Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay

Nederlandse versie you have filled in this form completely and collected all the required Dit aanvraagformulier is ook verkrijgbaar in het Nederlands. Bel met evidence and documents, so do not submit it in parts. If your application 0900 1234561 (€ 0.10 p.m. plus de kosten voor het bellen met uw is not complete it cannot be assessed properly. Non-payment or overdue mobiele telefoon). Vanuit het buitenland belt u +31 20 8893045. Of kijk payment and the submission of an incomplete application may slow op: www.ind.nl om dit formulier aan te vragen of te downloaden. down the handling of the application. You can only tick one purpose of stay on each application form. Please read the explanation on this page and the next carefully before you fill in the form. Minor children Why this form? If you are the parent or legal representative of a minor child, you can also You can use this form to submit an application for a Dutch Regular fill in this form on behalf of him/her. Where the form refers to ‘you’ or Residence Permit (VVR). You can only use this form if one of the ‘the applicant’, the child is meant. Fill in one form for each child. following situations applies to you: Please answer all questions on behalf of the child. If the child is 12 years • You do not have or do not need a Regular Provisional Residence of age or older, then he or she must sign the form himself/herself. If the Permit (MVV); or child is younger than 12 years of age, you do not have to fill in point 3, • You have an MVV for a specific purpose of stay, but you want to apply the ‘Antecedents Declaration’. for a residence permit for a another purpose of stay; or • You want to change your residence permit for a specific purpose of NB. It is possible that the minor child has Dutch nationality by operation stay into a residence permit for a another purpose of stay; or of law, and does not need a residence permit at all. This may be the case • Your personal situation has changed and you must submit a new in the following situations: application; or • At the time the child was born, the child’s father was living in the • The situation of your sponsor has changed and you must submit a Netherlands and his father’s father or mother was living in the new application. Netherlands when he was born himself; or In all other cases, it is not possible to use this form to submit an • At the time the child was born, the child’s mother was living in the application. On page 3 of this form you can read which form you must Netherlands and her mother’s father or mother was living in the use to submit your application. Netherlands when she was born herself. NB. If you want to stay in the Netherlands as a scientific research worker For more information you can contact the migration/immigration desk within the meaning of Directive 2005/71/EC, then contact the research or the Population Affairs Department in the municipality of your place of institute. The institute must submit the application on your behalf. residence.

How to fill in this form Have you been staying with your spouse or partner or registered partner Fill in one form for each person for whom an application is being for a period of three years or longer? Have you had, for a period of three submitted. The form consists of 19 pages and 21 appendices. years or longer, a residence permit to stay with a person who is permitted Tick under 6 (page 7) the box stating the purpose of stay for which you to stay in the Netherlands permanently or with a Dutch national? In that are submitting an application for a residence permit. Which appendices case, you may qualify for a residence permit for the purpose of continued you have to fill in depends on your situation. This has been indicated residence. The advantage of a residence permit for continued residence in the questions and on the appendices. Do not submit this form until is that the extension of the period of validity of this residence permit

– Signature of the foreign national (the applicant) I have filled in this form truthfully. I know that, for the purpose of implementing the Aliens Act 2000, the personal data filled in will be processed and passed on to the institutions that require these details for this purpose. I will immediately inform the IND of any changes in the situation that relates to the residence permit.

Name | City/Town Day month year

City/Town and date | Number Signature | | I submit this form and of appendices/documents in evidence

IND5007_M35A/11B 2 of 19 does not depend on your family situation. The residence permit for Union who, after having worked as an employee or on a self-employed continued residence is therefore also called an ‘independent’ residence basis, has retired or has taken early retirement, who has become permit. permanently unfit for work, or who has worked as a frontier worker. • Do you want to extend your current residence permit? In that case, How to submit this application use the form ‘Application for an Extension of the Residence Permit’. Before you submit the application, call 0900 1234561 (€ 0.10 per • Under specific conditions it is possible for formerly privileged foreign minute plus any additional costs charged by your operator if you are nationals, foreign nationals who remigrated with application of calling from a mobile phone) to make an appointment with the IND Article 8 of the Dutch Remigration Act, and adult individuals who desk in your region. The IND employee will tell you which information qualify for re-entry, as referred to in Article 3.92 of the Dutch Aliens you must bring with you to the appointment. Each person submitting an Decree, to apply for a Permanent VVR. In that case, use the form application must be present when the application is being submitted. ‘Aanvraag of wijziging verblijfsvergunning regulier voor onbepaalde tijd’. You must bring the originals of all the required evidence and documents • If you want to be considered for a residence permit for reasons that with you. The IND verifies these documents and makes copies of them, are based on asylum-related grounds, you cannot use this form. You after which the IND will return all original documents to you. The copies must apply for asylum at the Application Centre in Ter Apel. For more will be added to your application. information about this, call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a IND desks mobile phone) or +31 20 8893045 from outside the Netherlands. The IND has desks in Zwolle, Utrecht, Rijswijk, Den Haag, Rotterdam, Eindhoven, Den Bosch, Amsterdam, and Hoofddorp. These are the cities/ NB. If you want to stay in the Netherlands for study purposes, the towns where you must submit your application. Please visit www.ind.nl following applies: If you want to attend a higher education course and for the nearest IND desk. you do not have a provisional residence permit, then do not use this form, but contact the educational institution. The educational What will happen with your application? institution must submit the application on your behalf. Once you have submitted your application at one of the IND desks and you have paid the application costs (fees), your application will be New passport photo, signature, and Appendix ‘Photo Card’ assessed by the IND. If your application is not complete it cannot be This form must be accompanied by a Photo Card, which is necessary for assessed properly. Non-payment or overdue payment and the making your residence permit. Please place your colour passport photo submission of an incomplete application may slow down the handling and your signature on this Photo Card. The passport photo will be placed of the application. According to the law, the IND must make a decision on a chip on the residence permit. Your signature will also be included on your application within 6 months. You will receive a written notice on the residence permit. when the handling of your application has been completed. When your application is granted, you will receive a letter with information about Requirements of the colour passport photo where you can pick up your residence document. Your colour passport photo, which you must place on the enclosed Photo Card, must meet the following requirements: Period of validity of the residence permit • Your passport photo may not have been used for a residence permit You can use this form to submit an application for a Temporary VVR. before and it must bear a clear resemblance. The Temporary VVR is valid for one year, unless it becomes evident • In addition, your passport photo must meet the Dutch passport within that year that you no longer meet the conditions that apply to the requirements. You can find these requirements at purpose of stay you have stated in this application. You must also use www.paspoortinformatie.nl/nederlands/reisdocumenten/pasfoto. this form if you currently have a VVR for study purposes and you want to make use of the so-called orientation year for highly skilled migrants. If your passport photo does not meet these requirements, it will not be You can only apply for a VVR for one purpose of stay. possible to make a residence permit and issue it to you. So it is impor- tant that you send along a proper passport photo. Always have a new pas- Application costs (charges) sport photo made by a professional photographer who is familiar with Applying for a residence permit costs money. These costs must be paid the applicable requirements for passport photos in the Netherlands. the moment you submit the application. The costs depend on the purpose of stay for which you submit an application. This form does Signature requirement not include any information about the costs or a possible exemption Each person from 12 years or older must place his/her signature on the from paying charges. If you want to be informed of the costs in advance, Photo Card himself/herself. please visit www.ind.nl or call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a Bring the Photo Card along when you are submitting your application. mobile phone) or +31 20 8893045 from outside the Netherlands. If the assessment of your application establishes that you do not qualify for the Border-crossing document requested residence permit the money will not be refunded. When you are going to submit your application, you must also bring along your border-crossing document (e.g. your passport). A sticker will Other forms be affixed to this document and a copy will be made of it. This copy will • Do you already have a valid MVV and do you want to apply for a be added to your application. residence permit for the same purpose? In that case use the form ‘Application for a Residence Permit with an MVV’. Foreign documents • Do you have Bulgarian or Romanian nationality? Or are you a family Any official foreign documents about persons that are required for the member of a person with a nationality from an EU/EEA Member State application must have been legalised or provided with an Apostille or Switzerland? In those cases, you may, if you wish to do so, apply stamp by the competent authorities of the issuing country. This may for a certificate of lawful residence on the basis of EU Law instead relate to documents such as birth certificates, certificates of unmarried of applying for a VVR. In that case, do not use this form, but use status (not older than 6 months), marriage certificates, and court decisions the form ‘Application for Verification against EU Law’ (certificate of regarding adoption and guardianship. This may take a great deal of time. lawful residence). We therefore advice you to have the relevant documents legalised or • Are you a national of the Union or a family member of a national of provided with an Apostille stamp in the country of origin several months the Union and have you stayed in the Netherlands for a continuous before submitting the application. For more information about period of 5 years or more? In that case, use the form ‘Application for a legalisation or Apostille requirements for documents for each country Permanent Residence Permit for nationals of the Union and their and any exceptions to this, please call the Ministry of Foreign Affairs at Family Members’. You can also use this form if you are a national of the (+31) (0)70 348 4844 or visit www.minbuza.nl/en/Services.

