued residence - you had a residence permit for seeking and performing work whether as an employee or on a self-employed basis after the termination of the marriage;

– You are a minor and you have had a residence permit for at least 1 year to stay with parents or adoption or foster parents;

– Before submitting your application for continued residence you had a residence permit for a period of at least 3 years for the purpose of family reunification or family formation, medical treatment, as an unaccompanied minor foreign national, or because you cannot leave the Netherlands through no fault of your own;

– Before submitting your application for continued residence you had a residence permit to stay with your spouse or partner or registered partner, and your spouse or partner or registered partner has died;

– Before submitting your application for continued residence you had a residence permit to stay with your spouse or partner or registered partner, and you can prove that you are a victim of domestic violence;

– You had a residence permit because you are a victim or witness reporting human trafficking;

– You had a residence permit, but you cannot leave the Netherlands for special circumstances.

> Go to 21 on page 18 and follow the instructions written below this purpose of stay.

n You are a victim of domestic violence, or honour-related violence, or you are a victim of human trafficking, and you cannot or you do not want to report this to the police or render your cooperation in the criminal investigation and prosecution of the human trafficker due to serious threats and/or a medical or psychological impairment.

> Go to 22 on page 19 and follow the instruction written below this purpose of stay.

n You cannot leave the Netherlands because your are stateless or for other reasons

If you do not have a valid travel document and you have not obtained a replacement travel document through no fault of your own. In other cases you do not have to submit supplementary evidence. If the IND has any further questions, you will receive a separate letter after having submitted this form. For more information about this, call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile phone) or +31 20 8893045 from outside the Netherlands.> Go to 23 on page 19.

Otherwise, due to special and individual circumstances Explain in a separate letter for which purpose you are submitting an application for a residence permit. You must accompany your application by this letter together with as many pieces of evidence and documents of the special circumstances to substantiate your reasons. If the IND has any further questions, you will receive a separate letter after having submitted this form.> Go to 23 on page 19.

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7 Residence Permit to Stay with a Spouse or Partner, Registered Partner, Family Member or Relative

Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first.

n You are married to someone or you have a registered partnership with someone (the sponsor) who lives in the Netherlands (320, 324, 340, 344)

Your application must be accompanied by the following supplementary evidence and documents: – Proof of your sponsor’s income, see Appendix ‘Proof of Income’; – An original extract (not a copy) from the Municipal Administration (GBA)

showing your sponsor’s home address and the composition of your sponsor’s family. This extract may not be older than 6 months;

– Copies of all the pages containing the identification details of your sponsor’s Dutch passport or identity card. Also make copies of the pages containing travel stamps. If your sponsor does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.

If it concerns a marriage, you must also submit the following:– A copy of the marriage certificate (see the explanation on ‘Foreign

Documents’ on page 2 and ‘Language’ on page 3 of this form).If it concerns a registered partnership, you must also enclose the following:– A copy of the certificate of registered partnership.If the sponsor has a temporary asylum residence permit and if you have a different nationality from the sponsor, and the application has been submitted three months after the asylum residence permit has been granted to the sponsor, please also submit the following: – Evidence showing that the family life cannot be led in a third country with

which you or the sponsor have special ties. For example proof that you or the sponsor will not be admitted to that country. In that case, you do not have to send along any proof of the income of the sponsor.

> Go to 23 on page 19

n You are the unmarried partner of someone (the sponsor) who lives in the Netherlands (322, 342)

Your application must be accompanied by the following supplementary evidence and documents:– Proof of your sponsor’s income, see Appendix ‘Proof of Income’;– An original extract (not a copy) from the Municipal Administration (GBA)



– The Appendix ‘Sponsor Declaration’ filled in completely and signed by your sponsor;

– Your declaration of unmarried status, originating from your country of origin, or from the country where you are permitted to stay for a period of more than 3 months on the basis of a residence permit (see the explanation ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Your sponsor’s declaration of unmarried status. The declaration of unmarried status must originate from your sponsor’s country of origin, unless your sponsor has Dutch nationality or a permanent residence permit (see the explanation ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– The Appendix ‘Declaration of Relationship’ filled in completely and signed by you and your sponsor;

– The Appendix ‘Questionnaire for a Stay with a Partner’ filled in and signed by you;

If the sponsor has a temporary asylum residence permit and if you have a different nationality from the sponsor, and the application has been submitted three months after the asylum residence permit has been granted to the sponsor, please also submit the following: – Evidence showing that the family life cannot be led in a third country with



n You are a minor child (not born in the Netherlands) and you live at the same address as your parent or your legal representative (the sponsor) (326)




– Your birth certificate or - if the family relationship between you and your sponsor is not evident from your birth certificate - other documents showing that family relationship (see the explanation ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Documents relating to the parental authority the sponsor has over you (if you were born during the marriage of your parents, a birth certificate will suffice);

If you are 15 years of age or older, also submit the following: – An original Appendix ‘Declaration of Non-Impediment’ filled in completely

and signed by you and showing that you are unmarried and that you do not provide for children of your own or for children that depend on you.

If you are a child by a previous relationship of the sponsor, also submit the following – The declaration of consent signed by the parent staying behind in respect of

your departure from abroad (if the parents have joint parental authority); – Copies of the identification document of the parent staying behind;If the sponsor has a temporary asylum residence permit and if you have a different nationality from the sponsor, and the application has been submitted three months after the asylum residence permit has been granted to the sponsor, please also submit the following: – Evidence showing that the family life cannot be led in a third country with



n You are a minor child and born in the Netherlands and since then you have lived at the same address as your parent or your legal representative (the sponsor) (764)

Your application must be accompanied by the following supplementary evidence and documents:– An original extract (not a copy) from the Municipal Administration (GBA)



– Your birth certificate (NB. The document referred to here is copy of the birth certificate from the register of births, deaths, marriages, and registered partnerships. This is different from an extract from the Municipal Administration (GBA)). If your birth certificate does not show the family relationship between you and the sponsor, you must submit other documents showing that family relationship (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form).


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n You are married to someone or you have a registered partnership with someone (the sponsor) who has an EC residence permit for long-term residents This EC residence permit was issued by another Member State. The sponsor is a lawful resident of the Netherlands (that is, with a Dutch residence permit) (320, 324); or

n You are the minor child of someone (the sponsor) who has an EC permit for long-term residents issued by another Member State and who is a lawful resident of the Netherlands (that is with a Dutch residence) (326)

Your application must be accompanied by the following supplementary evidence and documents:– A copy of your residence permit showing that you were admitted to the

other Member State as a family member of the long-term resident (the sponsor);

– Evidence showing that you permanently and independently have sufficient means of existence, whether or not together with the long-term resident, see Appendix ‘Proof of Income’;


n You are the adult child of someone (the sponsor) who has an EC permit for long-term residents issued by another Member State and who is a lawful resident of the Netherlands (that is with a Dutch residence permit) (328)

Your application must be accompanied by the following supplementary evidence and documents:– A copy of your residence permit showing that you were admitted to the

other Member State as a family member of the long-term resident (the sponsor);

– Evidence showing that you permanently and independently have sufficient means of existence, whether or not together with the long-term resident, see Appendix ‘Proof of Income’;

– Evidence showing that leaving you behind in the first Member State would be disproportionally harsh (evidence showing that you are apparently not capable of supporting yourself for health reasons).


n You are a family member of someone in the Netherlands (the sponsor), but your are not the minor child or spouse or partner or registered partner and you live at the same address as your sponsor (330)




– The Appendix ‘Sponsor Declaration’ filled in completely and signed by the sponsor (and, if applicable, his/her spouse or partner or registered partner);

– An original Appendix ‘Declaration of Non-Impediment’ filled in completely and signed by you and showing that you are unmarried and that you do not provide for children of your own or for children that depend on you;

– Your declaration of unmarried status (this declaration of unmarried status must originate from your country of origin) (see the explanation ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Documents showing your family life with the your sponsor before your sponsor took up residence in the Netherlands (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Documents showing your family life with your sponsor after your sponsor took up residence in the Netherlands (see the explanation on ‘Foreign Documents’ and ‘Language’ on page 3 of this form);

– Documents relating to family members with whom you stayed or can stay in the country of origin (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Evidence showing that leaving you behind in the country of origin would be disproportionately harsh (e.g. documents showing that there are no family members left in the country of origin, that you depend on the family members with whom you want to stay in the Netherlands and/or that you are not capable of coping independently in the country of origin (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Evidence relating to the contributions towards the costs of your upbringing, education and living expenses paid by your sponsor from the date your sponsor took up residence in the Netherlands (e.g. deposit receipts or bank statements).

If you are an adult child, also submit the following:– Documents showing the actual parental authority over you (e.g. evidence

showing that the sponsor is or was involved in important decisions concerning your upbringing, education and/or care, including decisions regarding choice of school, housing, and social development);

If the sponsor has a temporary asylum residence permit and if you have a different nationality from the sponsor, and the application has been submitted three months after the asylum residence permit has been granted to the sponsor, please also submit the following: – Evidence showing that the family life cannot be led in a third country with



n You are a family member of a minor foreign national who has a temporary asylum residence permit (the sponsor) (347)

Your application must be accompanied by the following supplementary evidence and documents:– Copies of the front and back of the sponsor’s residence permit;– Evidence showing that you are the sponsor’s blood relative in the ascending

line (father, mother, grandfather, grandmother) (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

If you have a different nationality from your sponsor, also submit the following– Evidence showing that the family life cannot be led in a third country with

which you or the sponsor have special ties. For example proof that you or the sponsor will not be admitted to that country.

If you submit this application more than 3 months after your sponsor was granted a temporary asylum residence permit, also submit the following:– Proof of your sponsor’s income, see Appendix ‘Proof of Income’.If your sponsor has meanwhile reached the age of 18 years, also submit the following:– Evidence that the Dutch Court has appointed a guardian or mentor because

of your sponsor’s mental faculties> Go to 23 on page 19

n You are the father or mother of a child (the sponsor) that lives in the Netherlands and you are 65 years of age or older and you are single. Your sponsor has Dutch nationality, a Dutch permanent residence permit (regular or asylum), or a temporary asylum residence permit (332)

Your application must be accompanied by the following supplementary evidence and documents:– Proof of your sponsor’s income and, if applicable, his/her spouse or partner

or registered partner, see Appendix ‘Proof of Income’;– An original extract (not a copy) from the Municipal Administration (GBA)


– Copies of all the pages containing the identification details of your sponsor’s Dutch passport or identity card (and, if applicable, of the Dutch passport or identity card of your sponsor’s spouse or partner or registered partner). Also make copies of the pages containing travel stamps. If your sponsor (and, if applicable, your sponsor’s spouse or partner or registered partner) does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit(s) or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.

– The Appendix ‘Sponsor Declaration’ filled in completely and signed by the sponsor (and, if applicable, his/her spouse or partner or registered partner);

– Documents showing the family relationship with your sponsor (e.g. a copy of a marriage booklet, a birth certificate, or a family extract from the register of births, deaths, marriages and registered partnerships) (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– The divorce certificate or the death certificate of your spouse or partner or registered partner or the extract from the register of births, deaths, marriages and registered partnerships from the country of origin showing that you are single (this extract may not be older than 6 months);

– Documents showing the original composition of your family (number of children);

– Documents showing the residence data of all your children (where they live).

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If you have other children living in the Netherlands who are sponsoring you, also submit the following:– Proof of income, see Appendix ‘Proof of Income’;– The Appendix ‘Sponsor Declaration’ filled in completely and signed by the

children that are sponsoring you;– Copies of all the pages containing the identification details of their Dutch

passports or identity cards. Also make copies of the pages containing travel stamps. If they do not have Dutch nationality, please make copies of the front and back of the Dutch residence permits or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.


n You are the father or mother of a minor child that lives in the Netherlands and you want to have a family life with this child on the basis of Article 8 of the ECHR (334)

NB. You cannot submit this application if you are cohabiting with a spouse or partner or registered partner, or if you intend to cohabit with this spouse or partner or registered partner with whom you could reside. If you do not comply with this condition and you are submitting this application nevertheless, your application will be tested against the condition for residence with a spouse or partner or registered partner.Your application must be accompanied by the following supplementary evidence and documents:– Copies of all the pages containing the identification details of your minor

child’s Dutch passport or identity card. Also make copies of the pages containing travel stamps. If your minor child does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.

– Evidence showing the family relationship between you and your minor child, e.g. a copy of a birth certificate (see the explanation ‘Foreign documents’ on page 2 and ‘Language’ on page 3 of this form);

– Evidence showing the manner in which you give content to the family life with your minor child.


n You are a foster child of someone (the sponsor) The sponsor lives in the Netherlands (352)

NB. You must be a foster child from a family member. The sponsor may only be the foster child’s grandparent, brother, sister, uncle, or aunt. Your application must be accompanied by the following supplementary evidence and documents:– Proof of your sponsor’s income, see Appendix ‘Proof of Income’; – An original extract (not a copy) from the Municipal Administration (GBA)


– Copies of all the pages containing the identity details of the Dutch passport(s) and identity card(s) of your sponsor and, if applicable, your sponsor’s spouse or partner or registered partner. Also make copies of the pages containing travel stamps. If your sponsor and, if applicable, your sponsor’s spouse or partner or registered partner, do not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages;

– A copy of a medical declaration relating to you issued in the country of origin (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Evidence showing that your parent(s) or legal representative(s) consent to your going to live in the Netherlands with the sponsor. Insofar as required by the country of origin, you must also submit evidence showing that the authorities in the country of origin consent to your taking up residence with the sponsor’s family (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Documents showing the family relationship with your sponsor (e.g. a copy of a marriage booklet, a birth certificate, or a family extract from the register of births, deaths, marriages and registered partnerships) (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– A written statement of reasons of the special circumstances of you or your family members in the country of origin showing that you cannot be taken care of, at least not properly, by the family members who live in the country of origin (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– The Appendix ‘Sponsor Declaration’ filled in completely and signed by your sponsor;

– A certificate (e.g. a guardianship certificate) issued by the competent authorities certifying that the authority over the foster child rests with the foster parents.


n You have not yet been adopted, but will be adopted into your sponsor’s family (350)



– Copies of all the pages containing the identity details of the Dutch passport(s) and identity card(s) of your sponsor and, if applicable, your sponsor’s spouse or partner or registered partner. Also make copies of the pages containing travel stamps. If your sponsor and, if applicable, your sponsor’s spouse or partner or registered partner, do not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages;

– A copy of the Approval in Principle of the Ministry of Security and Justice, Directorate-General for Prevention, Youth and Sanctions;

– A copy of the declaration showing that a licensed adoption placement agency was used. If no use has been made of such licensed adoption placement agency: a Declaration of Approval of the Ministry of Security and Justice, Directorate-General for Prevention, Youth and Sanctions;

– A copy of the official decision of the authority competent in the matter, in the country of origin (e.g. the official judgment of the court in the country of origin) as well as a translation of this decision. This must show that you are permitted to be adopted into the family and that the authorities of the country of origin assent to your adoption by the sponsor (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Documents showing that your parent(s) has/have relinquished you (this approval may be evident from the above-mentioned judgment or from a separate official waiver) (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– A copy of the medical certificate about your state of health, as referred to in the Dutch Placement of Foreign Foster Children Act, recently issued in the country of origin. This certificate may not be older than 6 months (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form).


n You have been adopted immediately into your sponsor’s family following an adoption judgment The sponsor lives in the Netherlands (350)



– Copies of all the pages containing the identity details of the Dutch passport(s) and identity card(s) of your sponsor and, if applicable, your sponsor’s spouse or partner or registered partner. Also make copies of the pages containing travel stamps. If your sponsor and, if applicable, your sponsor’s spouse or partner or registered partner, do not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.

