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Proof of sponsorship and/or private accommodation

Proof of Sponsorship and/or private accommodation
Attestation of the person's liability for the visa obligation

Please read the explanation on this page before you start filling out the form.

You need this form to invite people who are subject to a visa requirement before coming to the Netherlands and to whom you wish to
provide accommodation. You also need this form if you want to act as guarantor for a foreigner who requires a visa.

Indicate clearly on the form under 3 'Declaration' what applies in your case: guarantee, accommodation or both.

The form you completed must be presented to the municipality for legalization of your signature. NB! If there is a guarantee, your
partner's signature must also be legalized at the municipality. If you use this form for the arrival of a person who does not require a visa,
you do not have to present it to the municipality for legalization of your signature.

You must then send this form to the person you invited. This person must submit the form with his visa application abroad,
together with all other documents that can serve to substantiate the visa application.

The data you enter on this form will be stored in both the systems of Dutch authorities responsible for processing short-stay visa
applications (the national VIS) and the European Visa Information System (VIS). This data can be shared with competent authorities to
optimally facilitate the performance of public tasks described in the Aliens Act 2000 in the field of inflow, throughflow and outflow. This
takes place under strict conditions, within the applicable laws and regulations in the field of data protection. For more information about
applying for a short-stay Schengen visa, how the visa application is assessed and what is done with your data, please consult the following
links:

• https://ind.nl/
• https://ind.nl/contact/Paginas/Verzoek-om-stuks-of-gegevens.aspx
• https://www.nederlandwereldwijd.nl/visum-nederland/schengenvisum/onderwerpen
• https://www.nederlandwereldwijd.nl/visum-nederland/schengenvisum/privacystatement

This form is a joint publication of: Ministry of Justice

and Security
Immigration and Naturalization Service (www.ind.nl ) Ministry
of Foreign Affairs (www.minbuza.nl )

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1 Details of guarantor and/or accommodation provider (the undersigned)
Undersigned/Soussigné(e)

1.1 Name
Surname/Nom

1.2 First names

Given names/Prenoms

1.3 Birthplace
Place of birth/Lieu de naissance
1.4 Date of birth Day Month Year
Date of birth/Date de naissance Day Month Year
Jour Moi Annee

1.5 Nationality
Nationality/Nationalite

1.6 Country of birth

Country of birth/Pays natal
1.7 Marital status
Civil status/Etat civil
- Single (Single/Célibate) Married (Married/Marie)
- Divorced (Divorced/Divorcé) Widow widower (
- Widow/widower/ Veuf) Other (Other/Autre):
-
-

1.8 phone number

Phone no./Téléphone
1.9 Residential address Street (Street/Rue)
Home address/Adresse de residence

House number and suffix/Numéro en entier

Postcode (Zipcode/Code postal)

Place (City, Town/Ville)

Country (Country/Pays)

1.10 Citizen service number

Citizen Service no./No
d'identification Social et Fiscal

1.11 Passport/identity card number Travel

document no./ No du document de
voyage

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2 Details of the undersigned's marital/registered partner
Details of sponsor's spouse/registered partner / Conjoint du/de la soussigné(e)

If you are married or have entered into a registered partnership, permission for a guarantee must also be granted by your
marital/registered partner.

If you are married or have entered into a registered partnership, your marital/registered partner must also grant a
permission for a guarantee.

And after the registration of the PACS type, the registration is completed and the registration of the partner is subject to the
consent of the attestation of the porter guarantee.

2.1 Name
Surname/Nom

2.2 First names

Given names/Prenoms

2.3 Citizen service number

Citizen Service no./No d'identification
Social et Fiscal
2.4 Passport/identity card number Travel
document no./ No du document de
voyage

declares that it consents to the guarantee.

declarations to grant permission for the guarantee.

don't give your consent to the attestation of your porter guarantee.

3 Declaration
Declaration/Atestation

As the undersigned, I agree that my data will be entered into the systems of Dutch authorities responsible for issuing short-stay
visas (the national VIS) and into the European Visa Information System (VIS) and will be stored there for a maximum of five years.
During that period, these data will be accessible to the visa authorities, the authorities competent to carry out visa controls at the
external borders and within the Member States and immigration and asylum authorities in the Member States. These authorities
use the data to assess whether the conditions for legal entry and legal residence in the territory of the Member States are met, to
identify persons who do not or no longer meet those conditions and to examine and process an asylum application. determine
who is responsible for this investigation. Under certain conditions, the data are also available to the designated authorities of the
Member States and to Europol for the purposes of the prevention, detection and investigation of terrorist offenses and other
serious crime. The authority of the Member State responsible for processing the data is: Ministry of Foreign Affairs, Directorate of
Consular Affairs and Visa Policy (DCV), PO Box 20061, 2500 EB THE HAGUE. The Ministry of Foreign Affairs.

In addition, I agree that the data stated on this form, together with data from other sources, will be used for information-driven
work, including drawing up profiles to enable competent authorities to perform the public task in the field of inflow, flow and
outflow of optimally facilitate foreigners in the Netherlands.

I am aware that I have the right to request from a Member State to inform me what data about me is stored in the European
VIS and which Member State has transmitted that data to the VIS, as well as what data about me is held in the European VIS
systems Dutch authorities responsible for processing short-stay visa applications are stored and that I have the right to request
that incorrect data about me be corrected and that unlawfully processed data about me be destroyed. At my express request,
the authority examining my application will inform me of how I can exercise my right to control my personal data and provide
this information

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correction or destruction, including related measures under the national law of the Member State concerned. A request
regarding the protection of personal data may be submitted to the national supervisory authority of that Member State. For the
Netherlands this is: Dutch Data Protection Authority, PO Box 93374, 2509 AJ THE HAGUE.

I am aware that if I do not complete this form truthfully, I may be guilty of a criminal offense, such as forgery (criminalized in
Article 225 of the Criminal Code). A report could be filed against me.

As the undersigned, I agree that my data will be entered into the systems of the Dutch authorities responsible for issuing short-
stay visas (the national VIS) and the European Visa Information System (VIS) and stored there for a maximum of five years. During
that period, this data is accessible to the visa authorities, the authorities competent to carry out visa checks at the external
borders and within the Member States and immigration and asylum authorities in the Member States. These authorities use the
data to verify whether the conditions for legal entry and residence on the territory of the Member States have been met, to
determine which persons do not or no longer meet these conditions and to examine an asylum application and be able to
determine who is in charge of this investigation. Under certain conditions, the data is also available to the designated authorities
of the Member States and to Europol for the purposes of prevention, detection and investigation of terrorist offenses and other
serious offenses. The authority of the Member State responsible for the processing of the data is: Ministry of Foreign Affairs,
Consular Affairs and Visa Policy Department (DCV), PO Box 20061, 2500 EB THE HAGUE. The Ministry of Foreign Affairs.

In addition, I agree that the data provided on this form, together with the data from other sources, will be used for information-
driven work, including profiling to enable competent authorities to fulfill the public task of inflow, throughput and outflow of to
optimally facilitate foreign nationals in the Netherlands.

I am aware that I have the right to require a Member State to be informed of what data about me is stored in the European VIS
and which Member State has transmitted this data to the VIS, as well as what data about me in the systems of Dutch authorities
in charge of processing short-stay visa applications have been saved and that I have the right to request that incorrect data about
me be corrected and that unlawfully processed data about me is destroyed. At my express request, the authority examining my
application will inform me of how I can exercise my right to control my personal data and have it corrected or destroyed,
including the related measures under the national law of the Member State concerned. A request regarding the protection of
personal data may be submitted to the national supervisory authority of that Member State. For the Netherlands this is: Dutch
Data Protection Authority, PO Box 93374, 2509 AJ THE HAGUE.

I am aware that in the event that I do not fill out this form truthfully, I may be guilty of a criminal offense, such as forgery in
writing (punishable by Article 225 of the Criminal Code). I can be reported.

Your signatory (e) accepts that you are welcome to the introduction of the Dutch authorities' charging systems for the delight of
the visas in the court (the VIS national) and the European information system for the visas (VIS) and your current needs. pendant
during the maximum period of the cinq ans. During this period, it is necessary to use the external visa controls, the external visa
controls, and the external visa controls igration et de l'asile. Use the necessary tools to verify the conditions of entry and test the
conditions for the test results, use the personal identifiers to determine the conditions and determine the conditions and
examine the requirements for assessment and determination. is charged for the survey. There are certain conditions that are
not suitable for the prevention and detection of terrorist activities and for infractions of graves, including investigations and
investigations. The autorité de l'état membre responsable du traitement des données est : Le ministère des Affaires étrangères,
Direction des affaires consulaires et de la politique des visas (DCV), PO Box 20061, 2500 EB LA HAYE. Le ministere des affaires
étrangères.

In addition, you are in agreement with the information presented in the formular form, as well as the information provided by the
sources, so that you can use the actions to view the information, and compris the tabulation of the permanent profiles of the
competent authorities. the return mission of the public service and transport equipment, the transit and the sortie of the
étrangers aux Pays-Bas.

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 You know how much information you have about your communication with me and how you communicate with it during your VIS
européen, and how you know how to communicate with your VIS Don't worry about the legal requirements of the Dutch
authorisations, you will be charged for the requirements for the visa requirements of the court and therefore the requirements of
the authorities will be corrected and the requirements will not be corrected. In order to be able to expressly examine the nature
of the information you require, do not hesitate to examine the characteristics of the personnel and to sort out the nature of the
information you have acquired, and compris the measures associated with the prizes. vertu de la législation nationale de l'État
membre concerné. A requirement for the protection of the données in the character of the personnel in question in the National
Surveillance Authority. Pour les Pays-Bas, il s'agit de : Autoriteit Persoonsgegevens, PO Box 93374, 2509 AJ LA HAYE.

You should be aware that if you do not have to comply with the formula, you are liable for an infraction penalty, which
means that falsification is punishable (punishable by article 225 of the Penal Code). Je peux être signalé.

3.A I hereby declare the following4said alienaccommodationto provide

I herewith undertake to provide the foreign national as specified under4with accommodation

You declare me charger of the personal name of the person4

> Tick(Please tick/Veuillez cocher)

- YesYes/Oui
- NoNo/Non

3.1 What is the reason for invitations to provide

accommodation?
Why have you undertaken to sponsor the
foreign national in question and provide
them with accommodation? / Raisons de
l'invitation et de
l'hébergement de la personne
concernée

3.2 Duration of the visit How long will the - To dawn (Days/Assigner)
visit take? / Durée de la visite - To soften (Weeks/Les semaines)
- Months (Months/Les mois)

3.3 What is the kinship/relationship to the visa

applicant?
In what way are you related to/ connected
with the visa applicant? / Lien (familial or
non) avec la personne concernée

In case you submit the following on behalf of an organization or company4invites the mentioned person, please provide
the following information:

In case you invite the person mentioned under4on behalf of an organization or company, please provide the following
information:

Si vous invite la personne mentionnée au point4according to the organization or the business, provide additional
information:

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 Name of company/organization/Name
of corporation/Nom de la société/de
l'organisation
Address/ Address/ Addresse Street (Street/Rue)

House number and addition (number and suffix/Numéro en entier)

Postcode (Zipcode/Code postal)

Place (City, Town/Ville)

Phone number/Phone no./Téléphone

Chamber of Commerce registration number/

Chamber of Commerce registration number/
Numéro d'immatriculation à la Chambre de
commerce et des sociétés (Chamber of
Commerce)

