m Vv Sample Form

Application form for MVV This application form is free of charge

Passport photo size �� by �� mm (width by height)

Take a loose extra passport photo with you... just in case. You probably will not need it as we already applied for your Visa with a photo card.

� �.� Surname (family name) �.� Surname at birth (previous family name) �.� First name(s) name(s) (given name(s))

Personal PASSPORT> > | < your family name AS SHOWN ON YOUR PASSPORT | < your family name at birth (for married women using their husband's name > | < all your first name(s) AS SHOW ON YOUR PASSPORT > Day

�.� Date of birth

month

year

< your date of birth as shown on your passport in format DDMMYY> Place

�.� Place of birth

�.�

Nationality

Country

| < your place of birth >

| < your country of birth >

Current nationality

Nationality at birth

| < your current nationality >

| < your nationality at birth >

�.� Sex

Male

Female

�.� Marital status

Single

Married

Widow(er)

Other, please Other,  please specify

Separated

Divorced

Tick the right boxes (one per question)

�.� Home address

| < your current home address >

�.�� Telephone numbers

| < your 1st telephone number, e.g. land line > | < a 2nd number, e.g. mobile phone >

�.�� E-mail address

| < your current email address > Surname

�.�� In case of minors minors details of parental authority / legal guardian

First name

|

|

Address

DO LEAVE BLANK asNationality you are not a minor

| �.�� Residence in a country other than the country of current nationality

|   No

Yes. Residence permit or equivalent

No.

Valid until

|

|

Only tick Yes  if  if you currently live in another country then the country of your nationality; then also fill in the number and end of validity date if you hold a Residence permit or tick No  equivalent. In all other cases ��BUZ������|E

� van �

�.�� Type of travel document

Ordinary passport

Diplomatic passport

Service passport

Special passport

Other travel document, please specify

Passport number

< date of issue (format DDMMYYYY)

Valid until

Issued by

< valid till date (format DDMMYYY) >

�

Tick the right box

Date of issue

| < your passport number >

�.�� Passport details

Official passport

|< organization who issued your passport >

Purpose of stay in the Netherlands

�.� Employment

�.� Family

Paid employment

Self employment

Highly educated migrant

Leave in the Nether lands, worker on North Sea drilling platforms

Join spouse or registered partner

Highly skilled migrant

Join partner

Join parents

 LEAVE ALL BOXES IN 2.1. AND 2.2. BLANK Join foster parents

Join a child, single parent of �� years or older 

Join adoptive parents

Visiting relatives, max. � months

Extended family reunification, children over �� years

�.� Study/exchange/work placement

�.� Other

Only tick the Re-admission box if you lived in NL before

Study

Cultural exchange, highschool students

Work placement

the 'Study' box Working holiday programme/scheme, Australia, Canada, New Zealand

Au pair

Medical treatment

month

Reselement of an invited refugee

year

< intended date of arrival in the Netherlands in format DDMMYYYY >

�.� Intended date of arrival in the Netherlands

Name

�.� Name and address of your host in the Netherlands

| Address

| �.� Has your host started the mvv-procedure for you with IND in the Netherlands �.� If not, who will pay the mvv-fees into the Dutch bankaccount of IND

Yes

No

PLEASE DO NOT FILL IN 2.6 - 2.9 (Officially/legally TU Delft is not your host, although we applied for your Visa ánd will pay on your behalf)

  My host will pay the fees

I will pay the fees myself 

You can still fill in this section at the Dutch embassy if they order you to do so. ONLY THEN use TU Delft, Jaffalaan 9A, 2628 BX Delft.

�.� Is your host an EU, EEA or Swiss citizen, living in the Netherlands, not a Dutch citizen

�

Yes

No

Signature Place

�.� Place and date

| < your home town >

�.� Signature

| < your signature >

>

Special grounds

Readmission to the Netherlands, lived in the Netherlands before Day

Tick in 2.3 and 2.4 only

For minors signature of parental authority/legal guardian

Day

month

year