– A copy of the Approval in Principle of the Ministry of Security and Justice, Directorate-General for Prevention, Youth and Sanctions;

– A copy of the declaration showing that a licensed adoption placement agency was used. If no use has been made of such licensed adoption placement agency, a Declaration of Approval of the Ministry of Security and Justice, Directorate-General for Prevention, Youth and Sanctions.

– A copy of the official decision of the authority competent in the matter, in the country of origin (e.g. the official judgment of the court in the country of origin) and a translation of this decision (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– Documents showing that your parent(s) has/have relinquished you (this approval may be evident from the above-mentioned judgment) (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

– A copy of the medical certificate of the foreign national’s state of health, as referred to in the Dutch Placement of Foreign Foster Children Act, issued in the country of origin. This certificate may not be older than 6 months (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

If it concerns an adoption judgment rendered by a foreign authority applying the Hague Adoption Convention, also submit the following; – A conformity statement > Go to 23 on page 19

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n You are a family member of a former privileged person (the sponsor) and you depend on him/her (464, 465, 466, 467)

Your application must be accompanied by the following supplementary evidence and documents:– Proof of your sponsor’s income, see Appendix ‘Proof of Income’. – An official certificate of the Ministry of Foreign Affairs showing that

immediately prior to submitting the application you had a residence permit on the basis of a privileged status as a dependent family member staying with the sponsor;

– Document showing that you cohabit with the sponsor;– Evidence showing that you are running a joint household with the sponsor;– If applicable, the certificate of registration at the Municipal Administration

(GBA) of your marriage or registered partnership;– Copies of all the pages containing the identification details of your sponsor’s

Dutch passport or identity card. Also make copies of the pages containing travel stamps. If your sponsor does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.

– Documents showing the family relationship: - In the case of a spouse: a copy of the marriage certificate; - In the case of a partner or registered partner: documents showing the joint

partnership and the cohabitation in the country of origin; - In the case of a child: a copy of the birth certificate.NB. Under specific conditions, you may qualify for a permanent residence permit. In that case, you must have resided with the sponsor on the basis of a privileged status as a dependent family member for a period of 10 consecutive years immediately before submitting the application. In that case, use the form ‘Application for or Change of a Temporary Regular Residence Permit’> Go to 23 on page 19

n You are a family member of non-privileged NATO personnel (the sponsor) (461, 462, 463)

Your application must be accompanied by the following supplementary evidence and documents:– The Appendix ‘Employer’s Declaration’ filled in completely and signed by

your sponsor’s employer (not older than 3 months);– An original extract (not a copy) from the Municipal Administration (GBA)

showing your sponsor’s home address and the composition of your sponsor’s family. This extract may not be older than 6 months. If your sponsor is not registered at the Municipal Administration (GBA), you must accompany your application by evidence showing that your sponsor’s main residence is in the Netherlands


– Evidence showing your family relationship with the sponsor: - In the case of a spouse: the marriage certificate; - In the case of a child younger than 21 years of age: the birth certificate; - In the case of relations by blood or affinity (also children of 21 years of age

or older): the document showing the family relationship and evidence showing that you depend financially on the sponsor or the sponsor’s spouse or partner or registered partner;

– Evidence showing that the main residence of the sponsor is in the Netherlands.


n You are a family member of someone (the sponsor) with a residence permit to undergo medical treatment (415, 416, 417, 418)

Your application must be accompanied by the following supplementary piece of evidence:– An original extract (not a copy) from the Municipal Administration (GBA)



n You want to visit a family member (the sponsor) in the Netherlands (for a period of longer than 3 months and not more than 6 months) (470)

Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’. If you do not have

sufficient means of existence yourself, the Appendix ‘Sponsor Declaration’ must be filled in completely and signed by your sponsor or another relative of you in the Netherlands

– Proof of your sponsor’s income and, if applicable, his/her spouse or partner or registered partner, see Appendix ‘Proof of Income’;

– An original extract (not a copy) from the Municipal Administration (GBA) showing your sponsor’s home address and the composition of your sponsor’s family. This extract may not be older than 6 months;

– Copies of all the pages containing the identification details of your sponsor’s Dutch passport or identity card. Also make copies of the pages containing travel stamps. If your sponsor does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages;

– Documents showing the family relationship with your sponsor (e.g. a copy of a marriage booklet, a birth certificate, or a family extract from the register of births, deaths, marriages and registered partnerships) (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form).


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8 Residence Permit to work


n As an employee (370)Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’;– If required: A copy of the application for a work permit or a copy of the work

permit itself (see the explanation on page 3 of this form).> Go to 23 on page 19

n For seeking and performing work whether as an employee or on a self-employed basis after the termination of the marriage and you have Turkish nationality (336)

Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that you were married for at least 3 years and that your

marriage has been dissolved– Evidence showing that you have had lawful residence on the basis of the

marriage for at least 1 year (a copy of your residence permit)> Go to 23 on page 19

n If you have an EC residence permit for long-term residents issued by another EU Member State (370)

Your application must be accompanied by the following supplementary evidence and documents:– A copy of the EC residence permit for long-term residents issued by the

other Member State;– Evidence showing that a health insurance policy has been taken out in your

name;– A copy of the application for a work permit or a copy of the work permit

itself (see the explanation on page 3 of this form);– The Appendix ‘Employer’s Declaration’ filled in completely and signed by

your employer (not older than 3 months); or– A copy of the employment agreement, or a draft employment agreement,

which includes information about your income.> Go to 23 on page 19

n As a trainee (374)Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income during your stay as a trainee, see Appendix ‘Proof of

Income’;– If required: A copy of the application for a work permit or a copy of the work

permit itself (see the explanation on page 3 of this form);– A copy of the trainee agreement.If you are going to do a traineeship in the context of the ‘Young Workers Exchange Program’ (YWEP), please also submit the following:– Evidence showing that you have Canadian nationality and that you live in

Canada;– Evidence showing that you are still studying at the moment of submitting

the request or evidence showing that you finished your studies not more than 12 months ago.


n For the purpose of work experience (375)Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income during your stay for the purpose of work experience,

see Appendix ‘Proof of Income’; – A copy of the work experience agreement;– If required: A copy of the application for a work permit or a copy of the work


n As a guest lecturer or paid scientific research worker (394, 395)Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’;– If required: A copy of the application for a work permit or a copy of the work


n As an unpaid scientific research worker (387)Your application must be accompanied by the following supplementary piece of evidence:– A document issued by the grantor or the European Union showing that a

fellowship has been granted to you, or proof of your income, see Appendix ‘Proof of Income’.


n As a director-major shareholder (456)Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’;– If required: A copy of the application for a work permit or a copy of the work

permit itself (see the explanation on page 3 of this form);– Evidence showing that your employer has reported your current

employment agreement to the Tax and Customs Administration;– Proof that your interest in the company is not more than 25% and that you

receive a salary that has been determined by third parties (if your interest is more than 25%, you must apply for a residence permit to work on a self-employed basis).


n As a spiritual leader or as a teacher of religious knowledge (376)Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’;– If required: A copy of the application for a work permit or a copy of the work

permit itself (see the explanation on page 3 of this form);– The Appendix ‘Spiritual Leader/Teacher of Religious Knowledge Awareness

Declaration’ filled in completely and signed by you;– Information about the religious community for which you will perform activities.> Go to 23 on page 19

n As a border-crossing service provider (500)You (the service provider) do not have an EU/EEA nationality, but you live and work in an EU/EEA country and you will be supplying services on the instruction of your employer (the services company) on a temporary basis Your application must be accompanied by the following supplementary evidence and documents:– A copy of your residence permit and a copy of your work permit showing

that you are entitled to stay in the country where the services company has its registered office and that you work there as an employee of the services company (if you have these permits);

– A copy of your employment agreement (with the services company).> Go to 23 on page 19

n After having worked on a Dutch sea-going vessel or in a mining installation on the continental shelf for 7 years or more (382)

Your application must be accompanied by the following supplementary evidence and documents:– A letter stating the reasons why you want to come to the Netherlands (for

work on Dutch territory, or if you wish to spend a leave period in the Netherlands, or due to illness, or due to unemployment);

– Proof of your income, see Appendix ‘Proof of Income’;– Proof of your employment history on board a Dutch sea-going vessel or in a

mining installation on the continental shelf (e.g. a copy of your seaman’s book or employment agreement). In the event that this employment history has been interrupted: documents relating to the duration and reason for this inter-ruption and, if applicable, documents relating to the benefits received by you;

– Proof of the national insurance schemes in connection with your employment in respect of a social security treaty concluded by the Netherlands or in respect of the Dutch national insurance schemes;

– An overview of the periods in which you were unemployed or when you did not work on board a sea-going vessel or in a mining installation on the continental shelf.

– If you want to spend your leave in the Netherlands, also submit the following: - Evidence showing that you spent your leave periods nearly entirely in the

Netherlands during the employment history; - Evidence showing that you will work for at least one year as an employee

on board a Dutch sea-going vessel or in a mining installation on the continental shelf by which you will acquire sufficient means of existence in a sustainable manner.


n If you wish you spend your leave in the Netherlands (only if you work in a mining installation on the continental shelf) (383)

Your application must be accompanied by the following supplementary evidence and documents:– A letter from your employer stating the reason why you require a residence

permit to spend your leave in the Netherlands;– Evidence showing that you will work for at least one year as an employee

in a mining installation on the continental shelf, by which you will acquire sufficient means of existence in a sustainable manner, see Appendix ‘Proof of Income’.


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Application

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9 Residence Permit to Work on a Self-Employed Basis


n To work on a self-employed basis (377)Your application must be accompanied by the following supplementary evidence and documents, in duplicate and not bound:– Proof of your income, see Appendix ‘Proof of Income’;– A copy of a document issued by the Dutch authority competent in this matter

showing that you are qualified to practise a profession or operate a business;– A copy of your business plan, including the following information: - Information about you, the entrepreneur (personal data, family and income

situation, financial obligations, education, and professional experience); - Business information (information about the line of industry in which you

will work, starting date of the enterprise, and place of business); - Legal aspects (legal form of your enterprise, trade name, licences, liability,

insurance, and supply conditions); - Commercial aspects (market potential): •Adescriptionofthetypeofbusinessandproduct(features,application,

need, innovative character, and unique selling points); •Amarketanalysis(descriptionandsizeofthemarket,andpotential

customers/market share), competitors, barriers, co-operations, and risks; •Thepricebreakdown,substantiatedbyagreementsandreferences. - Organisational aspects (description of the organisational structure of your

enterprise, the required competencies, and the number of staff); - Financial aspects (investment budget, financing plan, repayment schedule,

opening balance sheet, balance sheet, operating budget, and liquidity forecast); NB. The business plan must be substantiated by supplementary documents such as annual accounts, tax details, references, etc. The financial documents must have been prepared or assessed by an independent expert. If any new jobs are created, this must be demonstrated by either the contents of the business plan, which must, in particular, show the feasibility of the financial aspects, or by employment agreements.

– A copy of the deed of incorporation showing the powers, responsibilities, and allocation of the profit among the partners (if it concerns a general partnership or a limited partnership).

– A certificate of registration at the Chamber of Commerce– In the case of freelance activities on a self-employed basis: Agreement(s)

for the provision of services showing that you will perform activities on a freelance basis.

It is your responsibility to substantiate your application as much as possible by evidence showing that your enterprise can make a major contribution to the Dutch economy. For this purpose, you must also submit the following documents in duplicate and not bound:– Copies of diplomas obtained (if the diploma(s) were obtained abroad; the

diploma(s) must have been recognised by the Nuffic. You must arrange for this yourself);

– copies of certificates of education courses in the Netherlands or abroad (diploma(s) or Doctorates);

– evidence of any previous experience gained as an entrepreneur; if there is also an enterprise in the country of origin, you must also submit a deed of incorporation and the articles of association of this enterprise;

– Evidence of previous work experience, for example, by submitting reference(s) and/or testimonial(s), employment agreement(s) from/with former employer(s);

– Income statement over the last 12 months before the application, for example, by submitting an annual income statement, tax assessment, or employment agreement(s);

– Evidence of experience in the Netherlands, for example, by means of agreement(s) or reference(s) of Dutch partners and business partners, or sales figures concerning the Dutch market;

NB. If you have failed to substantiate your application sufficiently by means of the above-mentioned documents, your application will not be submitted for advice to the Minister of Economic Affairs, Agriculture and Innovation.If you have an EC residence permit for long-term residents issued by another EU Member State, also submit the following:– A copy of the EC residence permit for long-term residents issued by the


name;– A copy of your business plan as referred to above. In this context, however,

this business plan does not have to include a description of the innovative character of the business and the product.


n Work on a self-employed basis, and you have Turkish nationality (377)Your application must be accompanied by the following supplementary evidence and documents, in duplicate and not bound:– Proof of your income, see Appendix ‘Proof of Income’;– A copy of a document issued by the Dutch authority competent in this matter

showing that you are qualified to practise a profession or operate a business;– A copy of your business plan, including the following information: - Information about you, the entrepreneur (personal data, family and

income situation, and financial obligations) - Business information (information about the line of industry in which you

will work, starting date of the enterprise, and place of business); - Legal aspects (legal form of your enterprise, trade name, licences, liability,

insurance, and supply conditions); - Commercial aspects (market potential): •Adescriptionofthetypeofbusinessandproduct(features,application,

need, and unique selling points); •Amarketanalysis(descriptionandsizeofthemarket,andpotential

customers/market share), competitors, barriers, co-operations, and risks; •Thepricebreakdown,substantiatedbyagreementsandreferences. - Organisational aspects (description of the organisational structure of your

enterprise, the required competencies, and the number of staff); - Financial aspects (investment budget, financing plan, repayment schedule,

opening balance sheet, balance sheet, operating budget, and liquidity forecast); NB. The business plan must be substantiated by supplementary documents such as annual accounts, tax details, references, etc. The financial documents must have been prepared or assessed by an independent expert.

– A copy of the deed of incorporation showing the powers, responsibilities, and allocation of the profit among the partners (if it concerns a general partnership or a limited partnership).

– A certificate of registration at the Chamber of Commerce.

It is your responsibility to substantiate your application as much as possible by evidence showing that your enterprise can make a major contribution to the Dutch economy. NB. If you have failed to substantiate your application sufficiently by means of the above-mentioned documents, your application will not be submitted for advice to the Minister of Economic Affairs, Agriculture and Innovation.If you have an EC residence permit for long-term residents issued by another EU Member State, also submit the following:– A copy of the EC residence permit for long-term residents issued by the


name;– A copy of your business plan as referred to above. In this context, however,

this business plan does not have to include a description of the innovative character of the business and the product.


n As non-privileged NATO personnel (460)Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’; – An original extract (not a copy) from the Municipal Administration (GBA)

showing your home address and composition of the family. This extract may not be older than 6 months;

– If you will not be registered at the Municipal Administration (GBA) as non-privileged civilian personnel: evidence showing that you live in the Netherlands.


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IND5007_M35A/11B

11 Residence Permit to Work on the Basis of an International Treaty


12 As an Economically Non-Active Long-Term Third-Country National

n To work as an employee in the context of an EU action programme or an international agreement to which the Netherlands is a party, but not the Dutch-American Friendship Treaty, the Treaty of Amity and Commerce between the Netherlands and Japan, the Turkish Association Treaty, or the Dutch-German Convention on Establishment (370)

Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that paid research or paid work is to be carried out

temporarily in the context of an EU action programme or an international agreement to which the Netherlands is a party;

– Proof of your income, see Appendix ‘Proof of Income’;> Go to 23 on page 19

n Work as an employee on the basis of the Dutch-German Convention on Establishment (450)

Your application must be accompanied by the following supplementary evidence:– Evidence showing that you have sufficient means of existence for the

duration of your stay. This may be your own declaration or a declaration from a third party.


n Work as a key employee on the basis of the Dutch-American Friendship Treaty or the Treaty of Amity and Commerce between the Netherlands and Japan (454, 511)

Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’;– If required: A copy of the application for a work permit or a copy of the work

permit itself (see the explanation on page 3 of this form).– Evidence showing that you are employed as a key employee. > Go to 23 on page 19

n Work on a self-employed basis on the basis of the Dutch-American Friendship Treaty or the Treaty of Amity and Commerce between the Netherlands and Japan (453, 510)

Your application must be accompanied by the following supplementary evidence and documents:– A recent original extract from the registration of the enterprise/company at

the Chamber of Commerce.– Evidence showing the legal form of the company;– Evidence showing that you have made a substantial capital contribution to

your enterprise or your company. > Go to 23 on page 19

n Work as an employee on the basis of the EC-Turkish 1/80 Association Treaty (337)

Your application must be accompanied by the following supplementary evidence and documents:– Proof of your income, see Appendix ‘Proof of Income’;– If required: A copy of the application for a work permit or a copy of the work

permit itself (see the explanation on page 3 of this form).– Evidence showing that you have been employed by a Netherlands-based

company for at least 1 year (may also be a transport company) and that your current employer has work for you for another year in employment.


n As an economically non-active person with a residence permit as a long-term third-country national in another member state (507, 763)

Your application must be accompanied by the following supplementary evidence and documents:– A copy of the EC residence permit for long-term residents issued by the

other Member State– Evidence showing that a health insurance policy has been taken out in your

name;

– Evidence showing that you permanently and independently have sufficient means of existence, such as benefit payments from the Member State that issued the EC residence permit for long-term residents to you (it must concern a benefit payment that can be received in the Netherlands) or income from previous employment outside the Netherlands (such as a salary or a corporate or private pension, or on the basis of a early retirement scheme) or income from capital.


10 Residence Permit for an Orientation Year for Graduates


n Orientation year for graduates (501) If you want to search for a job as a highly skilled migrant within one year

after having finished your study at a Dutch university or a college of higher professional education, and you want to make use of the orientation year

Your application must be accompanied by the following supplementary piece of evidence:– A legalised copy of the diploma showing the graduation date. This must be a

diploma for a study programme followed at an educational institution in the Netherlands.


n Orientation year for highly educated migrants (508) If you want to search for a job as a highly educated migrant or if you want

to start an innovative business within three years after having finished your study, and you want to make use of the orientation year. You must have obtained a Master degree or a Doctorate at a Dutch university or a college of higher professional education or at a educational institution abroad which has been included in the Top 150 of the lists of the 'Times Higher Education Supplement' or the 'Jiao Tong Shanghai University' published in 2007.

Your application must be accompanied by the following supplementary evidence and documents:– A legalised copy of the Master or Doctorate diploma of an accredited

educational institution, as included in the CROHO (Central Register of Higher Education Study Programmes), showing the graduation date or the date

on which you obtained your Doctorate degree. This certificate may not be older than 1 month. Or a legalised copy of the Master or Doctorate diploma at a educational institution abroad which has been included in the Top 150 of the lists of the 'Times Higher Education Supplement' or the 'Jiao Tong Shanghai University' published in 2007, together with the relevant list of marks. Together with the diploma, you must also submit the written credential evaluation of Nuffic (Credential Evaluation Information Centre). If you want to be awarded points in the system of points, please also submit the following (where possible):

– A copy of your employment agreement or your Employer's Declaration if you have worked in the Netherlands in the past for a period of six months or more;

– A copy of a certificate of participation in a course in the Netherlands, which course you attended for a period of six months or more;

– A copy of an NT2 diploma for 'Dutch as a Second Language' at A2 level'; – If you did not graduate in an English-speaking country: a copy of a

declaration or a certificate of a language institute showing that you speak the English language at level 6 of the International English Language Testing System (IELTS)

– A copy of a diploma showing that you have obtained a Bachelor, Master or Doctorate degree in a country that is party to the Bologna Declaration. If the diploma is not written in the Dutch, English, French or German language, you must have this diploma translated.


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Application

IND5007_M35A/11B

13 Residence Permit to Attend a Secondary Education Course or a Vocational Education Course

If you want to attend an institution of higher education or a university, do not use this form, but contact the educational institution.

14 Residence Permit for Exchange Purposes


n To attend a Secondary Education course or a Vocational Education course (393)

Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing your registration (provisional or definite) at or admission

to the institution. This evidence must have been issued by the competent authority of the educational institution;

– The Appendix ‘Study Awareness Declaration’ filled in completely and signed by you;

– An original extract (not a copy) from the Municipal Administration (GBA) showing your home address. This extract may not be older than 6 months;

– Written substantiation that the foreign national can make a positive contri-bution to the development of his/her country of origin with this education.

– In the case of an Upper Secondary Vocational Education course (MBO), a declaration from the COLO that this education course cannot be attended in the country of origin (see COLO's website for more information www.colo.nl);

– In the case of a Secondary Education course, a declaration of the Ministry of Education in the country of origin stating that the relevant course cannot be attended in the country of origin.

If you receive a study grant, also submit the following:– A copy of the document showing that the study grant has been awarded to you.If you or a third party abroad (e.g. a private person or a legal person) is wholly or partially paying for the course, also submit the following:– A copy of a bank statement from a bank account jointly or exclusively made

out in your name, with the balance that is available for the study year; or– An original declaration from the bank (not a copy) showing which monthly

amount is being transferred in favour of you to a bank account jointly or exclusively made out in your name.

n Exchange through a private organisation (403)Your application must be accompanied by the following supplementary evidence and documents:– An original extract (not a copy) from the Municipal Administration (GBA)

showing the home address and the composition of your host family. This extract may not be older than 6 months;

– The Appendix ‘Exchange Organisation Sponsor Declaration’ filled in completely and signed by the private organisation;

– The Appendix ‘Declaration of Non-Impediment’ filled in completely and signed by you, showing that you are unmarried and that you do not provide for children of your own or for children that depend on you.

If the exchange concerns voluntary work, also submit the following:– A copy of the application for a work permit or a copy of the work permit

itself (see the explanation on page 3 of this form).> Go to 23 on page 19

If a third party in the Netherlands (e.g. a private person or a legal person) is wholly or partially paying for the course, also submit the following:– The Appendix ‘Sponsor Declaration’ filled in completely and signed by your

financial sponsor and, if applicable, his or her spouse or partner or registered partner;

– An original extract (not a copy) from the Municipal Administration (GBA) showing your home address and the composition of the family of your financial sponsor. This extract may not be older than 6 months;

– Proof of the income of the financial sponsor and, if applicable, his or her spouse or partner or registered partner, see Appendix ‘Proof of Income’;

– Copies of all the pages containing the identity details of the Dutch passport(s) and identity card(s) of your financial sponsor and, if applicable, his or her spouse or partner or registered partner. Also make copies of the pages containing travel stamps. If your financial sponsor and, if applicable, his or her spouse or partner or registered partner, do not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.

If you have the EC residence permit for long-term residents issued in another Member State, you are also permitted to attend the course on a part-time basis. You do not have to fill in and sign the Appendix ‘Study Awareness Declaration’. You must also submit the following:– A copy of the EC residence permit for long-term residents issued by the


name.> Go to 23 on page 19

n Exchange on the basis of the ‘Working Holiday Scheme’ or ‘Working Holiday Program’ (402)

Your application must be accompanied by the following supplementary piece of evidence:– A copy of the return ticket or evidence showing that you have sufficient

means to buy a return ticket.> Go to 23 on page 19

n as an au pair (400)NB. At the time of submitting the application for the residence permit in the Netherlands, you must at least be 18 years of age, but not yet 26 years of age.Your application must be accompanied by the following supplementary evidence and documents:– Copies of all pages of the identification documents of your host family (the

sponsor) if they are Dutch nationals, or of the front and back of the residence permits or of all pages containing the identification details, stamps, travel stamps and endorsements in the border-crossing document in which the residence permits of your host family have been recorded. It is not necessary to copy empty pages.

– An original extract (not a copy) from the Municipal Administration (GBA) showing the home address and composition of your host family (the sponsor). This extract may not be older than 6 months;

– The Appendix ‘Declaration of Non-Impediment’ filled in completely and signed by you and showing that you are unmarried and that you do not provide for children of your own or for children that depend on you.

– The Appendix ‘Au Pair Awareness Declaration’ filled in completely and signed by you and your host family;

– The Appendix ‘Au Pair – Host Family Agreement’ filled in completely and signed by you and your host family;

– The Appendix ‘Sponsor Declaration’ filled in completely and signed by your host family;

– A description about the manner in which you will become acquainted with the Dutch society and culture;

– Proof of the income of your host family, see Appendix ‘Proof of Income’. The income of the host family must at least be equal to the subsistence level applicable to the host family, supplemented by the subsistence level for a single person of 21 years of age or older.


15 Residence Permit as an Au Pair

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IND5007_M35A/11B

17 Residence Permit for Re-entry


n You are a former Dutch national and you were born and raised in the Netherlands (362)

Your application must be accompanied by the following supplementary piece of evidence:– Documents and information regarding the duration and nature of your

previous stay in the Netherlands;> Go to 23 on page 19

n You are a minor and your accommodation and legal representation in the Netherlands have been arranged and you were a lawful resident of the Netherlands (or as a Dutch national) from the age of 4 years for a period of 10 years (360)

Your application must be accompanied by the following supplementary evidence and documents:– Documents and information regarding the duration and nature of your

previous stay in the Netherlands;– Documents and information showing that your accommodation and

representation in the Netherlands have been arranged.> Go to 23 on page 19

n You are a minor and your accommodation and legal representation in the Netherlands have been arranged and you were a lawful resident of the Netherlands (or as a Dutch national) for a period of 5 years before submitting the application and the Netherlands is the most appropriate country for you (360)


previous stay in the Netherlands;– Documents and information showing that your accommodation and

representation in the Netherlands have been arranged.NB. For the purpose of assessing whether the Netherlands is the most appropriate country of residence for you, it is important that your ties with the Netherlands are stronger than your ties with your country of origin. In this assessment, the following factors may be included:• Thereasonforremigration;• ThedurationofyourstayintheNetherlandsandinthecountryoforigin;• Theeducation/schoolingreceivedintheNetherlandsandabroad;• TheworkexperiencegainedintheNetherlandsandabroad;• KnowledgeoftheDutchlanguage.You must accompany your application with as much information as possible.> Go to 23 on page 19

n You are a former Dutch national and you renounced your Dutch nationa-lity to be able to rely on the provisions of the Dutch Remigration Act (your situation before remigration) (364)

Your application must be accompanied by the following supplementary evidence and documents:– A certificate from the Social Insurance Bank (SVB) stating that the decision

on your application for remigration provisions will, in principle, be positive, provided that you renounce Dutch nationality;

– A copy of your 'Declaration of Renunciation of Dutch Nationality';– A certificate from the Population Affairs official that your 'Declaration of

Renunciation of Dutch Nationality' has been received.> Go to 23 on page 19

n You qualify for re-entry on the basis of Article 8 of the Dutch Remigration Act (your situation after remigration) (315)

If one of following situations applied to you immediately prior to your remigration from the Netherlands:• YouwerealawfulresidentintheNetherlandsforacontinuousperiodofat

least 3 years and you had a Regular Residence Permit; • YoustayedintheNetherlandswithavalidresidencepermitasaminorchild

of a person who himself or herself qualifies for re-entry on the basis of the Dutch Remigration Act, insofar as you both remigrated from the Netherlands at the same time and you are submitting an application for re-entry at the same time; or

• YoustayedintheNetherlandswithavalidresidencepermitasaminorchildof a person who himself or herself had lawful residence, you remigrated together with this person from the Netherlands on the basis of Article 8 of the Dutch Remigration Act and you came of age within one year after remigration and you are submitting an application for re-entry within that year.)

Your application must be accompanied by the following supplementary evidence and documents:– A copy of the decision of the SVB awarding the right to the basic provisions

or the remigration provisions and stating the departure date;– A copy of the Appendix to the decision of the SVB showing the entrance date

of the residence permit granted previously for a non-temporary purpose and the continuous duration of your previous stay in the Netherlands.

