Visa Application Form - Kingdom Of The Netherlands In The Caribbean
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9Visa application form
RECENT COLOUR
PHOTO
Kingdom of the Netherlands
3 x 4 cm
in the Caribbean
NB: Read the explanatory note and guidelines through before filling in the form.
APPLICANT’S DETAILS
1.
Surname(s) (as stated in travel document)
FOR OFFICIAL USE ONLY
Visa application number:
2.
Given names (as stated in travel document)
Submitted on:
Processed by:
3.
Other surnames(s) (e.g. maiden name etc.)
Supporting documents
4.
Date of birth
5.
Place of birth
7. ID number
Standard:
(Year-month-day)
Valid travel document
Financial means
6.
Country of birth
Means of transport
Health insurance/(medical) travel
insurance
8.
Current nationality
9.
Other nationality/nationalities
Optional (depending on purpose of
travel):
Invitation
10. Sex
11. Marital status
Guarantee/guarantor’s declaration
male
Single
Married
Divorced
VTA / landing permit /
Cohabiting
Widowed/widower
female
letter of notification / MVV-BES
Other:
Other:
12.
Father’s name (in case of minor)
13. Mother’s name (in case of minor)
Referral (yes/no):
no, independent decision
14.
Type of travel document
Travel document (1951 Convention
yes, referred to:
travel document)
(fill in: country and authority)
National passport
Alien’s passport
Diplomatic passport
Maritime passport/seaman’s book
Visa:
Official passport
Other travel document (please describe):
Granted
Territorially Limited Visa due to:
15.
Travel document number
16. Issued by
entry for specific purpose of travel
public order
17.
Issued on
18. Valid to
national security
public health
19.
If you currently live in a country other than your country of origin, has
Refused
this country issued you with a re-entry permit?
Code for ground of refusal:
Not applicable
No
Code for explanation:
Yes (provide copy of document)
Number of document:
Number of entries:
Issued on (date):
Valid to:
Multiple
19a. What is your current permanent address?
Single (for specific purpose of travel)
Street and number:
Place and postal code:
Country:
Period of stay for each visit:
Telephone number:
Email:
.……..days
20.
What is your current profession?
(maximum of 90 days)
Valid from ………………………….…………
To ………….……………….……………………
21.
Please supply your employer’s contact details (name, address and
telephone number)
For students: please supply the name, address and telephone number of your
educational institution.
This form is provided free of charge.
AVT15/BZ114167B
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