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Language of the documents to be enclosed residence permit for long-term residents issued by another EU Member All documents must have been drawn up in Dutch, English, French, State or if you are a family member of the long-term resident and you or German. Is this not the case? If this is not the case, you must have have already been admitted to another EU Member State as a family your documents translated by a translator who has been sworn in member of the long-term resident. as a translator by the Dutch court. Submit the translation(s) and the document(s) together with the application to the IND. If you do not Dutch Personal Data Protection Act have the document(s) translated in the Netherlands by a translator who Under the Dutch Personal Data Protection Act, the IND is obliged to has been sworn in as a translator by the Dutch court, but abroad, not inform you that the IND is the organisation that processes the data only the document, but also the translation must have been legalised included in your application. The IND does this to establish whether you or provided with an Apostille stamp by the competent authorities of the qualify for an asylum residence permit. The Minister for Immigration issuing country. and Asylum is responsible for this. If you have any questions about this data processing, you can ask these questions in a letter to the IND, Work permit Postbus 1200, 2280 GE Rijswijk, the Netherlands. You can also send a If you want to work as an employee, you will often need a work permit. request to the same address asking the IND for an overview of the data For further information about the work permit, please contact UWV processed about you. With reference to this overview, you may ask the WERKbedrijf (which is the work placement division of the Netherlands IND to correct, supplement, delete, or block your personal data. Employees Insurance Agency) (www.werk.nl). More information Tuberculosis Please call the IND for more information about this application form If you want to be considered for a residence permit, you must first take or about your situation. The IND can be reached at 0900 1234561 on a tuberculosis test and, if necessary, undergo treatment. You must prove working days from 9 a.m. to 5 p.m. (€ 0.10 p/m plus the costs of your this with an original recent Tuberculosis Test Reference Form filled in mobile telephone), or +31 20 8893045 from outside the Netherlands, and signed by the Dutch Municipal Health Service (GGD) if you are or visit www.ind.nl. You can also go to one of the IND desks. If you want applying for a residence permit for the first time. This obligation does to know where the nearest IND desk is, please visit www.ind.nl or call not apply to foreign nationals who have the nationality of an EU/EEA 0900 1234561 (€ 0.10 per minute plus any additional costs charged by country, Australia, Canada, Israel, Japan, Monaco, New Zealand, Surinam, your operator if you are calling from a mobile phone) or +31 20 889 3045 United States of America, and Switzerland. You are also not obliged to from outside the Netherlands. undergo a TB test if you have one of the following documents: An EC

1 Details of the foreign national (the applicant) I am submitting this application (for the maximum period of validity) for myself / my child / the child that I legally represent:

> Tick the situation that applies a. n An initial residence permit to you. b. n Change of the purpose of stay of the residence permit (together with the extension of the validity of the residence permit)

(The V-number can be found in previous correspondence 1.1 V-number n Yes n No from the IND or on your previous residence permit ) 1.2 Citizen Service Number (BSN) (if known) Surname as it appears in your passport or on your identity papers First names 1.3 Name | |

1.4 Gender n Male n Female Street Number 1.5 Home address | Postal code City/Town

| Day month year 1.6 Date of birth

1.7 Place of birth |

1.8 Country of birth |

1.9 Nationality |

1.10 Civil status | Telephone number E-mail 1.11 Contact |

1.12 Do you have an EC n Yes n No residence permit for long-term residents in another Member State? IND5007_M35A/11B 4 of 19

2 Details of the sponsor Fill in the required data concerning the sponsor. The sponsor is the person with whom you want to stay or the organisation that will pay for your stay in the Netherlands. If you want to stay in the Netherlands, for example to work, or in preparation of a study, or to attend a course, please fill in the data of the organisation by whom you will be employed or where you will attend a course, and its contact person.

2.1 Citizen Service Number (BSN) (if known) Surname as it appears in your passport or on your identity papers First names 2.2 Name | |

2.3 Gender n Male n Female Street Number 2.4 Home address | Postal code City/Town

| Day month year 2.5 Date of birth

2.6 Place of birth |

2.7 Country of birth |

2.8 Nationality |

2.9 Civil status | Telephone number E-mail 2.10 Contact |

2.11 Residence status n Dutch nationality n Awaiting the outcome of an application for a residence permit

n None n Privileged n Residence permit

> Fill in only in cases of work/study

2.12 Name of the organisation |

2.13 Contact person |

3 Antecedents Declaration 3.1 Tick the situation that applies to you. a. n I declare the following: You only have to fill in this declaration if you – I have never been sentenced to a term of imprisonment - nor have I received a custodial order - for (the applicant) are 12 years of age or older. committing a crime; – I have never been sentenced to perform unpaid work for the benefit of the general public or to NB. If you do not fill in this Antecedents Declaration perform community service for committing a crime; truthfully, this may have consequences for your residence – I have never received an unconditional fine for committing a crime; status. – I have never accepted an out-of-court settlement for committing a crime; – I have never received a punishment order for committing a crime; – I am currently not involved in criminal proceedings for committing a crime; – I have never been responsible for one of the following categories of acts as referred to in Article 1F of the Convention on Refugees of 1951: a crime against peace, a war crime, or a crime against humanity, a serious non-political crime (e.g. murder or an act of terrorism), or acts contrary to the purposes and principles of the United Nations (e.g. acts of terrorism); and – I am familiar with the fact that a sentence for committing a crime may result in a refusal of a residence application or a termination of residence.

b. n I cannot declare the above for the following reasons: |

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4 Tuberculosis The countries that are members If you want to be considered for a residence permit, you must first take a tuberculosis test and, if necessary, undergo treatment. If of the European Union (EU) are you are applying for a residence permit for the first time, you must prove that you have taken this test by means of the Tuberculosis the following: Austria, Belgium, Test Reference Form. Several nationalities are exempt from this obligation (see the explanation on the back/page 2 of this form). Bulgaria, Cyprus, Czech Republic, Tick the situation below that applies to you. If you – as a foster child or as an adopted child – have passed a TB examination in the Denmark, Estonia, Finland, country of origin and this is evidenced by a recent medical declaration to be submitted along with the application, you do not have France, Greece, Germany, to undergo a TB test. Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, a. n I do not have to undergo a TB test, because I have the nationality of one of the following countries: Australia, Canada, Israel, the Netherlands, Poland, Japan, Monaco, New Zealand, Surinam, Switzerland, United States of America, the EU/EEA countries. Portugal, Romania, Slovenia, Slovakia, Spain, Sweden, and b. n I do not have to undergo a TB test, because I have a valid EC residence permit for long-term residents issued by another EU the United Kingdom. Member State, or I am a family member of a long-term resident and I have already been admitted to another EU Member The countries that are members State as a family member of the long-term resident. of the European Economic Area (EEA) are the following: c. n I do not have to undergo a TB test, for I was born in the Netherlands and I have not moved my main residence outside the Liechtenstein, Norway, and Netherlands since my birth. Iceland. d. n I have already undergone a TB test in connection with my first application for a residence permit, and my new application concerns a continuation of that residence.

e. n I have another nationality and n I have already undergone a TB test in the Netherlands: You must accompany your application by an original recent TB Test Reference Form. This form proves that you have undergone a TB test, but the form may not be older than 6 months; n I have not yet undergone a TB test in the Netherlands: Your application must be accompanied by a signed ‘Declaration of Intent to Undergo a TB Test’ showing that you are prepared to undergo a TB test. Use the Appendix ‘Declaration of Intent to Undergo a TB test’ for this purpose. You must then make an appointment for this test. You can make an appointment with the Municipal Health Service (GGD) in the region where you are staying (visit www.ggd.nl for more information). Use the Appendix ‘TB Test Reference Form’ for this purpose.

5 Exemption from the Obligation to Have an MVV, and Special Situations You will usually be required to have a Provisional Residence Permit (MVV) to be able to apply for a Dutch residence permit. You must apply for an MVV in the country of permanent residence. This is your country of origin, or the country where you have been permitted to stay for a period longer than 3 months on the basis of a residence permit. You may enter the Netherlands with a valid MVV. Once in the Netherlands you can use this MVV to apply for a residence permit for the same purpose of stay. In some cases, you do not require a Provisional Residence Permit. The relevant situations are listed and explained below: Please read all the situations before ticking the situation that applies best to you. If your situation is not listed below, you will probably require an MVV. n I have a valid residence permit n I cannot apply for an MVV in my country of origin for health reasons The period of validity is stated on your residence permit. Your application must If, for medical reasons, it is not safe for you to travel to your country of origin, be accompanied by copies of the front and back of your residence permit. you do not have to apply for an MVV. You must prove this with the following evidence and documents: n I have a nationality that is exempt from the MVV requirement – The Appendix ‘Declaration on Your Medical Situation’ filled in completely Persons having the nationality of one of the following countries do not require and signed by your doctor. This declaration may not be older than 1 month. an MVV to apply for a residence permit: Australia, Austria, Belgium, Bulgaria, Any changes in your medical situation that may be relevant to taking a Canada, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Greece, decision must be declared in a new medical declaration. Germany, Hungary, Iceland, Ireland, Italy, Japan, Latvia, Liechtenstein, Lithuania, – The Appendix ‘Medical Information Disclosure Consent Form’ filled in Luxembourg, Malta, Monaco, New Zealand, Norway, Poland, Portugal, completely and signed by you. If several doctors are in charge of your Romania, Slovenia, Slovakia, Spain, South Korea, Sweden, United Kingdom, treatment, the consent to contact these doctors must be given separately United States of America, and Vatican City. for each doctor. Your consent must be given with respect to the contact with the doctor(s) in charge of your treatment in the Netherlands as well as the n The period of validity of my residence permit has expired doctor(s) in charge of your treatment in the country of origin; The period of validity is stated on your residence permit. If you have not been able to extend or change your residence permit within 2 years from expiry of n I am submitting an application for a residence permit for re-entry the document, you must state the reason for this in a separate letter. Only in A residence permit for re-entry is for former Dutch nationals and foreign cases where this was caused by circumstances beyond your control will it not be nationals who had a residence permit in the Netherlands in the past for many necessary for you to have an MVV. You must accompany you application by this years. If you want to qualify for a residence permit for the purpose of re-entry, letter together with as many pieces of evidence and documents as possible to you are usually exempt from the MVV requirement. The situations in which you substantiate your story. may submit an application for a residence permit for the purpose of re-entry are stated below. For each situation, an indication is given as to whether or not you are exempt from the MVV requirement. – You are a former Dutch national and you were born and raised in the Netherlands. There is no general exemption form the MVV requirement in this case. It is, however, very probable that you will be exempt from the MVV requirement after all, because you were a lawful resident of the Netherlands as a Dutch national before you were 19 years of age for a period of 5 consecutive years, and you did not change your main residence to a country outside the Netherlands. For more information about this, call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile phone) or +31 20 8893045 from outside the Netherlands).