NB. Under specific conditions, you may qualify for a permanent residence permit (if immediately prior to your remigration you stayed in the Netherlands as a Dutch national, as a holder of a permanent residence permit, or as a holder of a Regular Temporary Residence Permit for a continuous period of at least five years). In that case, use the form 'Application for or Change of a Temporary Regular Residence Permit'> Go to 23 on page 19

16 Residence Permit to Stay in the Netherlands with a Religious or Ideological Organisation

n On religious or ideological grounds (378)The monastery or convent or religious or ideological organisation must submit the following supplementary evidence and documents when the application is submitted:– A written explanation about the need for the foreign national to stay with

the religious or ideological organisation;– Written evidence showing that the foreign national at the time of the

application was already a member of the religious or ideological organisation;

– A detailed description of the activities the foreign national will perform at or through the intermediary of the religious or ideological organisation;

– A written statement of the means by which the stay of the foreign national will be paid (which facilities will the foreign national receive at the expense of the organisation);

– The Appendix ‘Sponsor and Awareness Declaration Regarding a Stay with Religious or Ideological Organisations’ filled in completely and signed by the organisation;

– The Appendix ‘Awareness Declaration Regarding the Transitional Regime on Religious or Ideological Grounds’ filled in completely and signed by you;

– Written evidence by which the organisation or the monastery or convent shows that it has sufficient financial means and that it is capable of providing for the foreign national’s living expenses.

If the foreign national intends to stay with another organisation than the following:• TheStichtingJeugdmeteenOpdracht,inHeerde;or• TheKerkvanJezusChristusvandeHeiligenderLaatsteDagen,inDordrecht;

or• CentraalMissieCommissariaat,inTheHague;or• TheSyrianOrthodoxChurch,inLosser;or• StichtingCongregatieFIC,inMaastricht;or• MaharishiEuropeanResearchUniversity/MaharishiVedicUniversity,in

Vlodrop; or• StichtingInternationalBuddhistProgressSocietyHolland,inAmsterdam;or• Anindividualmonasteryorconvent,the religious or ideological organisation must then also submit the following:– Evidence showing that in the five years preceding the effective date of this

scheme (8 January 2004) a residence permit was granted to a foreign national on religious or ideological grounds in respect of the organisation where the foreign national intends to stay. In this context, the reason for applying for a residence permit is not for study purposes or to work as an employee.


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Application

IND5007_M35A/11B

18 Residence Permit for Medical Reasons

19 Residence Permit for a Victim of Human Trafficking or for a Witness Reporting Human Trafficking

n To undergo medical treatment (410)Your application must be accompanied by the following supplementary evidence and documents:– The Appendix ‘Declaration on Your Medical Situation’ filled in completely

and signed by your doctor. This declaration may not be older than 1 month. Any changes in your medical situation that may be relevant to the decision to be made must be declared in a new ‘Declaration on Your Medical Situation’.

– The Appendix ‘Medical Information Disclosure Consent Form’ filled in completely and signed by you. If several doctors are in charge of your treatment, the consent to contact these doctors must be given separately for each doctor. This consent must be given with respect to the doctor(s) in charge of your treatment in the Netherlands as well as the doctor(s) in charge of your treatment in the country of origin;

– Proof of insurance for medical expenses incurred in the Netherlands or any other evidence showing that financing the costs of the medical treatment has been arranged adequately;

– A written explanation of why the Netherlands is the most appropriate country to undergo the relevant medical treatment(s). Accompany your application with as many pieces of evidence as possible.

– Evidence showing that you have sufficient means of existence for the duration of your stay in the Netherlands.

n You lived outside the Netherlands due to imprisonment or military service (360)

Your application must be accompanied by the following supplementary evidence and documents:– Copies of the front and back of your last residence permit;– Documents and information on your imprisonment abroad and the

termination of this, or on doing military service and the termination of this. > Go to 23 on page 19

n You have submitted an application to the District Court in The Hague to establish your Dutch nationality (361)

Your application must be accompanied by the following supplementary piece of evidence:– A complete copy of your application to the District Court concerning the

establishment of you Dutch nationality (pursuant to Article 17 of the Netherlands Nationality Act).


n You are a former Dutch national, you have lost your Dutch nationality because it was withdrawn because you did not renounce your original nationality (if you had had lawful residence in the Netherlands for a continuous period of at least 3 years before the date of becoming a Dutch national) (314)

Your application must be accompanied by the following supplementary evidence and documents:– Documents regarding the duration and nature of your previous stay in the

Netherlands;– A copy of the notice of naturalisation;– Letters from the Minister of the Interior and Kingdom Relations in which your

attention is drawn to the obligation to renounce your original nationality;– A copy of the decision by which the Dutch nationality has been withdrawn.NB. Under specific conditions, you may qualify for a permanent residence permit (if you had had lawful residence in the Netherlands for a continuous period of at least 5 years before the date of becoming a Dutch national). In that case, use the form 'Application for or Change of a Temporary Regular Residence Permit'> Go to 23 on page 19

n As a victim of human trafficking or as a witness reporting human trafficking (420)

Go to the police with this application form, and report human trafficking to the police or render your cooperation in the criminal investigation and prosecution investigation of human trafficking. The police will help you with your application for a residence permit. If you submit this application without having been to the police and you did not report the human trafficking or you did not cooperate, your application will not be handled.> Go to 23 on page 19

If you yourself do not have sufficient means of existence, also submit the following:– The Appendix ‘Sponsor Declaration’ filled in completely and signed by a

family member, relative or other relation of yours;– Proof of the guarantor’s income and, if applicable, his/her spouse or partner

or registered partner, see Appendix ‘Proof of Income’;– Copies of all the pages containing the identification details of the

guarantor’s Dutch passport or identity card. Also make copies of the pages containing travel stamps. If the guarantor does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages.

If you are a national of Surinam, also submit the following:– A copy of a visa issued on medical grounds.> Go to 23 on page 19

n You are a former Dutch national because you renounced your Dutch nationality yourself because it would otherwise have been withdrawn because of the failure to renounce your original nationality (313)


previous stay in the Netherlands;– A copy of the notice of naturalisation;– Letters from the Minister of the Interior and Kingdom Relations in which your

attention is drawn to the obligation to renounce your original nationality;– An original extract (not a copy) from the Municipal Administration (GBA)

showing the date on which you renounced Dutch nationality.NB. Under specific conditions, you may qualify for a permanent residence permit (if you had had lawful residence in the Netherlands for a continuous period of at least 5 years before the date of becoming a Dutch national). In that case, use the form 'Application for or Change of a Temporary Regular Residence Permit'> Go to 23 on page 19

n You are a former Dutch national, you are 18 years of age or older, and you do not live in the country of which you are a national, and you have special ties with the Netherlands (360)


previous stay in the Netherlands;– Documents and information showing that you do not live in the country of

which you have the nationality;– Documents and information showing that you received at least half of your

primary school education in the Netherlands, the Netherlands Antilles, or Aruba, or that when you were a minor you attended an education course that was focused on the Netherlands in a manner that was more than usual at the time, or that you have established close ties with the Netherlands due to other circumstances, such as upbringing, social position and/or employment.


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IND5007_M35A/11B

21 Residence Permit for Continued Residence


n You have Turkish nationality and you have a residence permit for seeking and performing work, whether as an employee or on a self-employed basis, after the termination of the marriage (304)

Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that - no later than the date that the period of validity of

your residence permit will expire - you have employment for at least 1 year,> Go to 23 on page 19

n Pursuant to Article 7 of the EEC-Turkey Association Agreement - Association Council Decision No 1/80 (301)

Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that the principal person was a Turkish employee when

you cohabited with him or her for a period of three years;– Evidence showing that a health insurance policy has been taken out in your name– An original historical extract (not a copy) from the Municipal Administration

(GBA) showing your home address and composition of the family. This extract may not be older than 6 months.


n After a residence period of 3 years or more with your spouse or partner or registered partner (301); or

n After a residence period of 3 years as an adult child with a parent (301); orn After a residence period of 3 years as a parent with a child (301)Your application must be accompanied by the following supplementary evidence and documents:– Appendix ‘Declaration of Circumstances’ filled in completely and signed by you– Evidence showing that a health insurance policy has been taken out in your name– An original extract (not a copy) from the Municipal Administration (GBA)


– Appendix 'Civic Integration Requirement’ (continued residence after three years of family reunification or family formation) filled in completely and signed by you.


n After a residence period of 1 year as a minor child with a parent or adoption parent or foster parent (301); or

n After a residence period of 3 years as an unaccompanied minor foreign national (301); or

n After a residence period of 3 years, if you were unable to leave the Netherlands through no fault or action of your own (301)

Your application must be accompanied by the following supplementary evidence and documents:– Appendix ‘Declaration of Circumstances’ filled in completely and signed by you– Evidence showing that a health insurance policy has been taken out in your name– An original extract (not a copy) from the Municipal Administration (GBA)

showing your home address and composition of the family. This extract may not be older than 6 months.


n Marriage, partnership, or registered partnership: compelling humanitarian grounds (301); or

n Residence with a partner: compelling humanitarian grounds (301)Your application must be accompanied by the following supplementary evidence and documents:– Appendix ‘Declaration of Circumstances’ filled in completely and signed by you– Evidence showing that a health insurance policy has been taken out in your name– An original extract (not a copy) from the Municipal Administration (GBA)


– Evidence showing that compelling humanitarian grounds are involved. > Go to 23 on page 19

n Marriage, partnership, or registered partnership: after the death of your spouse or partner or registered partner (302); or

n Minor child after the death of a parent or adoption parent or foster parent (302); or

n Adult child after the death of a parent (302)Your application must be accompanied by the following supplementary evidence and documents:– Appendix ‘Declaration of Circumstances’ filled in completely and signed by you– Evidence showing that a health insurance policy has been taken out in your name– An original extract (not a copy) from the Municipal Administration (GBA)


– The death certificate of your marriage partner, registered partner, or partner, or of your parent or adoption parent or foster parent.


n To undergo medical treatment (301)Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that a health insurance policy has been taken out in your name– Appendix ‘Declaration of Circumstances’ filled in completely and signed by you– Appendix ‘Declaration of Your Medical Situation’ filled in completely and

signed by your doctor. This declaration may not be older than 1 month. Any changes in your medical situation that may be relevant to the decision to be made must be declared in a new 'Declaration on Your Medical Situation'. If several doctors are in charge of your treatment, each doctor must fill in and sign a separate Appendix;

– Appendix ‘Medical Information Disclosure Consent Form’ filled in completely and signed by you. If several doctors are in charge of your treatment, the consent to contact these doctors must be given separately for each doctor. This consent must be given in respect of the doctor(s) in charge of your treatment in the Netherlands as well as the doctor(s) in charge of your treatment in the country of origin;

– Evidence showing that the financing of the medical expenses to be incurred in the Netherlands has been arranged adequately;

– A written explanation of why the Netherlands is the most appropriate country to undergo the relevant medical treatment(s).


n As a victim of domestic violence (303)Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that a health insurance policy has been taken out in your name– Evidence showing that you have demonstrably experienced domestic

violence: - a copy of the official record of the report to the police, and a declaration of

a doctor, confidential doctor or other professional; or - a declaration of the Public Prosecution Service or the Commissioner of

Police showing that ex officio prosecution investigation has been instituted against the offender, and a declaration of a doctor, confidential doctor or other professional.


n As a victim of human trafficking or as a witness reporting human trafficking (301)

If you are a victim of human trafficking, your application must be accompanied by the following supplementary evidence:– A copy of the Court judgment following your report of human trafficking or

following your cooperation in the criminal investigation and prosecution

20 Residence Permit through no Fault or Action of Your Own

n Residence Permit through no Fault or Action of Your Own (491)Your application must be accompanied by the following supplementary evidence and documents:– Documents showing that you have tried to realise your departure from the

Netherlands independently and that you did not succeed in this. You must prove that you have applied to the diplomatic representation of your country, or other countries where you had a residence permit and/or countries which may be expected to give you permission to enter, and that the request to issue travel documents has not been granted. You can prove this, for example, by declarations of the relevant authorities showing that you have demonstrably applied to those diplomatic representations and stating that a request to issue travel documents has not been granted.

– Documents showing that you have applied to the International Organisation for Migration to facilitate your departure, and that this organisation informed you that it is not capable of realising your departure due to the fact that you claim that you cannot obtain any travel documents, or that this organisation has declared to be able to facilitate your departure as soon as you have obtained the travel documents.

– Documents showing that you have applied to the Repatriation and Departure Service with the request to assist you in submitting an application for a replacement travel document, a so-called laissez passer. The Repatriation & Departure Service will also be willing to provide assistance at one or more diplomatic representations to obtain the required travel documents.


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Application

IND5007_M35A/11B

investigation of human trafficking and by which judgment the accused has been convicted (a conviction for one of the other charges made against the accused in the criminal proceedings is also relevant, provided that human trafficking was one of the charges made); or

– A copy of the Court judgment following your report of human trafficking or following your cooperation in the criminal investigation and prosecution investigation of human trafficking and by which judgment the accused has not been convicted (a conviction for one of the other charges made against the accused in the criminal proceedings is also relevant, provided that human trafficking was one of the charges made), but the judgment is otherwise; and if you have been in possession of a residence permit for a period of less than 3 years on the basis of the B9 scheme, you must also submit evidence showing that you cannot return to the country of origin (e.g. because you may become the victim of revenge) or evidence showing that there are compelling humanitarian grounds that, in your opinion, should justify continued residence (e.g. because you have psychological problems for which you are being treated in the Netherlands, or because you must provide for children who were born in the Netherlands or who attend an education course here);

– If you have been in possession of a residence permit for a period of more than 3 years on the basis of the B9 scheme and the criminal investigation is still before the court, a copy of the declaration of the police or the Public Prosecution Service that the criminal investigation is still before the court.

If your report to the police or your cooperation in the criminal investigation or criminal prosecution of human trafficking resulted in a decision not to prosecute, also submit the following:– Evidence showing that you cannot return to the country of origin (e.g.

because you may become the victim of revenge) or evidence showing that there are compelling humanitarian grounds that in your opinion should justify continued residence (e.g. because you have psychological problems for which you are being treated in the Netherlands or because you must provide for children who were born in the Netherlands or who are attending an education course here).

If you are a witness of human trafficking, your application must be accompanied by the following supplementary evidence:– A copy of the conviction following your report of human trafficking;– Evidence showing that you cannot return to your country of origin because

of the risk of reprisals.> Go to 23 on page 19

n After 1 year of residence, on the basis of honour-related violence or the threat thereof (303); or

n After 1 year of residence, on the basis of domestic violence or a real threat thereof (303)

Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that the threat, on the basis of which the permit had been

granted, is continuing.– Accompany your application by a separate letter in which you provide a

description of the situation you are in and the reason why you cannot return to the country of origin. Enclose as many pieces of evidence with your letter to substantiate this.


n After 1 year of residence, as a victim of human trafficking who cannot or does not want to report this to the police or who cannot or does not want to render his/her cooperation in the criminal investigation and prosecution of the human trafficker (301)

Your application must be accompanied by the following supplementary evidence and documents:– Evidence showing that the threat, on the basis of which the permit had

been granted to you, is continuing or evidence showing that you, given your medical or psychological condition, are still not capable of rendering your cooperation in the criminal proceedings.

