Kingdom Of The Netherlands In The Caribbean Visa Application Form

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Visa 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:
3.
Other surnames(s) (e.g. maiden name etc.)
Processed by:
4.
Date of birth
5.
Place of birth
7. ID number
Supporting documents
(Year-month-day)
Standard:
Valid travel document
6.
Country of birth
Financial means
Means of transport
Health insurance/(medical) travel
8.
Current nationality
9.
Other nationality/nationalities
insurance
Optional (depending on purpose of travel):
10. Sex
11. Marital status
Invitation
 male
Single
Married
Divorced
Guarantee/guarantor’s declaration
Cohabiting
Widowed/widower
 female
VTA / landing permit /
Other:
letter of notification / MVV-BES
12.
Father’s name (if you are a minor)
13. Mother’s name (if you are a minor)
Other:
14.
Type of travel document
Travel document (1951 Convention travel document)
Referral (yes/no):
National passport
Maritime passport/seaman’s book
no, independent decision
Diplomatic passport
Other travel document (please describe):
yes, referred to:
Official passport
(fill in: country and authority)
Alien’s passport
…………………………………………………………………………..
Visa:
15.
Travel document number
16. Issued by
Granted
Territorially Limited Visa due to:
17.
Issued on
18. Valid to
 entry for specific purpose of travel
 public order
19.
If you are currently living in a country other than your country of origin, has this country
 national security
issued you with a re-entry permit?
Not applicable
No
 public health
Yes (provide copy of document) Number of document:
Refused
Code for ground of refusal:
Issued on (date):
Valid to:
Code for explanation:
19a. What is your current permanent address?
Street and number:
Number of entries:
Multiple
Single (for specific purpose of travel)
Place and postcode:
Country:
Period of stay for each visit: .……..days
Telephone number:
Email:
(maximum of 30 consecutive days’ stay in each country)
20.
What is your current profession?
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.
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