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– You are a former Dutch national and you were born outside the Netherlands. n I am a victim or witness reporting human trafficking There is no general exemption form the MVV requirement in this case. If you are a victim or witness reporting human trafficking, you must report to It is, however, possible that you will be exempted from the MVV the police. On the basis of this report, you can obtain a residence permit. requirement for another reason, for example, because you have the You are not obliged to submit a separate application for this purpose. You do nationality of one of the countries to which the MVV requirement does not require an MVV in this case. not apply. For more information about this, call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling n I have an EC residence permit for long-term residents that was issued by from a mobile phone) or +31 20 8893045 from outside the Netherlands). another Member State or I am the principal person’s spouse or partner or You do not require an MVV in the following situations: registered partner or minor child, and I was admitted to the other – You are of age and you were a lawful resident of the Netherlands for at Member State as a family member of the long-term resident least 10 years when you were between 4 and 19 years of age and you are If you have an EC residence permit for a long-term resident in another Member submitting the application for the purpose of re-entry before you have State of the EU or if you are the spouse or partner or registered partner or minor reached the age of 23 years; child of a person who has an EC residence permit for long-term residents and – You are of age or you were a lawful resident of the Netherlands for a period you formed a family with that person in the other Member State, you do not of at least 5 consecutive years before you turned 19 years of age and the require an MVV. Netherlands is the most appropriate country of residence for you; – You are a minor, your accommodation and representation in the Netherlands n I am the child of someone with an EC residence permit for long-term have been arranged, and you were a lawful resident of the Netherlands (or residents in another Member State. I am unmarried, and of age. I was as a Dutch national) from the age of 4 years for a period of 10 years; also admitted to the other Member State as a family member of the – You are a minor, your accommodation and representation in the Netherlands long-term resident because I am not capable of supporting myself for has been arranged, and you were a lawful resident of the Netherlands (or as health reasons. a Dutch national) for a period of 5 years before submitting the application If you are the unmarried adult child of someone who has the EC residence and the Netherlands is the most appropriate country of residence for you; permit for long-term residents and you were admitted to the other Member – You are a former Dutch national and you renounced your Dutch nationality State as a family member of the long-term resident and you are not capable to be able to rely on the provisions of the Dutch Remigration Act; of supporting yourself, in that case your application must be accompanied by – You qualify for re-entry on the basis of Article 8 of the Dutch Remigration Act; evidence of this. – You are a former Dutch national and you lost your Dutch nationality because it was withdrawn because you did not renounce your original nationality; n I cannot leave the Netherlands – You are a former Dutch national because you renounced your Dutch If you cannot leave the Netherlands through no fault of your own, because you nationality yourself because it would otherwise have been withdrawn do not have a valid border-crossing document and it is not possible for you to because of the failure to renounce your original nationality; obtain replacement documents for valid reasons, you do not require an MVV. – You have submitted an application to the District Court in The Hague to Under 20, ‘Residence permit due to absence of all guilt’ on page 16, you will find establish your Dutch nationality and the Minister of Security and Justice a list of documents and supplementary evidence by which you must prove this. does not consider this application utterly unfounded. – You lived outside the Netherlands due to imprisonment or military service. n I am a minor child and I have been a lawful resident of the Netherlands for a period of at least 3 years. n I am staying as a family member with someone who has a privileged You do not require an MVV in the following cases: status. My family member himself/herself qualifies for a permanent • you are a minor; and residence permit. • you have been a lawful resident of the Netherlands for a period of at least If you are staying - as a family member - with someone with a privileged status 3 years; and and you currently also have a privileged status, you do not require an MVV. • you go to school; and This only applies if the family member with whom you are staying submitted • you intend to stay with a parent who is a lawful resident of the Netherlands. an application for a permanent residence permit at the same time as you did. Employees of a foreign diplomatic or consular post or an international treaty n I want to stay with a family member with an asylum residence permit, but organisation, for example, have a privileged status. my nationality is different from that of this family member You do not require an MVV in the following cases: n I have worked on a Dutch sea-going vessel or in a mining installation on • You are submitting the request for family reunification within three months the continental shelf for 7 years or more. after your family member who is staying in the Netherlands has been If you can prove that you have worked on a Dutch sea-going vessel or in a granted an asylum residence permit; mining installation on the continental shelf for 7 years or more, you do not • You cannot stay in a country with which you have special ties (e.g. your require an MVV. You must accompany this application by the relevant evidence. country of origin). n I have Turkish nationality and I have worked legally in the Netherlands n I cannot leave the Netherlands because this is contrary to Article 8 of the during the past year European Convention on Human Rights If you have Turkish nationality and you have worked legally in the Netherlands If you are of the opinion that you cannot leave the Netherlands because the during the past year, you do not require an MVV, on the basis of an international family life that you have in the Netherlands must be protected by Article 8 of the treaty. This treaty only applies if you want to continue to work as an employee ECHR, you must accompany this application by evidence showing the ties with in the Netherlands and you want to apply for a residence permit for this purpose. the family member who is staying in the Netherlands / the family members who are staying in the Netherlands. You must also set out clearly in which way you n I am a family member or a former family member of a Turkish employee give content to this family life. You must also submit evidence showing that you and I lived with this Turkish employee. and your family members are capable of supporting yourselves (e.g. by means If you have lived legally in the Netherlands as a family member of a Turkish of an employment agreement, salary slips, etc.). If either you or your family employee for three years, you do not require an MVV, on the basis of an members do not have any means of existence, you must submit evidence international treaty. showing what you and your family members have undertaken to earn an income or evidence showing that you are unfit for work or that you are exempt n I have Turkish nationality and I want to work in the Netherlands on a from the obligation to seek work. self-employed basis If you have Turkish nationality and you want to work in the Netherlands on a n Other self-employed basis, the MVV requirement will not be enforced against you in You want to apply for a Dutch residence permit and you do not have a valid advance if you immediately submit a business plan along with your application or correct MVV. Only if there are special and individual circumstances will you to work on a self-employed basis, and it is evident that you have sufficient possibly be able to obtain a residence permit without an MVV. This only applies personal experience and that your profession or business has added value to if you cannot be expected to apply for an MVV in your country of origin or a the Dutch economy. If during the handling of your application it becomes country of permanent residence outside the Netherlands. Explain in a separate evident that you meet all conditions of admission concerning work on a letter why this is not possible for you. You must accompany your application by self-employed basis, you do not require an MVV on the basis of an international this letter together with as many pieces of evidence and documents as possible treaty. to substantiate your reasons. n I was born in the Netherlands, I am 12 years of age or younger and I did not change my main residence to a country outside the Netherlands A child of 12 years of age or younger that was born in the Netherlands and is part of the family of the sponsor (who also did not change the main residence to a country outside the Netherlands) does not require an MVV. The parent(s) must have been (a) lawful resident(s) in the Netherlands.

IND5007_M35A/11B 7 of 19 Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay Immigration and Naturalisation Service Ministry of the Interior and Kingdom Relations

6 Purpose of Stay in the Netherlands Please state the main purpose of your stay in respect of which you are applying for a residence permit. Tick the most important purpose of stay and follow the instruction stated there. n To stay with a spouse or partner or registered partner or family member n For Medical Reasons or relative If you want to stay in the Netherlands because you must undergo medical If you want to stay with a spouse or partner or registered partner or family treatment here member or relative who lives in the Netherlands > Go to 18 on page 17 and follow the instruction written below this purpose of stay. > Go to 7 on page 8 and follow the instruction written below this purpose of stay. n As a victim or witness reporting human trafficking n To work as an employee or as a trainee or for the purpose of work > Go to 19 on page 17 and follow the instruction written below this purpose of stay. experience If you want to work as an employee or as a trainee or for the purpose of work n Through no fault or action of your own experience for a Netherlands-based company > Go to 20 on page 18 and follow the instruction written below this purpose of stay. > Go to 8 on page 12 and follow the instruction written below this purpose of stay. n Continued residence n To work on a self-employed basis You may qualify for continued residence in the following cases: If you want to practise a profession or operate a business in the Netherlands on – You have Turkish nationality and - before submitting the application for a self-employed basis continued residence - you had a residence permit for seeking and > Go to 9 on page 13 and follow the instruction written below this purpose of stay. performing work whether as an employee or on a self-employed basis after the termination of the marriage; n To search for a job as a highly skilled migrant or to start an innovative – You are a minor and you have had a residence permit for at least 1 year to business after having finished your study, and to make use of the stay with parents or adoption or foster parents; orientation year – Before submitting your application for continued residence you had a > Go to 10 on page 14 and follow the instruction written below this purpose of stay. residence permit for a period of at least 3 years for the purpose of family reunification or family formation, medical treatment, as an n To work on the basis of an international treaty unaccompanied minor foreign national, or because you cannot leave > Go to 11 on page 14 and follow the instruction written below this purpose of stay. the Netherlands through no fault of your own; – Before submitting your application for continued residence you had a n If you have an EC residence permit for long-term residents issued by residence permit to stay with your spouse or partner or registered partner, another EU Member State and your spouse or partner or registered partner has died; If you have an EC residence permit for long-term residents issued by another – Before submitting your application for continued residence you had a EU Member State, you can stay in the Netherlands for the following purposes residence permit to stay with your spouse or partner or registered partner, of stay: and you can prove that you are a victim of domestic violence; To work as an employee – You had a residence permit because you are a victim or witness reporting > Go to 8 on page 12 and follow the instruction written below this purpose of stay. human trafficking; To work on a self-employed basis – You had a residence permit, but you cannot leave the Netherlands for > Go to 9 on page 13 and follow the instruction written below this purpose of stay. special circumstances. For study purposes > Go to 21 on page 18 and follow the instructions written below this purpose of stay. > Go to 13 on page 15 and follow the instruction written below this purpose of stay. For other reasons (other than employment, study or vocational training n You are a victim of domestic violence, or honour-related violence, or course) you are a victim of human trafficking, and you cannot or you do not want > Go to 12 on page 15 for purpose of stay ‘economically non-active’, and follow the to report this to the police or render your cooperation in the criminal instruction written below this purpose of stay investigation and prosecution of the human trafficker due to serious If none of the above-mentioned purposes of stay apply, but another purpose threats and/or a medical or psychological impairment. mentioned in this form applies, follow the instruction written below this > Go to 22 on page 19 and follow the instruction written below this purpose of stay. purpose of stay. n You cannot leave the Netherlands because your are stateless or for other n For study purposes reasons > Go to 13 on page 15 and follow the instruction written below this purpose of stay. If you do not have a valid travel document and you have not obtained a replacement travel document through no fault of your own. In other cases n For Exchange Purposes you do not have to submit supplementary evidence. If the IND has any further If you want to become acquainted with the Dutch society and culture through questions, you will receive a separate letter after having submitted this form. the ‘Working Holiday Scheme’, the ‘Working Holiday Program’, or through a For more information about this, call 0900 1234561 (€ 0.10 per minute plus private organisation any additional costs charged by your operator if you are calling from a mobile > Go to 14 on page 15 and follow the instruction written below this purpose of stay. phone) or +31 20 8893045 from outside the Netherlands. > Go to 23 on page 19. n As an au pair If you want to stay in a host family as an au pair to become acquainted with the Otherwise, due to special and individual circumstances Dutch society and culture Explain in a separate letter for which purpose you are submitting an application > Go to 15 on page 15 and follow the instruction written below this purpose of stay. for a residence permit. You must accompany your application by this letter together with as many pieces of evidence and documents of the special n On religious or ideological grounds circumstances to substantiate your reasons. If the IND has any further If you want to stay in the Netherlands with a religious or ideological organisation questions, you will receive a separate letter after having submitted this form. > Go to 16 on page 16 and follow the instruction written below this purpose of stay. > Go to 23 on page 19. n Re-entry If you have lived in the Netherlands earlier, as a Dutch national or with a residence permit > Go to 17 on page 16 and follow the instruction written below this purpose of stay.