– Accompany your application by a separate letter in which you provide a description of the situation you are in and the reason why you cannot return to the country of origin. Enclose as many pieces of evidence with your letter to substantiate this.


22 Victims of violence


n You are a victim of domestic violence (300)Your application must be accompanied by the following supplementary evidence and documents:– Recent information from the police, for example, the recent report of an

incident, or a recent official record of the report; and – Recent information from a doctor, confidential doctor or other professional;

it is not necessary for the confidential doctor to be your own general practitioner; or

– Recent information about your stay in a women’s refuge; or– Other recent information, insofar as it concerns objective information from a

reliable source.– Evidence showing that you cannot withdraw from the violence by taking up

residence in the country of origin.> Go to 23 on page 19

n You are a victim of honour-related violence (300)Explain in a separate letter for which purpose you are submitting an application for a residence permit. You must accompany your application by this letter together with as many pieces of evidence and documents of the special circumstances. If the IND has any further questions, you will receive a separate

letter after having submitted this form.> Go to 23 on page 19

n You are a victim of human trafficking and you cannot or you do not want to report this to the police or render your cooperation in the criminal investigation and prosecution of the human trafficker due to serious threats and/or a medical or psychological impairment (420)

Your application must be accompanied by the following supplementary evidence and documents:– A declaration from the police showing that you are a victim of human

trafficking; and– If applicable, a declaration from the police showing that you cannot be

expected to render your cooperation in the criminal proceedings in connection with serious threats issued by the human trafficker in the Netherlands; or

– If applicable, medical information showing that a physical or psychological condition prevents you from rendering your cooperation in the criminal proceedings. The medical information must be provided by a professional who is listed either in the BIG register or in the NIP register.


23 Submitting your application

> Place your colour passport photo and your signature on the Appendix ‘Photo Card’ you will find enclosed with this form. Your passport photo may not have been used for a residence permit before, it must bear a clear resemblance, and it must meet the Dutch passport requirements (see www.paspoortinformatie.nl/nederlands/reisdocumenten/pasfoto).

> Check whether you have filled in the form completely. > Please accompany your application by all enclosures, evidence and documents that have been requested.

Do not use any staples or paperclips. > Now place your signature on the front page of this form. > First call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile

phone) or +31 20 8893045 from outside the Netherlands to make an appointment to visit the IND desk in your region. You must also make an appointment if you downloaded this form from www.ind.nl. Once you have made an appointment, you can hand in the application at the IND desk.

BE01/11B

AppendixProof of incomeM35A / M35A-1

If you or your sponsor has an employment agreement which is valid for a period of at least 1 year at the time of submitting your application; orIf you (the foreign national) will perform activities as an employee (in the context of an EU action programme or an international agreement to which the Netherlands is a party)– Your current employment agreement(s);– The Appendix ‘Employer’s Declaration’ filled in completely and signed (not

older than 3 months);– Pay slips over the past 3 months.Only if you earn structurally more than is apparent from your employment agreement (e.g. because of overtime)– Pay slips over the past 12 months.

If you or your sponsor has an employment agreement which is valid for a period for less than 1 year at the time of submitting your application– Your current employment agreement(s) showing that you will have work;– The Appendix ‘Employer’s Declaration’ filled in completely and signed (not

older than 3 months); – Over the past 3 years: - All salary statements; and - All annual income statements; and - All employment agreement(s) and temporary employment agreement(s)

(through an employment agency); and - grant decision(s) and benefit slip(s).

If you or your sponsor works as an agency employee or on the basis of an on-call contract, a seasonal work contract, a zero-hours contract, or any other employment agreement with a deferred duty of performance– Your current employment agreement(s) or temporary employment

agreement(s) (through an employment agency) showing that you will have work;

– The Appendix ‘Employer’s Declaration’ filled in completely and signed (not older than 3 months);

– Over the past 3 years: - All salary statements; and - All annual income statements; and - All employment agreement(s) and temporary employment agreement(s)

(through an employment agency); and - grant decision(s) and benefit slip(s).

If you or your sponsor receives supplementary or full benefitsIf you or your sponsor receives a supplementary or full benefit payment (e.g. an unemployment benefits (WW), sickness benefits (ZW), old age benefits (AOW), dependant's benefits (ANW), or a reintegration benefit payment (REA))– The letter of your benefits agency granting your benefit;– The most recent benefits statement;If you or your sponsor receives occupational disability benefits (WAO benefits), benefits under the Invalidity Insurance (Self-Employed Persons) Act (WAZ benefit), or benefits under the Invalidity Insurance (Young Disabled Persons) Act (Wajong benefit)– The grant decision showing that you are unfit for work (and which

percentage);– The most recent benefits statement (over a period of at least 1 year

following the grant decision);

If you or your sponsor has received invalidity benefits under the Work and Income (Capacity for Work) Act (WIA benefit) since 1 January 2006– The confirmation of benefits awarded that shows on the basis of which

regulations you are receiving the relevant benefits (Full Invalidity Benefit Regulations (IVA) or Return to Work (Partially Disabled) Regulations (WGA));

– (If available) the most recent reassessment;If you or your sponsor is permanently unfit for work and you or your sponsor does not receive occupational disability benefits (WAO benefits), invalidity benefits under the Work and Income (Capacity for Work) Act (WIA benefits), benefits under the Invalidity Insurance (Self-Employed Persons) Act (WAZ benefits), or benefits under the Invalidity Insurance (Young Disabled Persons) Act (Wajong benefit)– A declaration from the Municipal Health Service, or the company doctor, or

the medical examiner showing that you are wholly unfit for work, the date on which you became wholly unfit for work, and what the expected duration of the incapacity for work is;

If you or your sponsor receive(s) social assistance benefits and it is permanently impossible for you or your sponsor/partner to work again– All grant decisions of the past 5 years and any correspondence with the

Municipal Executive about the exemption of the obligation to seek work, and evidence showing that integration into the workforce is not to be expected within a reasonable period of time.

If you or your sponsor is a self-employed person– The Appendix ‘Declaration of Income as a Self-Employed Person’ filled in

completely and signed by you and a registered accountant, an auditor, an accounting consultant, a tax adviser of the Dutch Federation of Tax Advisers (NFB), or an accountant with a BECON number issued by the Tax and Customs Administration, together with the required appendices.

– A recent original extract from the registration of the enterprise/company at the Chamber of Commerce (unless registration is not possible).

If you or your sponsor is a director-major shareholder– The official documents showing the percentage of your interest in the

company (percentage of ownership);– A copy of your employment agreement (or agreements, if you have several

jobs);– An original Appendix ‘Employer’s Declaration’ filled in completely, stating

the date and provided with a signature of the employer and a company stamp (not older than 3 months);

– Information about the 3 months prior to the date of your application showing that you received a monthly salary (salary slips, bank statements);

– Proof that the wage tax that was withheld by the company was paid to the Tax and Customs Administration (bank statement).

As an unpaid research worker– If you receive sponsor money: evidence showing the amount of money you

receive and the duration of the sponsor agreement; or– If you receive periodic payments to pay for your stay in the Netherlands:

proof of these payments; or– If you have paid work abroad: a copy of an employment agreement with the

current employer abroad.

NB. The IND may verify the correctness of the enclosed wage, employment and benefit details at another government agency (e.g. the Netherlands Employees Insurance Agency (UWV) or the Tax and Customs Administration).

This list states which items of evidence that demonstrate proof of income are required by the IND for the assessment of the application. The application form states in which cases and from which person(s) you must enclose these items of evidence to prove the income. In most cases, this proof of income must be provided by you (the person providing residence) and your sponsor. The pieces of evidence you are submitting as a proof of your income may be copies, unless stated otherwise.

BE02/11B

AppendixEmployer’s DeclarationM35A / M35A-1

1 Details of the employee

1.1 Citizen Service Number (BSN)

1.2 Name

1.3 Gender

1.4 Home address

1.5 Date of birth

1.6 Place of birth


1.8 Nationality

2 Details of the company/institution

2.1 Name

2.2 Visiting address

2.3 Withholding tax number

If you have several employers, please copy this appendix. Fill in and sign one copy for each employer. The application form states in which cases and from which person(s) you must enclose the Employer’s Declaration.

NB. The IND may verify the correctness of the enclosed wage, employment and benefit details at another government agency (e.g. the Netherlands Employees Insurance Agency (UWV) or the Tax and Customs Administration).

3 Employment details

3.1 Employee’s job title

3.2 Date of employment

3.3 Type of employment

3.4 Employment period


| |

n Male n Female

Street Number

|


|Day month year

|

|

|

|Street Number

|


|

|Day month year

n Fixed employment n On-call contract n Ongoing temporary work

n Indefinite period, or Day month year Day month year

n Definite period from to

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BE02/11B

3.5 Is there a provision for continued payment of wages during the term of the agreement if there is not any work?

3.6 Trial period

3.7 Working hours per week

3.8 Gross salary (excluding holiday allowance)

3.9 Wage for social security purposes (excluding holiday allowance)

3.10 Net salary (excluding holiday allowance)

3.11 Percentage of holiday allowance

4 Signature of the employer

4.1 Name

4.2 Job title

4.3 Telephone number

4.4 City/Town and date

4.5 Signature

4.6 Stamp of company/institution

n No n Yes

Day month year

n No n Yes, until

Hours per week (contractual) Hours per week (actual)

All amounts rounded to the nearest full euro

n Per month, or n per 4 weeks €





%

I declare that the above-mentioned employee has been employed by the above-mentioned company/institution.I have filled in this form truthfully.

|

|

City/Town Day month year

|

|

|

BE03/11B

AppendixDeclaration of circumstancesM35A

1 Declaration of Circumstances

1.1 Tick the situation(s) below that applies/ apply to you (the permit holder) since your current residence permit has been issued. It concerns changes that may have consequences for your residence permit and possibly the residence permits of your family members.

NB. Always accompany your application by declarations and evidence. You must always inform the IND immediately of any changes in your personal situation or of the situation of the person with whom your stay that relate to our residence permit.

2 Signature

2.1 Name of the foreign national


2.3 Signature of the foreign national

2.4 Name of the legal representative (if applicable)


2.6 Signature of the legal representative

Only fill in this declaration if you already have a residence permit for a specific purpose of stay and you want to use this application form to apply for a residence permit for another purpose of stay. Enclose this declaration with your application.

a. n Since the current residence permit has been issued, there has been no change in any facts or circumstances that may have consequences for the residence permit;

b. n The person with whom I am staying in the Netherlands (the person providing residence) has a new border-crossing document (e.g. a passport) > Please enclose copies of the pages containing the identity

details, stamps, travel stamps and endorsements with your application. (It is not necessary to copy empty pages).

c. My own family situation (as the permit holder) or that of the person with whom I am staying in the Netherlands (the person providing residence) has changed as follows:

n Married/registered partnership > Your application must be accompanied by a copy of the marriage certification/registration

n New relationship > Do not send in this form. Contact the IND to ask them what to do

n Termination of marriage/relationship > Do not send in this form. Contact the IND to ask them what to do

d. n Child was born > Your application must be accompanied by a copy of the birth certificate

e. n Someone has died > Your application must be accompanied by a death certificate

f. n The income situation of myself or of the person with whom I am staying in the Netherlands (the person providing residence) has changed. > Your application must be accompanied by the evidence as

referred to in the Annexe ‘Proof of Income’.

g. n Otherwise, namely:

|

I have filled in this form truthfully.


|

|


|

|

BE06/11B

AppendixSponsor and Awareness Declaration Concerning the Stay with Religious or Ideological OrganisationsM35A / M35A-1

1 Details of the foreign national

1.1 V-number

1.2 Name

1.3 Gender

1.4 Date of birth1.5 Nationality

2 Details of the organisation



2.3 Name and position of the representative


2.5 Signature

Only fill in this declaration if you are submitting an application for a residence permit for a stay on religious or ideological grounds. Fill in and sign the declaration and submit it in together with your application.

The representative of the organisation is aware of the following:– A stay of the above-mentioned foreign national with the organisation in the

Netherlands will only be permitted for religious or ideological purposes;– The foreign national is not permitted to perform work;– By virtue of the restriction under which the residence permit is granted,

it is expected that the foreign national or the organisation will inform the Immigration and Naturalisation Service (IND) if the actual activities prove to be different from the envisaged purpose of stay;

– In the context of the monitoring of foreign nationals, the Aliens Police may visit the organisation and the foreign national or call up the organisation or the foreign national for a specific cause or for a random check.

The representative of the organisation declares:– That substantial recruiting activities have been performed as a result of

which it became evident that it is necessary for the foreign national to stay in the Netherlands to meet the need of the organisation;

– That the cost, excluding costs of social assistance, that are incurred by the State and other public bodies in respect of the foreign national's stay, including the costs of the journey of the foreign national to a place outside the Netherlands where his/her admittance is guaranteed, up to an annual maximum amount of € 5,000, may be recovered from the organisation;

– If the foreign national receives benefits pursuant to the Dutch Social Assistance Act, or the Dutch Work and Social Assistance Act as from 1 January 2004 respectively, the costs of social assistance that will have been incurred in connection with the benefit payments to the foreign national (related to the amount of the current benefits in accordance with the standard of the Dutch Social Assistance Act, or the Dutch Work and Social Assistance Act as from 1 January 2004, respectively), in addition to the above-mentioned annual amount of € 5,000, will be recovered from the organisation.

The undersigned, further referred to as the representative of the organisation, hereby declares with regard to the foreign national’s intended stay at the organisation:


| |

n Male n Female

Day month year Nationality

|

|Street Number

|


|Name Position

| |City/Town Day month year

|

|

BE07/11B

AppendixAwareness Declaration Regarding the Transitional Regime on Religious or Ideological GroundsM35A / M35A-1


1.1 V-number

1.2 Name

1.3 Gender

1.4 Home address

1.5 Date of birth

1.6 Place of birth


1.8 Nationality


Only fill in this declaration if you are submitting an application for a residence permit for a stay on religious or ideological grounds. Fill in and sign the declaration and submit it in together with your application.

