FOR
CEA Form K
OFFICIAL
(non-EU Nationals)
USE
A
PPLICATION FOR A
Bar Code
R
P
ESIDENCE
ERMIT
E
CONOMIC
Application No
S
-S
ELF
UFFICENCY
(To be filled in by persons who are not nationals of an EU Member State, Iceland,
Person Registration No
Liechtenstein, Norway or Switzerland)
1.
Applicant Personal Details
New Application
Renewal
Surname:
Current Permit No.
Forename (s):
Former Surname
(if applicable):
___________________________
Current Nationality:
Nationality at birth
:
(if different)
Received by:
Country of Birth:
Place of Birth:
Single
Married
Separated Divorced
Widow/er
Marital Status:
Vetted by:
Male
Female
Date of Birth
:
Sex:
(DD/MM/YYYY)
Foreign ID Other
Passport
:_____________________
Travel Document Type:
(specify)
Travel Document No:
Country of Issue:
Permit Decision:
Approved
Date of Issue
:
Valid Until
:
(DD/MM/YYYY)
(DD/MM/YYYY)
Validity: ________________
Address in Malta:
Property No:
Temporary
Validity: ________________
Property Name:
Refused
Street:
Validity: ________________
Locality:
Conditions:
Mobile:
Telephone:
E-mail:
Permanent Address Abroad:
Door:
Street:
Locality:
Card Permit No.
Country:
Telephone: