NLDMFADOM2406613575435

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Caribbean Visa Application - Short-Stay

Application

Country of Application
1. Country of application Dominican Republic

Personal Details

Identity
2. Surname(s) Sandoval Mota
3. Given name(s) Arianna Altagracia
4. Nationality Dominican
5. Gender Female
6. Marital status Single

Birth
7. Date of birth 13-07-2004
8. Place of birth San Pedro de Macoris
9. Country of birth Dominican Republic

Contact
10. Telephone number +18294970480
11. Email address Naomi9135@gmail.com
12. I hereby declare that I wish all correspondence regarding my visa Yes
application for the Caribbean parts of the Kingdom of the Netherlands
to be conducted via the email address as provided by me.

Address
13. Address Calle Fabio Fiallo#14
14. Additional address information
15. Address line 3 Miramar
16. Address line 4
17. Postal code 21000
18. City San Pedro de macoris
19. Country Dominican Republic

Insurance
20. Do you have travel insurance that includes medical cover and/or No
health insurance?

Occupation
21. Occupation Student, Trainee
22. Educational Establishment Cenapec

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23. Phone number 001-8094721155

24. Address AV. San Martìn 147
25. Additional address information
26. Address line 3
27. Address line 4
28. Postal code
29. City Santo Domingo
30. Country Dominican Republic

Journey

Travel Document
31. Type of travel document Normal passport
32. Document number RD8499553
33. Valid from 1-05-2024
34. Valid until 11-05-2030
35. Issued by Arianna Sandoval

Type of Visa
36. Number of entries Single entry (for a specific purpose of travel), valid for 90
days

First Entry
37. Country or island of first entry Sint Maarten

Destination(s)
38. Select all islands you will be visiting during your stay in the Caribbean [-] Aruba
[-] Bonaire
[-] Curaçao
[-] Saba
[-] Sint Eustatius
[x] Sint Maarten

39. Main destination Sint Maarten

Destination

Travel Dates
40. Date of arrival in Sint Maarten 10-07-2024
41. Date of departure from Sint Maarten 10-08-2024
42. Number of days in Sint Maarten 31

Main Purpose of Visit

43. Main purpose of visit to Sint Maarten Tourism

Invitation
44. Have you been invited to Sint Maarten? By a person
45. Surname(s) Santana
46. Given name(s) Naomi
47. Relationship to inviting person Cousin
48. Email address naomi9135@gmail.com

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49. Phone number 00590-690861981

50. Fax number

Inviting Person Home Address

51. Country or island Sint Maarten
52. Address Sugar cake drive #3.4
53. Additional address information
54. Address line 3
55. Address line 4
56. Postal code
57. City Cul de sac

Guarantor's Details
58. Is this person acting as a guarantor? Yes
59. Date of birth of guarantor 27-06-2004
60. Nationality of guarantor Dominican
61. Type of travel document of guarantor Normal passport
62. Travel document number RD6639576

Accommodation
63. Where will you be staying during your visit to Sint Maarten? Staying with the person who invited you

Funding

Means of Support
64. Who is funding the travel and living expenses? Partly me, partly sponsored by someone else
65. Select your means of support [-] Cash
[-] Traveler's cheques
[x] Credit card
[-] Prepaid accommodation
[-] Prepaid transport
[-] Other, please specify

66. Who will be sponsoring your travel or stay? [x] Sint Maarten: Naomi Santana
[-]
67. Indicate the sponsor's or financial guarantor's means of support [-] Cash
[-] Accommodation provided
[x] All expenses covered
[-] Prepaid transport
[-] Other, please specify

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Declaration:
- I have read and understood the information in the explanatory note and the guidelines for completing the form and have completed the form
in full, correctly and truthfully;

- I understand that the visa is a condition for entry to the Caribbean countries but does not give absolute right of entry. At each border control
I will need to be able to show that I satisfy all the requirements for the intended purpose of travel in the country in question. If I do not satisfy
all the conditions I will be refused entry;

- I will use the visa granted on the basis of this application correctly and lawfully. I will not overstay (exceed the permitted period of stay (for
each visit)). Misuse of the visa may mean my removal from the country. It may also mean that I may not be admitted to the Kingdom of the
Netherlands in the Caribbean in the future.

I am aware of and consent to the following:

The collection of the data required by this application form, including my photograph, is mandatory for the processing of the visa application.
Any personal data concerning me that appears on the visa application form, as well as my photograph, can be supplied to the relevant
authorities of the Caribbean parts of the Kingdom of the Netherlands and processed by those authorities, for the purposes of taking a decision
on my visa application.

Such data, as well as data concerning the decision taken on my application or a decision whether to annul, revoke or extend an issued visa,
will be stored and will be accessible to the visa authorities, the authorities competent for carrying out checks on visas at external borders and
to immigration and asylum authorities in the (Caribbean parts) of the Kingdom of the Netherlands. This data will enable these authorities to
verify whether the conditions for the legal entry, stay and residence have been met, and identify persons who do not or who no longer fulfil
these conditions. The authority responsible for processing the data is: Ministry of Foreign Affairs, Consular and Visa Affairs Department
(HDCV), PO Box 20061, 2500 EB THE HAGUE.

I am aware that I have the right to obtain data relating to me, to request that data relating to me which is inaccurate be corrected, and to
request that any data relating to me that has been processed unlawfully be deleted. At my express request, the authority processing my
application will inform me how I may exercise my right to check data relating to me and have it corrected or deleted, including the related
remedies under national law. The national supervisory authority will hear claims concerning the protection of personal data. For the
Netherlands this is: the Dutch Data Protection Authority (Autoriteit Persoonsgegevens) PO Box 93374, 2509 AJ The Hague.

Declaration of consent: use of email

I hereby declare that I wish all correspondence regarding my visa application for the Caribbean parts of the Kingdom of the Netherlands to be
conducted via the email address as provided by me.

Please be aware that the use of email is subject to security risks. You should be aware of these risks if you choose to have correspondence
regarding your visa application sent by email. The Ministry of Foreign Affairs cannot guarantee the reliability of sending or receiving
messages by email, or the confidentiality and integrity of email correspondence via the internet and therefore accepts no responsibility for
any email messages which are subject to delay in delivery or which fail to reach you. All email messages received are processed in
accordance with Dutch legislation on privacy and security. If you believe the risks to be too great, correspondence regarding your application
can be sent by conventional mail. In this case please be aware that it may take longer to send and receive relevant correspondence.

Place and date Signature (for minors: the signature of the person(s)
with parental responsibility/the legal guardian)

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FOR OFFICIAL USE ONLY

Visa application number: ..........................................................

Submitted on: ..........................................................
Processed by: ..........................................................
Supporting documents Standard:
[ ] Valid travel document
[ ] Financial means
[ ] Means of transport
[ ] Health insurance
Optional (depending on purpose of travel):
[ ] Invitation
[ ] Guarantee/guarantor's declaration
[ ] VTA / landing permit / letter of notification / MVV-BES
[ ] Other:
Referral (yes/no): [ ] no, independent decision
[ ] yes, referred to: (fill in: country and authority)

Visa: [ ] Granted
[ ] Territorially Limited Visa due to:
[ ] entry for specific purpose of travel
[ ] public order
[ ] national security
[ ] public health
[ ] Refused
Code for ground of refusal:
Code for explanation:

Number of entries [ ] Multiple

[ ] Single (for specific purpose of travel)

Period of stay for each visit: .......... days (maximum of 90 days)

Valid from ..........................................................

To ..........................................................

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