2 Signature


2.2 Signature


| |

n Male n Female

Street Number

|


|Day month year

|

|

|

The undersigned hereby declares to be familiar with the fact that:The residence permit will only be granted to him/her for a definite period of time for a stay on religious or ideological grounds with:

|

The residence permit will only be granted as long as he/she stays with the religious or ideological organisation for religious or ideological purposes, and he/she is to leave the Netherlands as soon as this purpose no longer exists;He/she is not permitted, during the stay in the Netherlands, to perform activities other than those for which he/she was granted a residence permit.



|

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BE09/11B

AppendixQuestionnaire for stay with a partnerM35A

Only fill in this declaration if you are submitting an application for a residence permit for a stay of your unmarried partner with you. Fill in and sign the declaration and submit it together with your application.

Your partner wishes to stay with you in the Netherlands. Please answer the questions below or tick the applicable box. You may submit the answers as an enclosure on a separate sheet of paper. Please substantiate your answers with as many documents as possible.

1 Previous stay of your partner in the Netherlands

1.1 Did your partner stay in the Netherlands before?

If so, what was the reason for this stay and where did your partner stay?

2 Information about your relationship

2.1 Since when have you known your partner?

2.2 Where and how did you meet your partner?> Please give as much information about this as possible.

If necessary, you may use an additional sheet of paper. In that case, you must place your signature and date of signature on this sheet as well.

2.3 Are you family members or relatives?

If so, what is the family relationship?

2.4 Since when do you have a relationship with your partner?

2.5 How did the relationship come about?

2.6 How do you currently maintain the relationship with your partner?

2.7 Have your family members and friends been informed of your relationship?

If not, why have they not been informed?

n Yes n No

|

Day month year

|

n Yes n No

|

Day month year

|

|

n Yes n No

|

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BE09/11B

3 Previous marriages or (registered) partnerships of you

3.1 Have you been married before or did you have a (registered) partnership with a foreign national who is still residing in the Netherlands?

If so, please give more detailed information.

4 Previous relationships of your partner

4.1 Has your partner been married before or did your partner have a (registered) partnership with a Dutch national or a foreign national residing in the Netherlands?

If so, please give more detailed information.

5 Minor children of your partner

5.1 Does your partner have minor children?

If so, what are the personal details, and temporary or permanent place of residence of these children?

5.2 Do the children travel with the partner to the Netherlands?

If not, why do the children not travel with the partner?

6 Signature

6.1 Name


6.3 Signature

n Yes n No

|

n Yes n No

|

n Yes n No

|

n Yes n No

|



|

|

BE11/11B

AppendixCivic Integration RequirementContinued residence after three years of family reunification or family formation - M35A

n You have passed the civic integration examination– The original or legalised copy of the Civic Integration Certificate under

the Civic Integration Act. Settled immigrants must have passed the civic integration examination at level A1; other foreign nationals must have passed the civic integration examination at level A2.

n You have Belgian or Luxembourg nationalityn You have the Turkish nationality or you are a family member of someone

with the Turkish nationalityn You are younger than 18 years of age or you are 65 years of age or older

n You lived in the Netherlands for at least 8 years during your compulsory school age (from 5 years of age until the end of the school year in which you turned 16 years of age)

– An extract (with the historical address details) from the Municipal Administration (GBA) showing that you lived in the Netherlands for a minimum period of 8 years from the age of 5 years until the end of the school year in which your turned 16 years of age.

You have one of the documents, diplomas or certificates mentioned below on the basis of which you will be exempted form the civic integration requirement.NB. If the diploma has not been issued in the Netherlands, the diploma or certificate must be provided with an Apostille stamp. In some cases, you will also be required to enclose a list of marks. This is only required if you were required to have passed the Dutch language course.Please accompany the application by one of the following supplementary pieces of evidence and documents or legalised copies thereof; tick the situation that is applicable to you:n A letter from the Municipal Executive stating that the Municipal Executive

have arrived at the opinion on the basis of demonstrable efforts made by you that you are not reasonably capable of passing the civic integration examination;

n The exemption test (Korte Vrijstellingstoets) under the Civic Integration Act issued by DUO (formerly the Information Management Group) if integration is evident;

n A diploma of, for example, a university, Higher Professional Education (HBO), Upper Secondary Vocational Education (MBO), Pre-University Education (VWO), Senior General Secondary Education (HAVO), Junior General Secondary Education (MAVO), or Pre-Vocational Secondary Education (VMBO) after having attended an education course in the Dutch language; You have such a diploma if the diploma states, for example: Wet op het hoger wetenschappelijk onderwijs, Wet op het voortgezet onderwijs, Wet educatie beroepsonderwijs, or Wet op het cursorisch onderwijs.

n State Examination Diploma in Dutch as a Second Language, (programme I or II);n A school diploma obtained in Belgium or Surinam The education course

must, however, have been taught in Dutch. In addition, you must have passed the Dutch language course. The educational level must be higher than primary school, and the diploma must be based on an Act. This Act need not necessarily be an Education Act;

n A diploma, certificate or other document obtained in education conducted in Dutch in Aruba, Curaçao, St. Maarten or Bonaire, St. Eustatius or Saba, provided that the foreign national passed the Dutch language course. It concerns the following diplomas: Junior General Secondary Education (MAVO), Senior General Secondary Education (HAVO), Pre-University Education (VWO), Lower Secondary Vocational Education (LBO), Upper Secondary Vocational Education (MBO), Higher Professional Education (HBO), and University.

n The European Baccalaureate awarded by one of the European Schools. You must have taken Dutch as a first or second language. In addition, you must have passed the Dutch language course.

n An International Baccalaureate Middle Years Certificate or an International General Certificate of Secondary Education or an International Baccalaureate. In addition, you must have passed the Dutch language course.

n The Naturalisation Certificate with the endorsement that you have the required knowledge of the Dutch language.

n A Civic Integration Certificate under the Civic Integration (Newcomers) Act, when the programme under this Act was completed not later than 31 December 2006. This must be accompanied by a declaration of the regional training centre (ROC). This declaration must state that you passed the components 'Listening' and 'Speaking' at level NT2-2, the components 'Reading' and 'Writing' at level NT2-1, and the component 'Social Orientation' at level 2, or 80% if the test was taken after 31 August 2001 and 85% if the test was taken before 1 September 2001, respectively (the foreign national is a settled immigrant).

n A Civic Integration Certificate under the Civic Integration (Newcomers) Act, when the programme under this Act continued in 2007 or 2008. This must be accompanied by a declaration of the regional training centre (ROC). This declaration must state that you passed the components 'Listening', 'Speaking', 'Reading', and 'Writing' at least at level NT2-2, and the component 'Social Orientation' at level 2, or 80% if the test was taken after 31 August 2001 and 85% if the test was taken before 1 September 2001, respectively (the foreign national is a newcomer).

n Settled Immigrants Civic Integration Certificate with:– level NT2-2 for the components 'Listening' and 'Speaking”; and– level NT2-1 for the components 'Reading' and 'Writing'.n The decision of the Municipal Executive that it has been decided pursuant

to Section 5(2) of the Civic Integration (Newcomers) Act not to implement a civic integration programme;

n A decision not to implement a civic integration programme, because the test as referred to in Section 5(4) of the Civic Integration (Newcomers) Act has been passed;

n The document showing that you do not have to or did not have to take the Naturalisation Test pursuant to Section 4 of the Naturalisation Test Decree (medical circumstances/efforts made).

n You are permanently unable to take the civic integration examination for medical reasons

– A letter from the Municipal Executive stating that you are not able to pass the civic integration examination due to a psychological disorder or physical or mental impairment; or

– Medical advice provided by an independent doctor appointed to this end by the Municipal Executive. On the basis of this advice, the Minister of Immigration and Asylum will determine whether you are permanently unable to take the civic integration examination due to a psychological disorder or physical or mental impairment.

Otherwise. You want to apply for a change of your purpose of stay into continued residence and you did not pass the civic integration examination and you do not qualify for one of the above-mentioned grounds for exemption. Please accompany the application by one of the following supplementary pieces of evidence and documents; tick the situation that is applicable to you:n It concerns a situation of special and individual circumstances. You want to

qualify for continued residence without having passed the civic integration examination. You will only be granted continued residence in this case if you cannot be expected to have passed the civic integration examination. Explain in a separate letter why this is not possible for you. You must accompany your application by this letter together with as many pieces of evidence and documents as possible to substantiate your reasons.

n Despite the efforts made, you cannot reasonably be expected to pass the civic integration examination due to the following facts and circumstances:

1. You are illiterate, both in your own language and in the Dutch language, and2. Your age and other circumstances that entail that you (at your age) cannot be

expected to learn how to read and write Dutch within a period of five years.In that case, you must submit a declaration from regional training centre in Amsterdam (ROC Amsterdam) containing the advice that - on the basis of a so-called 'feasibility test' - you will not be able to pass the civic integration examination within a period of five years, due to the fact that you are illiterate (possibly in combination with limited educational skills). You must also submit a document showing that you passed the Spoken Dutch Test at level A2 to demonstrate that you can speak and understand Dutch at level A2. Please visit www.ind.nl for more information.

If you are at least 18 years of age or older, but not yet 65 years of age, you must have passed the civic integration examination. In some cases, you may be exempt from the examination, for instance on the basis of diplomas, certificates, or other documents. Tick the situation that applies to you. Please accompany your application by the following relevant evidence.

BM38/11B

AppendixTuberculosis Test Reference FormM35A / M35A-1

Please fill in the Reference Form before you make an appointment at the Municipal Health Service (GGD). Please visit www.ggd.nl for more information about the Municipal Health Service (GGD). The Municipal Health Service (GGD) will fill in and sign the Reference Form, which shows that you have undergone a TB test. The Municipal Health Service (GGD) will send the Reference Form to the IND. The IND must have received the Reference Form from the Municipal Health Service (GGD) within three months after the date on which the application for a residence permit was submitted.

The obligation to undergo the TB test does not apply if you have the nationality of one of the following countries: the Member States of the EU or the EEA, Australia, Canada, Israel, Japan, Monaco, New Zealand, Surinam, United States of America, and Switzerland (including Liechtenstein). The obligation to undergo the TB test also applies if you have an EC residence permit for long-term residents issued by another EU Member State or if you are a family member of the long-term resident and you have been admitted to another EU Member State as a family member of the long-term resident.

In order to be granted a residence permit, you (or the person you are representing) must be willing to undergo a tuberculosis test (TB test) and - if necessary - to undergo treatment of tuberculosis. If you enclose the Declaration of Intent to Undergo a Tuberculosis Test filled in by you with your application when you are submitting it to the IND (and you also comply with all other conditions), the IND will grant you a residence permit as quickly as possible.

You will then receive this permit under the explicit condition that you will actually undergo a TB test within three months. If it turns out after the issue of the residence permit that - despite the fact that you signed the Declaration of Intent - you have failed to undergo a TB test within the period of three months, this may result in the withdrawal of the residence permit granted.

In order to undergo the TB test, you must make an appointment with the Municipal Health Service (GGD). At your appointment, you must hand over the Reference Form filled in by as completely as possible (part 1).

1 Details of the foreign national to be tested (the applicant)

> The foreign national (the applicant) is to fill in this part (part 1)

1.1 Application for a residence permit for work, as a trainee, for work experience or study purposes?

1.2 How did you come to the Netherlands?

1.3 V-number

1.4 Name

1.5 Gender

1.6 Home address

1.7 Date of birth

1.8 Place of birth


1.10 Nationality

1.11 Civil status

1.12 Border-crossing document

The Minister of Immigration and Asylum hereby requests the Director of the Municipal Health Service (GGD) to examine the person identified below for tuberculosis (of the respiratory organs) pursuant to the Aliens Act Implementation Guide-lines.

n Yes n No

n With n Without a valid provisional residence permit (mvv)


| |

n Male n Female

Street Number

|


|Day month year

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|Type Number

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2 Declaration of the doctor of the Municipal Health Service (GGD doctor)

> The doctor of the Municipal Health Service is to fill in this part (part 2)

2.1 Name of the Municipal Health Service (GGD)

2.2 Name of the doctor

2.3 Test Number and test date


2.5 Signature of the doctor

> The Municipal Health Service (GGD) forwards this declaration, completed in full and signed, to the Immigration and Naturalisation Service. Please use the address applicable to the situation of the foreign national.

Does the application of the foreign national relate to a purpose of stay for work, traineeship, Yeswork experience or study?

No

Did the foreign national enter the Netherlands with a valid provisional residence permit (mvv)? Yes

No

1.13 Do you have a spouse or partner or registered partner?

– Name

– Gender

– Home address

– Nationality

The undersigned, employed by the Municipal Health Service (GGD) as a doctor, states that he/she has tested the foreign national, referred to in this form by the number below, for tuberculosis (of the respiratory organs) on behalf of the Minister of Immigration and Asylum.

|

|Number Day month year


|

|

Immigratie-en NaturalisatiedienstIND-loket kennis- en arbeidsmigratiePostbus 30222280 GA RIJSWIJK

Immigratie-en Naturalisatiedienstafdeling vvr na mvvPostbus 2265201 AE ’S-HERTOGENBOSCH

Immigratie-en Naturalisatiedienstafdeling vvrPostbus 32122280 GA RIJSWIJK

n Spouse n (Registered) partner > Enter the requested data further


| |

n Male n Female

Street Number

|


|

|

BM38/11B

AppendixDeclaration of Intent to Undergo a Tuberculosis TestM35A / M35A-1

Fill in and sign the Declaration of Intent to Undergo a Tuberculosis test and send it to the IND together with your application before you make an appointment at the Municipal Health Service (GGD). By signing this form, you declare to be willing to undergo a tuberculosis test and, if necessary, to undergo treatment of tuberculosis. At your appointment with the Municipal Health Service (GGD), you must hand over the Reference Form, filled in as completely as possible (part 1).

The obligation to undergo the TB test does not apply if you have the nationality of one of the following countries: the Member States of the EU or the EEA, Australia, Canada, Israel, Japan, Monaco, New Zealand, Surinam, United States of America, and Switzerland (including Liechtenstein). The obligation to undergo the TB test also applies if you have an EC residence permit for long-term residents issued by another EU Member State or if you are a family member of the long-term resident and you have been admitted to another EU Member State as a family member of the long-term resident.

In order to be granted a residence permit, you (or the person you are representing) must be willing to undergo a tuberculosis test (TB test) and - if necessary - to undergo treatment of tuberculosis. If you enclose the Declaration of Intent to Undergo a Tuberculosis Test filled in by you with your application when you are submitting it to the IND (and you also comply with all other conditions), the IND will grant you a residence permit as quickly as possible.

You will then receive this permit under the explicit condition that you will actually undergo a TB test within three months. If it turns out after the issue of the residence permit that - despite the fact that you signed the Declaration of Intent - you have failed to undergo a TB test within the period of three months, this may result in the withdrawal of the residence permit granted.