3.B I imagineguarantorfor the bottom4said alien

I will sponsor the foreign national as specified under4

You guarantee your personal name4

> Tick (Please tick/Veuillez cocher)

- YesYes/Oui
- NoNo/Non

I (the undersigned) hereby declare that I guarantee thepayment of the costs of accommodation, medical care and
repatriationthat are caused by the person mentioned under 4. and this for a period of one yearperiod of 5 yearsor as much
shorter as the duration of the foreigner's stay, counting from the entry of that person into the Schengen territory, up to a
maximum of € 10,000 per year, insofar as these costs would otherwise be borne by the State and/or public bodies. The
guarantee ends if it can be sufficiently demonstrated that the person referred to under 4. has left the Schengen area (such as an
exit stamp affixed by a Schengen State or entry stamp affixed by an authority responsible for border control in the country of
origin).

I (the undersigned) hereby guaranteethe payment of the costs of the stay, medical care and repatriationcaused by the
person mentioned under 4. fora period of 5 yearsor so much shorter as the stay of the foreign national lasts from the date of the
person's entry into the Schengen territory, up to a maximum of € 10,000 per year, insofar as these costs would otherwise be
borne by the State and/or public bodies . The guarantee ends when it can be demonstrated sufficiently that the person
mentioned under 4. has left the Schengen area (for example an exit stamp affixed by a Schengen state or an entry stamp affixed
by a border control authority in the country of origin).

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 Your soussigné(e) certifie par la presente me porter garant pourthe preparation of fresh water, the medical treatment and
the recoverythe person in view of the point 4 pendant oneperiod the 5 ansDuring the period during which the last resort is
concerned, the calculation takes into account the moment of entry into the Schengen territory, with a maximum of € 10,000 per
year, depending on the circumstances. autrement supportés par l'État et/ou les organismes du secteur public. The guarantee
must be followed by the conclusion of the person's vision at point 4 after quitting the Schengen space (by example, the
inspection procedure for the Schengen inspection and the Schengen entry procedure for the control procedure) frontières dans
le pays d'origin).

4 Alien subject to a visa requirement

Foreign national who requires a visa/Personne soumise à l'obligation de visa

4.1 Name
Surname/Nom
4.2 First names
Given names/Prenoms
4.3 Date of birth Day Month Year
Date of birth/Date de naissance

4.4 Current nationality

Current nationality/Nationalité actuelle

4.5 Nationality at birth Nationality at birth/

Nationalité à la naissance

4.6 Country of birth

Country of birth/Pays natal
4.7 Marital status - Single (Single/Célibate) Married (Married/Marie)
Civil status/Etat civil - Divorced (Divorced/Divorcé) Widow widower (
- Widow/widower/ Veuf) Other (Other/Autre):
-
-

4.8 Residential address Street (Street/Rue)

Home address/Adresse de residence

House number and addition (Number/Numéro)

Postcode (Zipcode/Code postal)

Place (City, Town/Ville)

Country (Country/Pays)

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5 Signature
Signature/Signature

The signing must take place in the presence of an authorized municipal officer. The document must be signed in the
presence of an authorized municipal officer
La signature doit être place and presence d'un functional municipal competence

- I declare that I have completed the form truthfully I declare I have

completed the form truthfully Je déclare avoir rempli le formculaire
honnêtement

5.1 Place
City, Town/Ville

5.2 Date Day Month Year

Date/Date Day Month Year
Jour Mois Annee

5.3 Signature of accommodation

provider/guarantor
Signature of host/sponsor / Signature de la
personne se portant garant/se chargeant de
l'hébergement

5.4 Signature
marital/registered partner in case this
also applies
guarantee
Signature of spouse/registered partner or
host/sponsor /
Signature du conjoint de la personne se
portant garant/se chargeant de
l'hébergement

Only the municipality will fill in the space below

5.5 Legalization municipality

5.6 Seen for legalization of the

signature of

5.7 On behalf of the Mayor of the

municipality

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