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7 Residence Permit to Stay with a Spouse or Partner, Registered Partner, Family Member or Relative Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n You are married to someone or you have a registered partnership with n You are a minor child (not born in the Netherlands) and you live at the someone (the sponsor) who lives in the Netherlands (320, 324, 340, 344) same address as your parent or your legal representative (the sponsor) Your application must be accompanied by the following supplementary evidence (326) and documents: Your application must be accompanied by the following supplementary evidence – Proof of your sponsor’s income, see Appendix ‘Proof of Income’; and documents: – An original extract (not a copy) from the Municipal Administration (GBA) – Proof of your sponsor’s income, see Appendix ‘Proof of Income’; showing your sponsor’s home address and the composition of your – An original extract (not a copy) from the Municipal Administration (GBA) sponsor’s family. This extract may not be older than 6 months; showing your sponsor’s home address and the composition of your – Copies of all the pages containing the identification details of your sponsor’s sponsor’s family. This extract may not be older than 6 months; Dutch passport or identity card. Also make copies of the pages containing – Copies of all the pages containing the identification details of your sponsor’s travel stamps. If your sponsor does not have Dutch nationality, please make Dutch passport or identity card. Also make copies of the pages containing copies of the front and back of the Dutch residence permit or of the pages travel stamps. If your sponsor does not have Dutch nationality, please make containing the identification details of the valid border-crossing document copies of the front and back of the Dutch residence permit or of the pages (e.g. a passport) in which the residence permit has been recorded. Also make containing the identification details of the valid border-crossing document copies of the pages containing travel stamps and the residence permit. It is (e.g. a passport) in which the residence permit has been recorded. Also make not necessary to copy empty pages. copies of the pages containing travel stamps and the residence permit. It is If it concerns a marriage, you must also submit the following: not necessary to copy empty pages. – A copy of the marriage certificate (see the explanation on ‘Foreign – Your birth certificate or - if the family relationship between you and your Documents’ on page 2 and ‘Language’ on page 3 of this form). sponsor is not evident from your birth certificate - other documents showing If it concerns a registered partnership, you must also enclose the following: that family relationship (see the explanation ‘Foreign Documents’ on page 2 – A copy of the certificate of registered partnership. and ‘Language’ on page 3 of this form); If the sponsor has a temporary asylum residence permit and if you have a different – Documents relating to the parental authority the sponsor has over you (if nationality from the sponsor, and the application has been submitted three months after the you were born during the marriage of your parents, a birth certificate will asylum residence permit has been granted to the sponsor, please also submit the following: suffice); – Evidence showing that the family life cannot be led in a third country with If you are 15 years of age or older, also submit the following: which you or the sponsor have special ties. For example proof that you or – An original Appendix ‘Declaration of Non-Impediment’ filled in completely the sponsor will not be admitted to that country. In that case, you do not and signed by you and showing that you are unmarried and that you do not have to send along any proof of the income of the sponsor. provide for children of your own or for children that depend on you. > Go to 23 on page 19 If you are a child by a previous relationship of the sponsor, also submit the following – The declaration of consent signed by the parent staying behind in respect of n You are the unmarried partner of someone (the sponsor) who lives in the your departure from abroad (if the parents have joint parental authority); Netherlands (322, 342) – Copies of the identification document of the parent staying behind; Your application must be accompanied by the following supplementary evidence If the sponsor has a temporary asylum residence permit and if you have a different and documents: nationality from the sponsor, and the application has been submitted three months after the – Proof of your sponsor’s income, see Appendix ‘Proof of Income’; asylum residence permit has been granted to the sponsor, please also submit the following: – An original extract (not a copy) from the Municipal Administration (GBA) – Evidence showing that the family life cannot be led in a third country with showing your sponsor’s home address and the composition of your which you or the sponsor have special ties. For example proof that you or sponsor’s family. This extract may not be older than 6 months; the sponsor will not be admitted to that country. In that case, you do not – Copies of all the pages containing the identification details of your sponsor’s have to send along any proof of the income of the sponsor. Dutch passport or identity card. Also make copies of the pages containing > Go to 23 on page 19 travel stamps. If your sponsor does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages n You are a minor child and born in the Netherlands and since then you containing the identification details of the valid border-crossing document have lived at the same address as your parent or your legal representative (e.g. a passport) in which the residence permit has been recorded. Also make (the sponsor) (764) copies of the pages containing travel stamps and the residence permit. It is Your application must be accompanied by the following supplementary evidence not necessary to copy empty pages. and documents: – The Appendix ‘Sponsor Declaration’ filled in completely and signed by your – An original extract (not a copy) from the Municipal Administration (GBA) sponsor; showing your sponsor’s home address and the composition of your – Your declaration of unmarried status, originating from your country of sponsor’s family. This extract may not be older than 6 months; origin, or from the country where you are permitted to stay for a period of – Copies of all the pages containing the identification details of your sponsor’s more than 3 months on the basis of a residence permit (see the explanation Dutch passport or identity card. Also make copies of the pages containing ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form); travel stamps. If your sponsor does not have Dutch nationality, please make – Your sponsor’s declaration of unmarried status. The declaration of unmarried copies of the front and back of the Dutch residence permit or of the pages status must originate from your sponsor’s country of origin, unless your containing the identification details of the valid border-crossing document sponsor has Dutch nationality or a permanent residence permit (see the (e.g. a passport) in which the residence permit has been recorded. Also make explanation ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this copies of the pages containing travel stamps and the residence permit. It is form); not necessary to copy empty pages. – The Appendix ‘Declaration of Relationship’ filled in completely and signed – Your birth certificate (NB. The document referred to here is copy of the by you and your sponsor; birth certificate from the register of births, deaths, marriages, and registered – The Appendix ‘Questionnaire for a Stay with a Partner’ filled in and signed by partnerships. This is different from an extract from the Municipal you; Administration (GBA)). If your birth certificate does not show the family If the sponsor has a temporary asylum residence permit and if you have a different relationship between you and the sponsor, you must submit other nationality from the sponsor, and the application has been submitted three months after the documents showing that family relationship (see the explanation on asylum residence permit has been granted to the sponsor, please also submit the following: ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form). – Evidence showing that the family life cannot be led in a third country with > Go to 23 on page 19 which you or the sponsor have special ties. For example proof that you or the sponsor will not be admitted to that country. In that case, you do not have to send along any proof of the income of the sponsor. > Go to 23 on page 19