1 Details of the foreign national to be tested (the applicant)

1.1 Application for a residence permit for work, as a trainee, for work experience or study purposes?

1.2 V-number

1.3 Name

1.4 Gender

1.5 Home address

1.6 Date of birth

1.7 Place of birth


1.9 Nationality

1.10 Civil status

1.11 Border-crossing document

n Yes n No


| |

n Male n Female

Street Number

|


|Day month year

|

|

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|Type Number

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1.12 Do you have a spouse or partner or registered partner?

– Name

– Gender

– Home address

– Nationality

2 Signature

2.1 Name of the foreign national



2.4 Name of the legal representative (if applicable)


2.6 Signature of the legal representative (if applicable)

n Spouse n (Registered) partner > Enter the requested data further


| |

n Male n Female

Street Number

|


|

|

I hereby declare that I am prepared to cooperate in the tuberculosis examination and, if necessary, to undergo treatment for tuberculosis. I am aware of my obligation to undergo a tuberculosis examination within three months after the date on which the application for a residence permit was filed. Failure on my part to comply with this requirement will have consequences for my right to stay in the Netherlands.


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BM39A/11B

AppendixMedical information disclosure consent formM35A / M35A-1

Information for the foreign national: If you have more than two doctors/professionals 1

in charge of your treatment, you are requested to copy this appendix, so that you can fill in more than one consent form.

1 The doctor(s)/professional(s) in charge of your treatment must be listed in the BIG-register or in the register of the NIP.

2 If the applicant is 12 years of age or younger or incapable of performing legal acts, this appendix must be filled in by the legal representative. If the applicant is older than 12 years of age but younger than 16 years of age, this appendix must be filled in by the foreign national and his/her legal representative. If the applicant is 16 years of age or older, this appendix must be filled in by the foreign national.

1 Medical Examination

1.1 V-number

1.2 Name

1.3 Date of birth

2 Signature

2.1 Name of the foreign national 2



2.4 Name of the legal representative 2



1. The undersigned hereby declares to have no objection to fact that the medical advisor of the Immigration and Naturalisation Service of the Ministry of the Interior and Kingdom Relations (hereinafter: "IND") will ask for information about his/her state of health from the doctor(s)/professional(s) in charge of his/her treatment in connection with an investigation into the medical circumstances around his/her residence status in the Netherlands.

2. The undersigned grants permission to send this completed consent form in copy form to the doctors/care workers to be contacted.3. The undersigned also gives his/her consent to the medical advisor to provide his/her medical information to a medical specialist

that may be engaged in any further investigation.4. The undersigned authorises the following doctor(s)/professional(s) in charge of his/her treatment who are listed in the

BIG-register (pursuant to the Dutch Individual Healthcare Professionals Act (BIG)) and/or at the NIP (the Dutch professional association of psychologists) (doctors, dentists, physiotherapists, midwives, nurses, pharmacists, healthcare psychologists, psychotherapists, and special educators) to provide information to the medical advisor of the IND. The undersigned declares to be aware that this consent form will be stored in digital form.


| |Day month year


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3 Details of the doctor/professional in charge of the treatment

3.1 Name of the GP/ COA-doctor/specialist 1

3.2 Name of the hospital/ practice/institution



3.1 Name of the GP/ COA-doctor/specialist 1

3.2 Name of the hospital/ practice/institution



4 Passing on the medical advice

4.1 Name of the foreign national 2



4.4 Name of the legal representative 2



| n GP n COA-doctor n Specialist

|Street Number

|


|

| n GP n COA-doctor n Specialist

|Street Number

|


|

The undersigned gives consent to the medical advisor of the IND to provide the medical advice to the civil servants of the Immigration and Naturalisation Service who are responsible for decision-making, to the civil servants of the Repatriation & Departure Service to enable medical arrangements to be made before, during or after removal, to the relevant legal experts of the office of the State Advocate, and to the bodies assigned by law for the administration of justice.


|

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|

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BM39D/11B

AppendixDeclaration of the Medical Situation of the Foreign NationalM35A / M35A-1

Information for the foreign national: Have your doctor/professional in charge of your treatment 1 fill in this appendix fully and sign it. If you have more than one doctor/profes-sional in charge of your treatment, you are requested to copy this appendix, so that every doctor or professional can fill in and sign a copy. Fill in and sign the appendix and submit it in together with your application.

1 The doctor/professionals in charge of your treatment must be listed in the BIG-register or in the register of the NIP.

1 Details of the medical professional

1.1 Name


1.3 Professional title

1.4 BIG registration number



2.1 Name

2.2 Gender

2.3 Home address

2.4 Date of birth

2.5 Place of birth

2.6 Nationality

Information for the doctor/professionals in charge of your treatment: By means of this form, several questions are asked about the presence of a medical treatment of the foreign national mentioned by you below. With your answers, the foreign national can show that there are medical facts or that there is a medical treatment that may be important for the assessment of his/her application for a stay in the Netherlands. In answering these questions, you are not required to assess whether or not the foreign national is complying with the conditions for a stay in the Netherlands. You only have to provide factual details in simple terms that can be understood by non-medically qualified people. The non-medically qualified civil servants of the Immigration and Naturalisation Service (IND) will not form an independent medical opinion on the basis of your answers, but they want to be informed of any active medical treatment being given by you. If the foreign national is under treatment, they may request advice from an independent doctor of the Medical Advice Bureau of the IND. With reference to this advice, the Medical Advice Bureau will contact you, with the specific written consent to this end from the foreign national.

|

|

| 1.5 Registered at NIP? n Yes n No

Street Number

|


|


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n Male n Female

Street Number

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|Day month year

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3 Details of the treatment

3.1 Does the foreign national have one or more medical complaints?

3.2 Is the foreign national currently receiving active medical treatment for these complaint(s)

3.3 If so, what is the nature of this/these complaint(s)?

3.4 If so, when was this medical treatment started?

3.5 When, according to expectations, will the treatment have been completed?

4 Signature


4.2 Signature

n Yes n No

n Yes n No

|

Day month year

Day month year

The undersigned, medical care provider, hereby declares that the following foreign national, is currently receiving active medical treatment from him/her.


|

|

BM41/11B

AppendixDeclaration of Non-ImpedimentM35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay– as a child of 15 years of age or older;– as an au pair;– for exchange purposes through a private exchange organisation.Fill in and sign the declaration and submit it in together with your application.


1.1 V-number

1.2 Name

1.3 Gender

1.4 Date of birth

1.5 Place of birth


> Tick the situation(s) that applies/apply to you.

2 Signature


2.2 Signature


| |

n Male n Female

Day month year

|

|

a. n I declare that I am unmarried and have never been married before nor have I ever entered into a registered partnership

b. n I declare that - after the dissolution of my marriage with my former spouse - I did not get married again (nor did I enter into a registered partnership)

Name ex-spouse

|

c. n I declare that - after the dissolution of the registered partnership with my former registered partner – I did not get married again (nor did I enter into a registered partnership)

Name of former registered partner

|

d. n I declare that I do not have to provide for any children

I am aware that completing this declaration untruthfully may have consequences for the right of residence.


|

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BM42/11B

AppendixDeclaration of RelationshipM35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay with your unmarried partner. Fill in and sign the declaration and submit it in together with your application.

1 Details of the foreign national (the applicant)

1.1 V-number

1.2 Name

1.3 Gender

1.4 Home address

1.5 Civil status

1.6 Date of birth

1.7 Place of birth


1.9 Nationality

– Date

2 The sponsor (the partner)

2.1 Name

2.2 Gender

2.3 Home address


| |

n Male n Female

Street Number

|


|

|Day month year

|

|

|

The applicant declares as follows:He/she has maintained an exclusive relationship with the co-undersigned and that he/she has run a joint household to this end and has actually cohabited at the above-mentioned address as from:

Day month year

He/she undertakes to inform the Immigration and Naturalisation Service immediately of the termination of his/her exclusive elationship with the co-undersigned;He/she will also inform the Immigration and Naturalisation Service of any other relevant changes in this context


| |

n Male n Female

Street Number

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|

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2.4 Civil status

2.5 Date of birth

2.6 Place of birth


2.8 Nationality

– Date

3 Signature



3.3 Signature of the person providing residence

|Day month year

|

|

|

The person providing residence declares that the undersigned is his/her life partner and that he/she is running a joint household with him/her and that he/she has actually been cohabiting with him/her at the above-mentioned address as from:

Day month year



|

|

|

> Completing a declaration of relationship untruthfully is an offence and will be reported at all times.

BM43/11B

AppendixStudy Awareness DeclarationM35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for study purposes. Fill in and sign the declaration and submit it in together with your application.


1.1 V-number

1.2 Name

1.3 Gender

1.4 Home address

1.5 Date of birth

1.6 Place of birth


1.8 Nationality

– Name of study programme

– Name of the educational institution

- City/Town

2 Signature


2.2 Signature


| |

n Male n Female

Street Number

|


|Day month year

|

|

|

I declare that I am aware of the following:My stay in the Netherlands is only permitted for the following purpose:

|

|

|

My stay will be permitted for one year and I will submit an application for an extension of the period of validity to the IND not later than one day before the expiry date of this period.Upon completion, interim termination of the study, or insufficient efforts spent on the study - as a result of which the study will take a disproportionately long time for me to finish it - the IND may decide to withdraw my residence permit or not to extend it. I have to leave the Netherlands at the end of my study.



|

|

> Completing a declaration of awareness (study) untruthfully is an offence and will be reported at all times.

BM42/11B

AppendixAu Pair Awareness DeclarationM35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay as an au pair. Fill in and sign the declaration and submit it in together with your application.

The au pair will be staying in the Netherlands to become acquainted with Dutch society and culture, and the host family will give the au pair the opportunity (within the meaning of free time) to realise this. The host family will assume the above-mentioned financial responsibility for the stay. In addition to board and lodging, the host family will provide a monthly amount in pocket money, to be agreed upon in consultation.

In consideration for the facilities provided, the au pair will assist in the domestic work of the host family alone and/or in looking after and caring for any children present in this family. This consideration may not be in the nature of work, for which a work permit is required within the meaning of the Labour Act for Foreign Nationals. This means that the au pair may only perform activities for which an alternative is always available when she/he is absent. The supportive nature of the work also implies that the au pair will not be fully responsible for the domestic chores, with the exclusion of the members of the host family. The au pair will, after all, stay in the host family on the basis of equality (with the family members). In addition, the supportive nature implies that the au pair will not perform any work for more than 30 hours a week. The division of those 30 hours a week is free, on the understanding that the au pair is not permitted to work for more than 8 hours a day (including babysitting activities in the evening), and that she/he will have at least two days off a week.

If the host family has the au pair perform activities for which a work permit is required pursuant to the Labour Act for Foreign Nationals, the host family is punishable, and the competent authorities in this matter will be notified hereof. By virtue of the restriction under which the residence permit is granted, it is expected that the au pair or the host family will inform the Aliens Department if the actual activities prove to be different from those envisaged for the purpose of stay.

In the context of the monitoring of foreign nationals, the Aliens Department may visit or call up the au pair and/or the host family for a specific cause or for a random check.

The undersigned parties, hereinafter referred to as the au pair and the host family, declare as follows:

The au pair and the host family are aware that the stay as an au pair in the Netherlands will only be permitted in the following cases:– At the time of submitting the application for the residence permit in the

Netherlands, the au pair is at least 18 years of age, but not yet 26 years of age;– The au pair has never stayed in the Netherlands before on the basis of a

residence permit. This does not apply if the au pair is only asking for a change of host family;

– The au pair has a valid Regular Provisional Residence Permit, if required;– The au pair has never had an employment relationship with the host family

before, when living abroad;– All costs ensuing from the au pair's stay in the Netherlands (including an

appropriate health insurance policy, and his or her departure from the Netherlands (whether this departure is forced or not) will be paid by the host family, which has signed an Appendix 'Sponsor Declaration' for this purpose;

– The host family is capable of bearing the above-mentioned costs, which is taken for granted if it is proved that - for the intended period - the host family has an independent income that is at least equal to the applicable social assistance benefit level within the meaning of the Work and Social Assistance Act, plus the social assistance benefit level for single persons of 21 years of age and older within the meaning of this Work and Social Assistance Act.

– If required, the au pair will undergo a tuberculosis test;– The au pair does not pose a danger to public order and national security; – The au pair is unmarried and does not have to provide for any dependent

family member and is not obliged to do so.

The au pair may stay with the host family for a maximum period of one year, to be counted from the arrival date in the Netherlands, if and for so long as the au pair has a residence permit for this period and the au pair continues to comply with the applicable conditions during the stay. The period of validity of the residence permit will not be extended at the end of the year, and the au pair will have to leave the Netherlands at that time.

1 Details of the au pair

1.1 V-number

1.2 Name

1.3 Date of birth

1.4 Place of birth

1.5 Nationality


| |Day month year

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2 Details of the heads /both heads of the host family

2.1 Name of person 1

2.2 Name of person 2

2.3 Home address

3 Signature


3.2 Signature of the au pair


3.4 Signature of person 1

3.5 Signature of person 2


| |Surname as it appears in your passport or on your identity papers First names

| |Street Number

|


|


|


|

|

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BM44A/11B

AppendixAu Pair - Host Family AgreementM35A / M35A-1

Fill in this agreement as completely as possible together with your host family if you are applying for a residence permit as an au pair. Enclose this agreement with your application.

1 Details of the agreement

1.1 The Au Pair - Host Family Agreement (hereinafter 'the Agreement') was concluded on

1.2 between the parties

1.3 the foreign national residing in the Netherlands for a period of one year

1.4 born on

1.5 (hereinafter to be referred to as 'the au pair'), and the family providing free board and lodging to this foreign national

1.6 born on

1.7 (hereinafter to be referred to as 'the host family'), residing at

1.8 to be reached at

1.9 The intermediary services between the Parties was provided by> This only needs to be filled in, of course, if intermediary services have been

provided.

Considering that:The Parties have exchanged information during the past period. The au pair has stated that she/he wishes to become acquainted with Dutch society and culture during a period of one year, and to realise this by staying with a Dutch host family as an au pair. The family has declared that it will provide facilities to the au pair, in return for which the au pair will carry out light domestic work to assist the host family. For this purpose, the au pair has submitted an application for a residence permit (in consultation with the host family, who will act as the family providing residence). The Agreement (signed by the Parties) will be included in the assessment of the above-mentioned application and must therefore be submitted together with the application. The au pair and the host family have read the contents of the Appendix 'Au Pair Awareness Declaration' and have signed and submitted the declaration.

