Application form for MVV

This application form is free of charge

Passport photo size 35 by 45 mm (width by height)

1
1.1 Surname (family name) 1.2 Surname at birth (previous family name) 1.3 First name(s) (given name(s)) 1.4 Date of birth

Personal
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Day month year

Place

Country

1.5 Place of birth 1.6 Nationality 1.7 Sex 1.8 Marital status

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Current nationality

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Nationality at birth

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Male Single Widow(er) Female Married Other, please specify Separated

Divorced

1.9 Home address 1.10 Telephone numbers 1.11 E-mail address 1.12 In case of minors details of parental authority / legal guardian

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Surname First name

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Address

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Nationality

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No. Valid until

1.13 Residence in a country other than the country of current nationality

No

Yes. Residence permit or equivalent

10BUZ010063|E

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1.14 Type of travel document

Ordinary passport Special passport

Passport number

Diplomatic passport

Service passport

Official passport

Other travel document, please specify

Date of issue

1.15 Passport details

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Valid until Issued by

2
2.1 Employment 2.2 Family

Purpose of stay in the Netherlands

Paid employment Highly educated migrant Join spouse or registered partner Join foster parents Join adoptive parents Self employment Highly skilled migrant Leave in the Netherlands, worker on North Sea drilling platforms Join partner Join a child, single parent of 65 years or older Visiting relatives, max. 6 months Join parents

Extended family reunification, children over 18 years 2.3 Study/exchange/work placement Study Work placement 2.4 Other Au pair Cultural exchange, highschool students Working holiday programme/scheme, Australia, Canada, New Zealand Medical treatment Special grounds Resettlement of an invited refugee

Readmission to the Netherlands, lived in the Netherlands before

Day month year

2.5 ntended date of arrival I in the Netherlands 2.6 ame and address of your N host in the Netherlands

Name

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Address

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2.7 as your host started the H mvv-procedure for you with IND in the Netherlands 2.8 f not, who will pay the I mvv-fees into the Dutch bankaccount of IND 2.9 s your host an EU, EEA or I Swiss citizen, living in the Netherlands, not a Dutch citizen Yes No

My host will pay the fees

I will pay the fees myself

Yes

No

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3.1 Place and date

Signature
Place Day month year

3.2 ignature S

>

F or minors signature of parental authority/legal guardian

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