IND5007_M35A/11B 9 of 19 Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay Immigration and Naturalisation Service Ministry of the Interior and Kingdom Relations n You are married to someone or you have a registered partnership with – Evidence relating to the contributions towards the costs of your upbringing, someone (the sponsor) who has an EC residence permit for long-term education and living expenses paid by your sponsor from the date your residents This EC residence permit was issued by another Member State. sponsor took up residence in the Netherlands (e.g. deposit receipts or bank The sponsor is a lawful resident of the Netherlands (that is, with a Dutch statements). residence permit) (320, 324); or If you are an adult child, also submit the following: n You are the minor child of someone (the sponsor) who has an EC permit – Documents showing the actual parental authority over you (e.g. evidence for long-term residents issued by another Member State and who is a showing that the sponsor is or was involved in important decisions lawful resident of the Netherlands (that is with a Dutch residence) (326) concerning your upbringing, education and/or care, including decisions Your application must be accompanied by the following supplementary evidence regarding choice of school, housing, and social development); and documents: If the sponsor has a temporary asylum residence permit and if you have a different – A copy of your residence permit showing that you were admitted to the nationality from the sponsor, and the application has been submitted three months after the other Member State as a family member of the long-term resident (the asylum residence permit has been granted to the sponsor, please also submit the following: sponsor); – Evidence showing that the family life cannot be led in a third country with – Evidence showing that you permanently and independently have sufficient which you or the sponsor have special ties. For example proof that you or means of existence, whether or not together with the long-term resident, the sponsor will not be admitted to that country. In that case, you do not see Appendix ‘Proof of Income’; have to send along any proof of the income of the sponsor. > Go to 23 on page 19 > Go to 23 on page 19 n You are the adult child of someone (the sponsor) who has an EC permit n You are a family member of a minor foreign national who has a for long-term residents issued by another Member State and who is a temporary asylum residence permit (the sponsor) (347) lawful resident of the Netherlands (that is with a Dutch residence permit) Your application must be accompanied by the following supplementary evidence (328) and documents: Your application must be accompanied by the following supplementary evidence – Copies of the front and back of the sponsor’s residence permit; and documents: – Evidence showing that you are the sponsor’s blood relative in the ascending – A copy of your residence permit showing that you were admitted to the line (father, mother, grandfather, grandmother) (see the explanation on other Member State as a family member of the long-term resident (the ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form); sponsor); If you have a different nationality from your sponsor, also submit the following – Evidence showing that you permanently and independently have sufficient – Evidence showing that the family life cannot be led in a third country with means of existence, whether or not together with the long-term resident, which you or the sponsor have special ties. For example proof that you or see Appendix ‘Proof of Income’; the sponsor will not be admitted to that country. – Evidence showing that leaving you behind in the first Member State would If you submit this application more than 3 months after your sponsor was granted a be disproportionally harsh (evidence showing that you are apparently not temporary asylum residence permit, also submit the following: capable of supporting yourself for health reasons). – Proof of your sponsor’s income, see Appendix ‘Proof of Income’. > Go to 23 on page 19 If your sponsor has meanwhile reached the age of 18 years, also submit the following: – Evidence that the Dutch Court has appointed a guardian or mentor because n You are a family member of someone in the Netherlands (the sponsor), of your sponsor’s mental faculties but your are not the minor child or spouse or partner or registered > Go to 23 on page 19 partner and you live at the same address as your sponsor (330) Your application must be accompanied by the following supplementary evidence n You are the father or mother of a child (the sponsor) that lives in the and documents: Netherlands and you are 65 years of age or older and you are single. – Proof of your sponsor’s income, see Appendix ‘Proof of Income’; Your sponsor has Dutch nationality, a Dutch permanent residence permit – An original extract (not a copy) from the Municipal Administration (GBA) (regular or asylum), or a temporary asylum residence permit (332) showing your sponsor’s home address and the composition of your Your application must be accompanied by the following supplementary evidence sponsor’s family. This extract may not be older than 6 months; and documents: – Copies of all the pages containing the identification details of your sponsor’s – Proof of your sponsor’s income and, if applicable, his/her spouse or partner Dutch passport or identity card. Also make copies of the pages containing or registered partner, see Appendix ‘Proof of Income’; travel stamps. If your sponsor does not have Dutch nationality, please make – An original extract (not a copy) from the Municipal Administration (GBA) copies of the front and back of the Dutch residence permit or of the pages showing your sponsor’s home address and the composition of your containing the identification details of the valid border-crossing document sponsor’s family. This extract may not be older than 6 months; (e.g. a passport) in which the residence permit has been recorded. Also make – Copies of all the pages containing the identification details of your sponsor’s copies of the pages containing travel stamps and the residence permit. It is Dutch passport or identity card (and, if applicable, of the Dutch passport not necessary to copy empty pages. or identity card of your sponsor’s spouse or partner or registered partner). – The Appendix ‘Sponsor Declaration’ filled in completely and signed by the Also make copies of the pages containing travel stamps. If your sponsor sponsor (and, if applicable, his/her spouse or partner or registered partner); (and, if applicable, your sponsor’s spouse or partner or registered partner) – An original Appendix ‘Declaration of Non-Impediment’ filled in completely does not have Dutch nationality, please make copies of the front and back of and signed by you and showing that you are unmarried and that you do not the Dutch residence permit(s) or of the pages containing the identification provide for children of your own or for children that depend on you; details of the valid border-crossing document (e.g. a passport) in which the – Your declaration of unmarried status (this declaration of unmarried status residence permit has been recorded. Also make copies of the pages must originate from your country of origin) (see the explanation ‘Foreign containing travel stamps and the residence permit. It is not necessary to Documents’ on page 2 and ‘Language’ on page 3 of this form); copy empty pages. – Documents showing your family life with the your sponsor before your – The Appendix ‘Sponsor Declaration’ filled in completely and signed by the sponsor took up residence in the Netherlands (see the explanation on sponsor (and, if applicable, his/her spouse or partner or registered partner); ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form); – Documents showing the family relationship with your sponsor (e.g. a copy of – Documents showing your family life with your sponsor after your sponsor a marriage booklet, a birth certificate, or a family extract from the register of took up residence in the Netherlands (see the explanation on ‘Foreign births, deaths, marriages and registered partnerships) (see the explanation Documents’ and ‘Language’ on page 3 of this form); on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form); – Documents relating to family members with whom you stayed or can stay in – The divorce certificate or the death certificate of your spouse or partner or the country of origin (see the explanation on ‘Foreign Documents’ on page 2 registered partner or the extract from the register of births, deaths, and ‘Language’ on page 3 of this form); marriages and registered partnerships from the country of origin showing – Evidence showing that leaving you behind in the country of origin would be that you are single (this extract may not be older than 6 months); disproportionately harsh (e.g. documents showing that there are no family – Documents showing the original composition of your family (number of members left in the country of origin, that you depend on the family children); members with whom you want to stay in the Netherlands and/or that you – Documents showing the residence data of all your children (where they live). are not capable of coping independently in the country of origin (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form);