The au pair and the host family therefore agree as follows:

Article 1 - Weekly ScheduleIn exchange for board, lodging, and pocket money, the au pair may not work more than 8 hours a day, with a maximum of 30 hours a week. The au pair is entitled to at least two twenty-four hours' periods of free time, and, in addition to this, to two evenings of free time a week. The au pair may only be asked to perform light domestic work. Examples of this are cleaning up the nursery, doing the laundry of the children's clothes, preparing light meals, babysitting, and doing some shopping now and then. The Parties undertake to comply with these stipulations. For this purpose, the Parties have filled in the table (weekly schedule and alternative) on the back of this appendix, in mutual consultation.

Article 2 - AlternativeThe au pair will function as an equal member of the family. This means that the au pair is not allowed to perform any work for which he or she is indispensable. The host family promises that the au pair will not be solely responsible for any light domestic work or otherwise, or for the care of the children, and that (if the au pair is absent) there will always be an alternative help or babysit present or this alternative help or babysit will be arranged. The host family will state in the table (weekly schedule and alternative) on the back of this appendix which family member will function or may function as the alternative for the au pair.

Day month year

> The au pair and the host family are collectively referred to as Parties.

|Name of the foreign national

|Day month year

Name(s) head(s) of family

|Day month year Day month year

Street Number

|


|Telephone number

Name of office or organisation

|

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BM44A/11B

Article 3 - Cultural ExchangeBeing an au pair is aimed at cultural exchange. This means that the au pair is to participate in a number of leisure activities. These activities may include attending a course; learning a language; joining the host family on their outings; and participating in an organised trip (whether or not with other au pairs). The au pair and the host family undertake to comply at least with the following activities:

1.

2.

3.

4.

5.

Article 4 - Pocket MoneyThe au pair is entitled to receive a payment for the work performed in the family by the au pair. This payment will be made in the form of pocket money and will not be paid as wages, because the au pair is not permitted to perform work within the meaning of the Labour Act for Foreign Nationals. The maximum amount may not be higher than€ 340 a month. The host family promises to pay the au pair an amount of:

€ a month

Article 5 - ValidityThis Agreement is valid from the time it was signed and will continue to be valid until the date that the period of validity of the residence permit of the au pair will expire.

Article 6 - Au Pair Information LineThe au pair has the possibility to report any complaints about his or her stay in the Netherlands at the Au Pair Information Line. Dependent on the type of complaint, it will be passed on to the police or the labour inspection or to both institutions. The Information Line is not available for reports about physical and/or psychological abuse. The host family also has the possibility to contact the Information Line.> For the time being, the Information Line has been incorporated with the IND.

The telephone number of the Information Line is: +31 (0)70 779 48 88

Article 7 - DisputesThis Agreement is subject to Dutch law. Any dispute about the interpretation of this Agreement will be settled the competent court.

3 Signature


3.2 Signature of the au pair as a party to this Agreement

3.3 Signature of the heads/ head of the host family as a party to this Agreement

2 Table. Week Schedule and Alternative

Day Weekly activities Light domestic Taking care of Free time Stand-in work the children Enter the number Enter the number Tick the day(s) Enter the name of the family of hours of hours that apply to member who will act as a stand-in the au pair

Sunday | | |

Monday | | |

Tuesday | | |

Wednesday | | |

Thursday | | |

Friday | | |

Saturday | | |

Drawn up in triplicate (the Parties and the IND each receive a copy)


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|

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BM45/11B

AppendixSpiritual Leader/Teacher of Religious Knowledge Awareness DeclarationM35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay as a spiritual leader or a teacher of religious knowledge. Fill in and sign the declaration and submit it in together with your application.


1.1 Name

1.2 Gender

1.3 Home address

1.4 Date of birth

1.5 Place of birth


1.7 Nationality

2 Signature


2.2 Signature


| |

n Male n Female

Street Number

|


|Day month year

|

|

|

I declare that I am aware of the following:My temporary stay in the Netherlands will be permitted for the purpose of performing activities as a spiritual leader or a teacher of religious knowledge for:

|

My stay in the Netherlands will only be permitted for the duration of the activities.I have to leave the Netherlands after having finished my activities.I am not permitted to perform any other activities during my stay in the Netherlands.



|

|

> Completing a declaration of awareness (spiritual leader/teacher of religion knowledge) untruthfully is an offence and will be reported at all times.

BM47/11B

AppendixSponsor declarationM35A

Only have this declaration filled in if you are submitting an application for a stay:– With your unmarried partner;– With your child;– As a foster child;– As a family member (other than child/parent);– For a family visit;– For study purposes;– As an au pair;– To undergo medical treatment– As an dependent family member of someone who is working for an international

organisation and does not have sufficient means of existence himself/herself.

Fill in and sign the declaration and submit it in together with your application.If the guarantor and his/her partner are both Dutch nationals, please accompany your application with copies of their valid identification documents. If either of the two has a different nationality: a copy of the valid border-crossing document in which the residence permit has been recorded or a copy of the front and back of the residence permit. If the guarantor is not your sponsor /(person providing residence), please accompany a copy of the valid identification document of this guarantor. This is not necessary if this guarantor fills in and signs this sponsor declaration on behalf of an organisation or institution.

foreign national to a place outside the Netherlands where his/her admittance is guaranteed, up to an annual maximum amount of € 5,000, may be recovered from the guarantor. In addition, the undersigned declares to be familiar with the fact that, if the foreign national receives a benefit payment pursuant to the Dutch Work and Social Assistance Act, the costs of social assistance that will have been incurred in connection with the benefits paid to the foreign national (related to the amount of the current benefits in accordance with the standard of the Dutch Work and Social Assistance Act) in addition to the above- mentioned annual amount of € 5,000, will be recovered from the guarantor.

The undersigned acts as a guarantor for the costs incurred by the State and other public bodies as a result of the foreign national’s stay in the Netherlands for a period of five years. The guarantee will end if sufficient security has been provided otherwise, if the foreign national has left the Netherlands permanently, if the foreign national has been granted a residence permit for another purpose or a permanent residence permit, or if the foreign national has become a Dutch national. In addition, the undersigned declares that the cost, excluding costs of social assistance, that are incurred by the State and other public bodies in respect of the foreign national's stay, including the costs of journey of the


1.1 V-number

1.2 Name

1.3 Gender

1.4 Date of birth

2 Details of the guarantor

2.1 Name

2.2 Home address

3 Signature


3.2 Signature of the guarantor> If you are a marriage partner or

registered partner, your partner must also sign for approval


| |

n Male n Female

Day month year


| |Street Number

|


|


| Guarantor Partner guarantor

| |

BM48/11B

AppendixExchange Organisation Sponsor DeclarationM35A / 35A-1

Only fill in this declaration if you are submitting an application for a residence permit for exchange purposes. Fill in and sign the declaration and submit it in together with your application.

The organisation acts as a guarantor for the following:– The costs ensuing from the foreign national's stay in the Netherlands and

his/her departure from the Netherlands (whether this departure is forced or not);

– Taking out adequate insurance against medical expenses and insurance against third-party liability;

– Informing the Aliens Police and the Immigration and Naturalisation Service (IND) immediately of any change (e.g. change of address or change of host family);

– Ensuring that the foreign national is not permitted to perform paid work and that any voluntary work will not be performed without a work permit (for non EU citizens) having been issued;

– The timely return of the foreign national, which return may in any case not be later than one year after the arrival of the foreign national in the Netherlands.

The undersigned, as a representative of the exchange organisation, guarantees that the following cumulative conditions are fulfilled in view of the stay in the Netherlands of the foreign national (mentioned below) in the context of its exchange programme:– The foreign national is not younger than 15 years of age, but not older than

26 years of age;– The foreign national will have a valid passport during the stay;– The foreign national has never stayed in the Netherlands before on the basis

of a residence permit;– The foreign national has never had an employment relationship with the

host family before, when residing abroad;– The foreign national is unmarried and is not providing for dependent family

members;– The foreign national does not pose a danger to public order and national

security;– The foreign national will undergo an tuberculosis test (if applicable).


1.1 Name

1.2 Date of birth

1.3 Nationality

2 Details of the exchange organisation


2.2 City/Town

2.3 Name of the contact person

2.4 Employee’s job title

3 Signature


3.2 Signature of the exchange organisation


| |Day month year

|

|

|

|

|


|

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BM57/11B

AppendixDeclaration of Income as a Self-Employed PersonM35A / M35A-1

1 Details of the accountant

1.1 Professional title

1.2 BECON number Tax Office


Only have this declaration filled in and signed by an accountant if you are submitting an application for a residence permit and you or the person providing residence has an income as a self-employed person. Accompany the declaration filled in and signed by you and your accountant with your application.NB. The IND can verify the correctness of this declaration at another government agency (e.g. the Netherlands Employees Insurance Agency (UWV) or the Tax and Customs Administration).

By means of this form, several questions are asked about the income of the foreign national or of the person who has an interest in the fact that a residence permit is granted to a foreign national. On the basis of your answers, a decision will be made on whether the person involved permanently and independently has sufficient means of existence within the meaning of the Dutch Aliens Act 2000.

2 Details of the self-employed person

2.1 V-number

2.2 Name

2.3 Home address

2.4 Date of birth

2.5 Place of birth

2.6 Nationality

2.7 Name of the enterprise


2.9 Registration number with the Chamber of Commerce

n Tax Advisor from the Netherlands Tax Consultants Association n Tax Advisor from the Dutch Federation of Tax Advisors n Chartered accountant n Accounting consultant n NOAB Advisor n Other, namely:

|

| 1.3 Telephone number

Street Number

|


|


| |Street Number

|


|Day month year

|

|

|Street Number

|


|

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BM57/11B

3 Income from business activities

Current financial year, immediately precedingthe date on which the application was submitted

3.1 The data included at 3.2 and 3.3 relate to the period (from-to)

3.2 Profit or profit share from the business activities over the € above-mentioned period (see explanation)3.3 Amount to mentioned at 3.2 divided by the number of € months stated

Last closed financial year, immediately precedingthe date on which the application was submitted

3.4 Financial year (from-to)

3.5 Profit or profit share from the business activities € in conformity with the annual accounts (see explanation)3.6 Amount mentioned at 3.5 divided by the number of € months in the last closed financial year3.7 Adjustments to the above-mentioned profit or profit € share from the business activities before taxable profit*3.8 Taxable profit* €

3.9 Processing status of return by Tax and Customs Administration> Tick one situation only and enclose the relevant document with your application

3.10 If the Tax and Customs Administration has already imposed an assessment, did it base its assessment on the profit from business activities stated?

Second but last closed financial year

3.11 Financial year (from-to)

3.12 Profit or profit share from the business activities € in conformity with the annual accounts (see explanation)3.13 Amount mentioned at 3.5 divided by the number of € months in the last closed financial year3.14 Adjustments to the above-mentioned profit or profit € share from the business activities before taxable profit*3.15 Taxable profit* €

3.16 Processing status of return by Tax and Customs Administration> Tick one situation only and enclose the relevant document with your application

3.17 If the Tax and Customs Administration has already imposed an assessment, did it base its assessment on the profit from business activities stated?

(*required only for verification purposes by the IND)

NB. The profit of the past financial year or the current financial year of the enterprise is calculated by decreasing the sum of the operating income by the sum of the operating costs. The income and costs must be calculated in accordance with the commercial principles. Please also note the following in this respect. If there is no past financial year, the calculation of the monthly

profit must be made on the basis of the so-called ‘permanence’ rule. This involves the stipulation that both the operating income and the operating costs must be attributable to the relevant period. If the enterprise has the form of a partnership, a general partnership, or a limited partnership, the profit is distributed among the relevant partners.

4 Signature


4.2 Signature Entrepreneur


4.4 Signature Accountant

Day month year Day month year


n Proof that the tax return has been received by the Tax and Customs Administration > For a sole-trader, attach IB-60n Provisional assessment > Attach provisional assessmentn Final assessment > Attach final assessment

n Yesn No > Attach an explanation on a separate annex


n Proof that the tax return has been received by the Tax and Customs Administration > For a sole-trader, attach IB-60n Provisional assessment > Attach provisional assessmentn Final assessment > Attach final assessment

n Yesn No > Attach an explanation on a separate annex

The accountant hereby truthfully declares that the worker on a self-employed basis has earned an income from business activities in accordance with the data filled in on this form


|


|

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IND4014_BE04/11A

Bijlage fotokaartAppendix Passport Photo Form

1. Voorna(a)m(en) en achternaam First name(s) and surname

2. Woonadres Home address

3. Geboortedatum Date of birth

4. Nationaliteit Nationality

5. V-nummer V-number

6. Handtekening Signature

> Plak hier uw pasfoto Your passport photo here

De pasfoto Onder aan deze pagina moet u een nieuwe, nog niet eerder gebruikte pasfoto van uzelf plakken. Als de aanvraag bedoeld is voor uw kind, dan moet u een nieuwe, nog niet eerder gebruikte pasfoto van uw kind plakken. Uw pasfoto moet voldoen aan de Nederlandse paspoorteisen. Laat daarom altijd een nieuwe pasfoto maken door een beroepsfotograaf die bekend is met de eisen die in Nederland aan pasfoto’s worden gesteld. Als uw pasfoto niet aan de Nederlandse paspoort eisen voldoet, kan er geen verblijfsdocument aan u worden uitgereikt. Het is dus belangrijk dat u een goede pasfoto meestuurt.

Hoe plakt u de foto op dit formulier? • Trekhetniet-plakkendevelpapierlos,beginbijdepijl; • Leguwfotorechtophetgrijzekader; • Plakdefotoendrukstevigaan; • Zet uw handtekening in het vak linksonder. Doe dit met een pen

meteendonkerekleurinkt,hetliefstzwarteinkt.Alsuwhandteke-ning niet duidelijk is, kan geen verblijfsdocument worden gemaakt.

The Passport Photo Stick a new and unused passport photo on the designated frame at the bottom of this page. If the application is meant for your child, please use a new and unused passport photo of your child. Your passport photo has to meet the Dutch passport requirements. Always have your passport photo made by a professional photographer who is acquainted with the Dutch passport requirements. No residence document can be issued to you if your passport photo does not meet the Dutch passport requirements. It is therefore very important to supply a good passport photo with this form.

How to append a photo to this form? • Pull away the paper cover, start at the arrow; • Placeyourphotostraightonthegreyareabelow; • Tightlypressthephotoonthepaper; • Place your signature within the frame on the lower left side.

Use a pen with dark, preferably black ink. If your signature is not clearly visible, a residence permit can not be created.

> Invullen in blokletters Complete in capital letters

|Straat Street Nummer Number

|

Postcode Postcode Plaats City/Town

|Dag Day maand month jaar year

|

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