Application form for MVV

This application form is free of charge

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

1 Personal

1.1 Surname (family name) |

1.2 S urname at birth |
(previous family name)

1.3 First name(s) (given name(s)) |

Day month year

1.4 Date of birth

Place Country

1.5 Place of birth | |

Current nationality Nationality at birth

1.6 Nationality | |
1.7 Sex Male Female

1.8 Marital status Single Married Separated Divorced

Widow(er) Other, please specify

1.9 Home address |

1.10 Telephone numbers | |
1.11 E-mail address |
Surname First name

1.12 In case of minors details of | |

parental authority / legal guardian Address Nationality

| |
No. Valid until

1.13 Residence in a country other No Yes. Residence permit or equivalent | |

than the country of current
nationality

10BUZ010063|E

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 2 van 2

1.14 Type of travel document Ordinary passport Diplomatic passport Service passport Official passport

Special passport Other travel document, please specify

Passport number Date of issue

1.15 Passport details |

Valid until Issued by

2 Purpose of stay in the Netherlands

2.1 Employment Paid employment Self employment Highly skilled migrant

Highly educated migrant Leave in the Netherlands, worker on North Sea drilling platforms

2.2 Family Join spouse or registered partner Join partner Join parents

Join foster parents Join a child, single parent of 65 years or older

Join adoptive parents Visiting relatives, max. 6 months

Extended family reunification, children over 18 years

2.3 Study/exchange/work placement Study Cultural exchange, highschool students

Work placement Working holiday programme/scheme, Australia, Canada, New Zealand

2.4 Other Au pair Medical treatment Special grounds

Readmission to the Netherlands, lived in the Netherlands before Resettlement of an invited refugee
Day month year

2.5 I ntended date of arrival

in the Netherlands Name

2.6 N
 ame and address of your |
host in the Netherlands Address

|
2.7 H
 as your host started the Yes No
mvv-procedure for you with
IND in the Netherlands

2.8 I f not, who will pay the My host will pay the fees I will pay the fees myself
mvv-fees into the Dutch
bankaccount of IND

2.9 I s your host an EU, EEA or Yes No

Swiss citizen, living in
the Netherlands, not a Dutch citizen

3 Signature
Place Day month year

3.1 Place and date |

3.2 Signature |
> F or minors signature
of parental authority/legal guardian

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