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If you have other children living in the Netherlands who are sponsoring you, also submit the n You have not yet been adopted, but will be adopted into your sponsor’s following: family (350) – Proof of income, see Appendix ‘Proof of Income’; Your application must be accompanied by the following supplementary evidence – The Appendix ‘Sponsor Declaration’ filled in completely and signed by the and documents: children that are sponsoring you; – An original extract (not a copy) from the Municipal Administration (GBA) – Copies of all the pages containing the identification details of their Dutch showing your sponsor’s home address and the composition of your passports or identity cards. Also make copies of the pages containing travel sponsor’s family. This extract may not be older than 6 months; stamps. If they do not have Dutch nationality, please make copies of the – Copies of all the pages containing the identity details of the Dutch front and back of the Dutch residence permits or of the pages containing the passport(s) and identity card(s) of your sponsor and, if applicable, your identification details of the valid border-crossing document (e.g. a passport) sponsor’s spouse or partner or registered partner. Also make copies of in which the residence permit has been recorded. Also make copies of the the pages containing travel stamps. If your sponsor and, if applicable, pages containing travel stamps and the residence permit. It is not necessary your sponsor’s spouse or partner or registered partner, do not have Dutch to copy empty pages. nationality, please make copies of the front and back of the Dutch residence > Go to 23 on page 19 permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit n You are the father or mother of a minor child that lives in the Netherlands has been recorded. Also make copies of the pages containing travel stamps and you want to have a family life with this child on the basis of Article 8 and the residence permit. It is not necessary to copy empty pages; of the ECHR (334) – A copy of the Approval in Principle of the Ministry of Security and Justice, NB. You cannot submit this application if you are cohabiting with a spouse or Directorate-General for Prevention, Youth and Sanctions; partner or registered partner, or if you intend to cohabit with this spouse or – A copy of the declaration showing that a licensed adoption placement partner or registered partner with whom you could reside. If you do not comply agency was used. If no use has been made of such licensed adoption with this condition and you are submitting this application nevertheless, your placement agency: a Declaration of Approval of the Ministry of Security and application will be tested against the condition for residence with a spouse or Justice, Directorate-General for Prevention, Youth and Sanctions; partner or registered partner. – A copy of the official decision of the authority competent in the matter, in Your application must be accompanied by the following supplementary evidence the country of origin (e.g. the official judgment of the court in the country and documents: of origin) as well as a translation of this decision. This must show that you – Copies of all the pages containing the identification details of your minor are permitted to be adopted into the family and that the authorities of the child’s Dutch passport or identity card. Also make copies of the pages country of origin assent to your adoption by the sponsor (see the containing travel stamps. If your minor child does not have Dutch explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of nationality, please make copies of the front and back of the Dutch residence this form); permit or of the pages containing the identification details of the valid – Documents showing that your parent(s) has/have relinquished you (this border-crossing document (e.g. a passport) in which the residence permit approval may be evident from the above-mentioned judgment or from a has been recorded. Also make copies of the pages containing travel stamps separate official waiver) (see the explanation on ‘Foreign Documents’ on and the residence permit. It is not necessary to copy empty pages. page 2 and ‘Language’ on page 3 of this form); – Evidence showing the family relationship between you and your minor child, – A copy of the medical certificate about your state of health, as referred to in e.g. a copy of a birth certificate (see the explanation ‘Foreign documents’ on the Dutch Placement of Foreign Foster Children Act, recently issued in the page 2 and ‘Language’ on page 3 of this form); country of origin. This certificate may not be older than 6 months (see the – Evidence showing the manner in which you give content to the family life explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of with your minor child. this form). > Go to 23 on page 19 > Go to 23 on page 19 n You are a foster child of someone (the sponsor) The sponsor lives in the n You have been adopted immediately into your sponsor’s family following Netherlands (352) an adoption judgment The sponsor lives in the Netherlands (350) NB. You must be a foster child from a family member. The sponsor may only be Your application must be accompanied by the following supplementary evidence the foster child’s grandparent, brother, sister, uncle, or aunt. and documents: Your application must be accompanied by the following supplementary evidence – An original extract (not a copy) from the Municipal Administration (GBA) and documents: showing your sponsor’s home address and the composition of your – Proof of your sponsor’s income, see Appendix ‘Proof of Income’; sponsor’s family. This extract may not be older than 6 months; – An original extract (not a copy) from the Municipal Administration (GBA) – Copies of all the pages containing the identity details of the Dutch showing your sponsor’s home address and the composition of your passport(s) and identity card(s) of your sponsor and, if applicable, your sponsor’s family. This extract may not be older than 6 months; sponsor’s spouse or partner or registered partner. Also make copies of – Copies of all the pages containing the identity details of the Dutch the pages containing travel stamps. If your sponsor and, if applicable, passport(s) and identity card(s) of your sponsor and, if applicable, your your sponsor’s spouse or partner or registered partner, do not have Dutch sponsor’s spouse or partner or registered partner. Also make copies of nationality, please make copies of the front and back of the Dutch residence the pages containing travel stamps. If your sponsor and, if applicable, permit or of the pages containing the identification details of the valid your sponsor’s spouse or partner or registered partner, do not have Dutch border-crossing document (e.g. a passport) in which the residence permit nationality, please make copies of the front and back of the Dutch residence has been recorded. Also make copies of the pages containing travel stamps permit or of the pages containing the identification details of the valid and the residence permit. It is not necessary to copy empty pages. border-crossing document (e.g. a passport) in which the residence permit – A copy of the Approval in Principle of the Ministry of Security and Justice, has been recorded. Also make copies of the pages containing travel stamps Directorate-General for Prevention, Youth and Sanctions; and the residence permit. It is not necessary to copy empty pages; – A copy of the declaration showing that a licensed adoption placement – A copy of a medical declaration relating to you issued in the country of origin agency was used. If no use has been made of such licensed adoption (see the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on placement agency, a Declaration of Approval of the Ministry of Security and page 3 of this form); Justice, Directorate-General for Prevention, Youth and Sanctions. – Evidence showing that your parent(s) or legal representative(s) consent to – A copy of the official decision of the authority competent in the matter, in your going to live in the Netherlands with the sponsor. Insofar as required the country of origin (e.g. the official judgment of the court in the country by the country of origin, you must also submit evidence showing that the of origin) and a translation of this decision (see the explanation on ‘Foreign authorities in the country of origin consent to your taking up residence with Documents’ on page 2 and ‘Language’ on page 3 of this form); the sponsor’s family (see the explanation on ‘Foreign Documents’ on page 2 – Documents showing that your parent(s) has/have relinquished you (this and ‘Language’ on page 3 of this form); approval may be evident from the above-mentioned judgment) (see the – Documents showing the family relationship with your sponsor (e.g. a copy of explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of a marriage booklet, a birth certificate, or a family extract from the register of this form); births, deaths, marriages and registered partnerships) (see the explanation – A copy of the medical certificate of the foreign national’s state of health, as on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form); referred to in the Dutch Placement of Foreign Foster Children Act, issued in – A written statement of reasons of the special circumstances of you or your the country of origin. This certificate may not be older than 6 months (see family members in the country of origin showing that you cannot be taken the explanation on ‘Foreign Documents’ on page 2 and ‘Language’ on page care of, at least not properly, by the family members who live in the country 3 of this form); of origin (see the explanation on ‘Foreign Documents’ on page 2 and If it concerns an adoption judgment rendered by a foreign authority applying the Hague ‘Language’ on page 3 of this form); Adoption Convention, also submit the following; – The Appendix ‘Sponsor Declaration’ filled in completely and signed by your – A conformity statement sponsor; > Go to 23 on page 19 – A certificate (e.g. a guardianship certificate) issued by the competent authorities certifying that the authority over the foster child rests with the foster parents. > Go to 23 on page 19 IND5007_M35A/11B 11 of 19 Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay Immigration and Naturalisation Service Ministry of the Interior and Kingdom Relations n You are a family member of a former privileged person (the sponsor) and n You are a family member of someone (the sponsor) with a residence you depend on him/her (464, 465, 466, 467) permit to undergo medical treatment (415, 416, 417, 418) Your application must be accompanied by the following supplementary evidence Your application must be accompanied by the following supplementary piece of and documents: evidence: – Proof of your sponsor’s income, see Appendix ‘Proof of Income’. – An original extract (not a copy) from the Municipal Administration (GBA) – An official certificate of the Ministry of Foreign Affairs showing that showing your sponsor’s home address and the composition of your immediately prior to submitting the application you had a residence permit sponsor’s family. This extract may not be older than 6 months; on the basis of a privileged status as a dependent family member staying > Go to 23 on page 19 with the sponsor; – Document showing that you cohabit with the sponsor; n You want to visit a family member (the sponsor) in the Netherlands (for a – Evidence showing that you are running a joint household with the sponsor; period of longer than 3 months and not more than 6 months) (470) – If applicable, the certificate of registration at the Municipal Administration Your application must be accompanied by the following supplementary evidence (GBA) of your marriage or registered partnership; and documents: – Copies of all the pages containing the identification details of your sponsor’s – Proof of your income, see Appendix ‘Proof of Income’. If you do not have Dutch passport or identity card. Also make copies of the pages containing sufficient means of existence yourself, the Appendix ‘Sponsor Declaration’ travel stamps. If your sponsor does not have Dutch nationality, please make must be filled in completely and signed by your sponsor or another relative copies of the front and back of the Dutch residence permit or of the pages of you in the Netherlands containing the identification details of the valid border-crossing document – Proof of your sponsor’s income and, if applicable, his/her spouse or partner (e.g. a passport) in which the residence permit has been recorded. Also make or registered partner, see Appendix ‘Proof of Income’; copies of the pages containing travel stamps and the residence permit. It is – An original extract (not a copy) from the Municipal Administration (GBA) not necessary to copy empty pages. showing your sponsor’s home address and the composition of your – Documents showing the family relationship: sponsor’s family. This extract may not be older than 6 months; - In the case of a spouse: a copy of the marriage certificate; – Copies of all the pages containing the identification details of your sponsor’s - In the case of a partner or registered partner: documents showing the joint Dutch passport or identity card. Also make copies of the pages containing partnership and the cohabitation in the country of origin; travel stamps. If your sponsor does not have Dutch nationality, please make - In the case of a child: a copy of the birth certificate. copies of the front and back of the Dutch residence permit or of the pages NB. Under specific conditions, you may qualify for a permanent residence containing the identification details of the valid border-crossing document permit. In that case, you must have resided with the sponsor on the basis of a (e.g. a passport) in which the residence permit has been recorded. Also make privileged status as a dependent family member for a period of 10 consecutive copies of the pages containing travel stamps and the residence permit. It is years immediately before submitting the application. In that case, use the form not necessary to copy empty pages; ‘Application for or Change of a Temporary Regular Residence Permit’ – Documents showing the family relationship with your sponsor (e.g. a copy of > Go to 23 on page 19 a marriage booklet, a birth certificate, or a family extract from the register of births, deaths, marriages and registered partnerships) (see the explanation n You are a family member of non-privileged NATO personnel (the sponsor) on ‘Foreign Documents’ on page 2 and ‘Language’ on page 3 of this form). (461, 462, 463) > Go to 23 on page 19 Your application must be accompanied by the following supplementary evidence and documents: – The Appendix ‘Employer’s Declaration’ filled in completely and signed by your sponsor’s employer (not older than 3 months); – An original extract (not a copy) from the Municipal Administration (GBA) showing your sponsor’s home address and the composition of your sponsor’s family. This extract may not be older than 6 months. If your sponsor is not registered at the Municipal Administration (GBA), you must accompany your application by evidence showing that your sponsor’s main residence is in the Netherlands – Copies of all the pages containing the identification details of your sponsor’s Dutch passport or identity card. Also make copies of the pages containing travel stamps. If your sponsor does not have Dutch nationality, please make copies of the front and back of the Dutch residence permit or of the pages containing the identification details of the valid border-crossing document (e.g. a passport) in which the residence permit has been recorded. Also make copies of the pages containing travel stamps and the residence permit. It is not necessary to copy empty pages. – Evidence showing your family relationship with the sponsor: - In the case of a spouse: the marriage certificate; - In the case of a child younger than 21 years of age: the birth certificate; - In the case of relations by blood or affinity (also children of 21 years of age or older): the document showing the family relationship and evidence showing that you depend financially on the sponsor or the sponsor’s spouse or partner or registered partner; – Evidence showing that the main residence of the sponsor is in the Netherlands. > Go to 23 on page 19

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8 Residence Permit to work Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n As an employee (370) n As a director-major shareholder (456) Your application must be accompanied by the following supplementary evidence Your application must be accompanied by the following supplementary evidence and documents: and documents: – Proof of your income, see Appendix ‘Proof of Income’; – Proof of your income, see Appendix ‘Proof of Income’; – If required: A copy of the application for a work permit or a copy of the work – If required: A copy of the application for a work permit or a copy of the work permit itself (see the explanation on page 3 of this form). permit itself (see the explanation on page 3 of this form); > Go to 23 on page 19 – Evidence showing that your employer has reported your current employment agreement to the Tax and Customs Administration; n For seeking and performing work whether as an employee or on a – Proof that your interest in the company is not more than 25% and that you self-employed basis after the termination of the marriage and you have receive a salary that has been determined by third parties (if your interest is Turkish nationality (336) more than 25%, you must apply for a residence permit to work on a Your application must be accompanied by the following supplementary evidence self-employed basis). and documents: > Go to 23 on page 19 – Evidence showing that you were married for at least 3 years and that your marriage has been dissolved n As a spiritual leader or as a teacher of religious knowledge (376) – Evidence showing that you have had lawful residence on the basis of the Your application must be accompanied by the following supplementary evidence marriage for at least 1 year (a copy of your residence permit) and documents: > Go to 23 on page 19 – Proof of your income, see Appendix ‘Proof of Income’; – If required: A copy of the application for a work permit or a copy of the work n If you have an EC residence permit for long-term residents issued by permit itself (see the explanation on page 3 of this form); another EU Member State (370) – The Appendix ‘Spiritual Leader/Teacher of Religious Knowledge Awareness Your application must be accompanied by the following supplementary evidence Declaration’ filled in completely and signed by you; and documents: – Information about the religious community for which you will perform activities. – A copy of the EC residence permit for long-term residents issued by the > Go to 23 on page 19 other Member State; – Evidence showing that a health insurance policy has been taken out in your n As a border-crossing service provider (500) name; You (the service provider) do not have an EU/EEA nationality, but you live and – A copy of the application for a work permit or a copy of the work permit work in an EU/EEA country and you will be supplying services on the instruction itself (see the explanation on page 3 of this form); of your employer (the services company) on a temporary basis – The Appendix ‘Employer’s Declaration’ filled in completely and signed by Your application must be accompanied by the following supplementary evidence your employer (not older than 3 months); or and documents: – A copy of the employment agreement, or a draft employment agreement, – A copy of your residence permit and a copy of your work permit showing which includes information about your income. that you are entitled to stay in the country where the services company has > Go to 23 on page 19 its registered office and that you work there as an employee of the services company (if you have these permits); n As a trainee (374) – A copy of your employment agreement (with the services company). Your application must be accompanied by the following supplementary evidence > Go to 23 on page 19 and documents: – Proof of your income during your stay as a trainee, see Appendix ‘Proof of n After having worked on a Dutch sea-going vessel or in a mining Income’; installation on the continental shelf for 7 years or more (382) – If required: A copy of the application for a work permit or a copy of the work Your application must be accompanied by the following supplementary evidence permit itself (see the explanation on page 3 of this form); and documents: – A copy of the trainee agreement. – A letter stating the reasons why you want to come to the Netherlands (for If you are going to do a traineeship in the context of the ‘Young Workers Exchange Program’ work on Dutch territory, or if you wish to spend a leave period in the (YWEP), please also submit the following: Netherlands, or due to illness, or due to unemployment); – Evidence showing that you have Canadian nationality and that you live in – Proof of your income, see Appendix ‘Proof of Income’; Canada; – Proof of your employment history on board a Dutch sea-going vessel or in a – Evidence showing that you are still studying at the moment of submitting mining installation on the continental shelf (e.g. a copy of your seaman’s book the request or evidence showing that you finished your studies not more or employment agreement). In the event that this employment history has than 12 months ago. been interrupted: documents relating to the duration and reason for this inter- > Go to 23 on page 19 ruption and, if applicable, documents relating to the benefits received by you; – Proof of the national insurance schemes in connection with your employment n For the purpose of work experience (375) in respect of a social security treaty concluded by the Netherlands or in Your application must be accompanied by the following supplementary evidence respect of the Dutch national insurance schemes; and documents: – An overview of the periods in which you were unemployed or when you – Proof of your income during your stay for the purpose of work experience, did not work on board a sea-going vessel or in a mining installation on the see Appendix ‘Proof of Income’; continental shelf. – A copy of the work experience agreement; – If you want to spend your leave in the Netherlands, also submit the following: – If required: A copy of the application for a work permit or a copy of the work - Evidence showing that you spent your leave periods nearly entirely in the permit itself (see the explanation on page 3 of this form). Netherlands during the employment history; > Go to 23 on page 19 - Evidence showing that you will work for at least one year as an employee on board a Dutch sea-going vessel or in a mining installation on the n As a guest lecturer or paid scientific research worker (394, 395) continental shelf by which you will acquire sufficient means of existence in Your application must be accompanied by the following supplementary evidence a sustainable manner. and documents: > Go to 23 on page 19 – Proof of your income, see Appendix ‘Proof of Income’; – If required: A copy of the application for a work permit or a copy of the work n If you wish you spend your leave in the Netherlands (only if you work in a permit itself (see the explanation on page 3 of this form). mining installation on the continental shelf) (383) > Go to 23 on page 19 Your application must be accompanied by the following supplementary evidence and documents: n As an unpaid scientific research worker (387) – A letter from your employer stating the reason why you require a residence Your application must be accompanied by the following supplementary piece of permit to spend your leave in the Netherlands; evidence: – Evidence showing that you will work for at least one year as an employee – A document issued by the grantor or the European Union showing that a in a mining installation on the continental shelf, by which you will acquire fellowship has been granted to you, or proof of your income, see Appendix sufficient means of existence in a sustainable manner, see Appendix ‘Proof ‘Proof of Income’. of Income’. > Go to 23 on page 19 > Go to 23 on page 19

IND5007_M35A/11B 13 of 19 Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay Immigration and Naturalisation Service Ministry of the Interior and Kingdom Relations n As non-privileged NATO personnel (460) – If you will not be registered at the Municipal Administration (GBA) as Your application must be accompanied by the following supplementary evidence non-privileged civilian personnel: evidence showing that you live in the and documents: Netherlands. – Proof of your income, see Appendix ‘Proof of Income’; > Go to 23 on page 19 – An original extract (not a copy) from the Municipal Administration (GBA) showing your home address and composition of the family. This extract may not be older than 6 months;

9 Residence Permit to Work on a Self-Employed Basis Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n To work on a self-employed basis (377) NB. If you have failed to substantiate your application sufficiently by means of Your application must be accompanied by the following supplementary evidence the above-mentioned documents, your application will not be submitted for and documents, in duplicate and not bound: advice to the Minister of Economic Affairs, Agriculture and Innovation. – Proof of your income, see Appendix ‘Proof of Income’; If you have an EC residence permit for long-term residents issued by another EU – A copy of a document issued by the Dutch authority competent in this matter Member State, also submit the following: showing that you are qualified to practise a profession or operate a business; – A copy of the EC residence permit for long-term residents issued by the – A copy of your business plan, including the following information: other Member State; - Information about you, the entrepreneur (personal data, family and income – Evidence showing that a health insurance policy has been taken out in your situation, financial obligations, education, and professional experience); name; - Business information (information about the line of industry in which you – A copy of your business plan as referred to above. In this context, however, will work, starting date of the enterprise, and place of business); this business plan does not have to include a description of the innovative - Legal aspects (legal form of your enterprise, trade name, licences, liability, character of the business and the product. insurance, and supply conditions); > Go to 23 on page 19 - Commercial aspects (market potential): • A description of the type of business and product (features, application, n Work on a self-employed basis, and you have Turkish nationality (377) need, innovative character, and unique selling points); Your application must be accompanied by the following supplementary evidence • A market analysis (description and size of the market, and potential and documents, in duplicate and not bound: customers/market share), competitors, barriers, co-operations, and risks; – Proof of your income, see Appendix ‘Proof of Income’; • The price breakdown, substantiated by agreements and references. – A copy of a document issued by the Dutch authority competent in this matter - Organisational aspects (description of the organisational structure of your showing that you are qualified to practise a profession or operate a business; enterprise, the required competencies, and the number of staff); – A copy of your business plan, including the following information: - Financial aspects (investment budget, financing plan, repayment schedule, - Information about you, the entrepreneur (personal data, family and opening balance sheet, balance sheet, operating budget, and liquidity income situation, and financial obligations) forecast); - Business information (information about the line of industry in which you NB. The business plan must be substantiated by supplementary will work, starting date of the enterprise, and place of business); documents such as annual accounts, tax details, references, etc. - Legal aspects (legal form of your enterprise, trade name, licences, liability, The financial documents must have been prepared or assessed by an insurance, and supply conditions); independent expert. If any new jobs are created, this must be - Commercial aspects (market potential): demonstrated by either the contents of the business plan, which must, in • A description of the type of business and product (features, application, particular, show the feasibility of the financial aspects, or by employment need, and unique selling points); agreements. • A market analysis (description and size of the market, and potential – A copy of the deed of incorporation showing the powers, responsibilities, customers/market share), competitors, barriers, co-operations, and risks; and allocation of the profit among the partners (if it concerns a general • The price breakdown, substantiated by agreements and references. partnership or a limited partnership). - Organisational aspects (description of the organisational structure of your – A certificate of registration at the Chamber of Commerce enterprise, the required competencies, and the number of staff); – In the case of freelance activities on a self-employed basis: Agreement(s) - Financial aspects (investment budget, financing plan, repayment schedule, for the provision of services showing that you will perform activities on a opening balance sheet, balance sheet, operating budget, and liquidity freelance basis. forecast); NB. The business plan must be substantiated by supplementary It is your responsibility to substantiate your application as much as possible documents such as annual accounts, tax details, references, etc. by evidence showing that your enterprise can make a major contribution to The financial documents must have been prepared or assessed by an the Dutch economy. For this purpose, you must also submit the following independent expert. documents in duplicate and not bound: – A copy of the deed of incorporation showing the powers, responsibilities, – Copies of diplomas obtained (if the diploma(s) were obtained abroad; the and allocation of the profit among the partners (if it concerns a general diploma(s) must have been recognised by the Nuffic. You must arrange for partnership or a limited partnership). this yourself); – A certificate of registration at the Chamber of Commerce. – copies of certificates of education courses in the Netherlands or abroad (diploma(s) or Doctorates); It is your responsibility to substantiate your application as much as possible by – evidence of any previous experience gained as an entrepreneur; if there is evidence showing that your enterprise can make a major contribution to the also an enterprise in the country of origin, you must also submit a deed of Dutch economy. incorporation and the articles of association of this enterprise; NB. If you have failed to substantiate your application sufficiently by means of – Evidence of previous work experience, for example, by submitting the above-mentioned documents, your application will not be submitted for reference(s) and/or testimonial(s), employment agreement(s) from/with advice to the Minister of Economic Affairs, Agriculture and Innovation. former employer(s); If you have an EC residence permit for long-term residents issued by another EU – Income statement over the last 12 months before the application, for Member State, also submit the following: example, by submitting an annual income statement, tax assessment, or – A copy of the EC residence permit for long-term residents issued by the employment agreement(s); other Member State; – Evidence of experience in the Netherlands, for example, by means of – Evidence showing that a health insurance policy has been taken out in your agreement(s) or reference(s) of Dutch partners and business partners, or name; sales figures concerning the Dutch market; – A copy of your business plan as referred to above. In this context, however, this business plan does not have to include a description of the innovative character of the business and the product. > Go to 23 on page 19

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10 Residence Permit for an Orientation Year for Graduates Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n Orientation year for graduates (501) on which you obtained your Doctorate degree. This certificate may not be If you want to search for a job as a highly skilled migrant within one year older than 1 month. Or a legalised copy of the Master or Doctorate diploma after having finished your study at a Dutch university or a college of higher at a educational institution abroad which has been included in the Top 150 professional education, and you want to make use of the orientation year of the lists of the 'Times Higher Education Supplement' or the 'Jiao Tong Your application must be accompanied by the following supplementary piece of Shanghai University' published in 2007, together with the relevant list of evidence: marks. Together with the diploma, you must also submit the written – A legalised copy of the diploma showing the graduation date. This must be a credential evaluation of Nuffic (Credential Evaluation Information Centre). diploma for a study programme followed at an educational institution in the If you want to be awarded points in the system of points, please also submit Netherlands. the following (where possible): > Go to 23 on page 19 – A copy of your employment agreement or your Employer's Declaration if you have worked in the Netherlands in the past for a period of six months or n Orientation year for highly educated migrants (508) more; If you want to search for a job as a highly educated migrant or if you want – A copy of a certificate of participation in a course in the Netherlands, which to start an innovative business within three years after having finished your course you attended for a period of six months or more; study, and you want to make use of the orientation year. You must have – A copy of an NT2 diploma for 'Dutch as a Second Language' at A2 level'; obtained a Master degree or a Doctorate at a Dutch university or a college of – If you did not graduate in an English-speaking country: a copy of a higher professional education or at a educational institution abroad which declaration or a certificate of a language institute showing that you speak has been included in the Top 150 of the lists of the 'Times Higher Education the English language at level 6 of the International English Language Testing Supplement' or the 'Jiao Tong Shanghai University' published in 2007. System (IELTS) Your application must be accompanied by the following supplementary evidence – A copy of a diploma showing that you have obtained a Bachelor, Master or and documents: Doctorate degree in a country that is party to the Bologna Declaration. If the – A legalised copy of the Master or Doctorate diploma of an accredited diploma is not written in the Dutch, English, French or German language, educational institution, as included in the CROHO (Central Register of Higher you must have this diploma translated. Education Study Programmes), showing the graduation date or the date > Go to 23 on page 19

11 Residence Permit to Work on the Basis of an International Treaty Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n To work as an employee in the context of an EU action programme or an n Work on a self-employed basis on the basis of the Dutch-American international agreement to which the Netherlands is a party, but not the Friendship Treaty or the Treaty of Amity and Commerce between the Dutch-American Friendship Treaty, the Treaty of Amity and Commerce Netherlands and Japan (453, 510) between the Netherlands and Japan, the Turkish Association Treaty, or Your application must be accompanied by the following supplementary evidence the Dutch-German Convention on Establishment (370) and documents: Your application must be accompanied by the following supplementary evidence – A recent original extract from the registration of the enterprise/company at and documents: the Chamber of Commerce. – Evidence showing that paid research or paid work is to be carried out – Evidence showing the legal form of the company; temporarily in the context of an EU action programme or an international – Evidence showing that you have made a substantial capital contribution to agreement to which the Netherlands is a party; your enterprise or your company. – Proof of your income, see Appendix ‘Proof of Income’; > Go to 23 on page 19 > Go to 23 on page 19 n Work as an employee on the basis of the EC-Turkish 1/80 Association n Work as an employee on the basis of the Dutch-German Convention on Treaty (337) Establishment (450) Your application must be accompanied by the following supplementary evidence Your application must be accompanied by the following supplementary evidence: and documents: – Evidence showing that you have sufficient means of existence for the – Proof of your income, see Appendix ‘Proof of Income’; duration of your stay. This may be your own declaration or a declaration – If required: A copy of the application for a work permit or a copy of the work from a third party. permit itself (see the explanation on page 3 of this form). > Go to 23 on page 19 – Evidence showing that you have been employed by a Netherlands-based company for at least 1 year (may also be a transport company) and that your n Work as a key employee on the basis of the Dutch-American Friendship current employer has work for you for another year in employment. Treaty or the Treaty of Amity and Commerce between the Netherlands > Go to 23 on page 19 and Japan (454, 511) Your application must be accompanied by the following supplementary evidence and documents: – Proof of your income, see Appendix ‘Proof of Income’; – If required: A copy of the application for a work permit or a copy of the work permit itself (see the explanation on page 3 of this form). – Evidence showing that you are employed as a key employee. > Go to 23 on page 19

12 As an Economically Non-Active Long-Term Third-Country National n As an economically non-active person with a residence permit as a – Evidence showing that you permanently and independently have sufficient long-term third-country national in another member state (507, 763) means of existence, such as benefit payments from the Member State that Your application must be accompanied by the following supplementary evidence issued the EC residence permit for long-term residents to you (it must and documents: concern a benefit payment that can be received in the Netherlands) or – A copy of the EC residence permit for long-term residents issued by the income from previous employment outside the Netherlands (such as a other Member State salary or a corporate or private pension, or on the basis of a early retirement – Evidence showing that a health insurance policy has been taken out in your scheme) or income from capital. name; > Go to 23 on page 19

IND5007_M35A/11B 15 of 19 Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay Immigration and Naturalisation Service Ministry of the Interior and Kingdom Relations

13 Residence Permit to Attend a Secondary Education Course or a Vocational Education Course If you want to attend an institution of higher education or a university, do not use this form, but contact the educational institution. n To attend a Secondary Education course or a Vocational Education course If a third party in the Netherlands (e.g. a private person or a legal person) is wholly or (393) partially paying for the course, also submit the following: Your application must be accompanied by the following supplementary evidence – The Appendix ‘Sponsor Declaration’ filled in completely and signed by your and documents: financial sponsor and, if applicable, his or her spouse or partner or registered – Evidence showing your registration (provisional or definite) at or admission partner; to the institution. This evidence must have been issued by the competent – An original extract (not a copy) from the Municipal Administration (GBA) authority of the educational institution; showing your home address and the composition of the family of your – The Appendix ‘Study Awareness Declaration’ filled in completely and signed financial sponsor. This extract may not be older than 6 months; by you; – Proof of the income of the financial sponsor and, if applicable, his or her – An original extract (not a copy) from the Municipal Administration (GBA) spouse or partner or registered partner, see Appendix ‘Proof of Income’; showing your home address. This extract may not be older than 6 months; – Copies of all the pages containing the identity details of the Dutch – Written substantiation that the foreign national can make a positive contri- passport(s) and identity card(s) of your financial sponsor and, if applicable, bution to the development of his/her country of origin with this education. his or her spouse or partner or registered partner. Also make copies of the – In the case of an Upper Secondary Vocational Education course (MBO), a pages containing travel stamps. If your financial sponsor and, if applicable, his declaration from the COLO that this education course cannot be attended in or her spouse or partner or registered partner, do not have Dutch nationality, the country of origin (see COLO's website for more information www.colo.nl); please make copies of the front and back of the Dutch residence permit or of – In the case of a Secondary Education course, a declaration of the Ministry of the pages containing the identification details of the valid border-crossing Education in the country of origin stating that the relevant course cannot be document (e.g. a passport) in which the residence permit has been recorded. attended in the country of origin. Also make copies of the pages containing travel stamps and the residence If you receive a study grant, also submit the following: permit. It is not necessary to copy empty pages. – A copy of the document showing that the study grant has been awarded to you. If you have the EC residence permit for long-term residents issued in another Member State, If you or a third party abroad (e.g. a private person or a legal person) is wholly or you are also permitted to attend the course on a part-time basis. You do not have to fill in partially paying for the course, also submit the following: and sign the Appendix ‘Study Awareness Declaration’. You must also submit the following: – A copy of a bank statement from a bank account jointly or exclusively made – A copy of the EC residence permit for long-term residents issued by the out in your name, with the balance that is available for the study year; or other Member State; – An original declaration from the bank (not a copy) showing which monthly – Evidence showing that a health insurance policy has been taken out in your amount is being transferred in favour of you to a bank account jointly or name. exclusively made out in your name. > Go to 23 on page 19

14 Residence Permit for Exchange Purposes Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n Exchange through a private organisation (403) n Exchange on the basis of the ‘Working Holiday Scheme’ or ‘Working Your application must be accompanied by the following supplementary evidence Holiday Program’ (402) and documents: Your application must be accompanied by the following supplementary piece of – An original extract (not a copy) from the Municipal Administration (GBA) evidence: showing the home address and the composition of your host family. This – A copy of the return ticket or evidence showing that you have sufficient extract may not be older than 6 months; means to buy a return ticket. – The Appendix ‘Exchange Organisation Sponsor Declaration’ filled in > Go to 23 on page 19 completely and signed by the private organisation; – The Appendix ‘Declaration of Non-Impediment’ filled in completely and signed by you, showing that you are unmarried and that you do not provide for children of your own or for children that depend on you. If the exchange concerns voluntary work, also submit the following: – A copy of the application for a work permit or a copy of the work permit itself (see the explanation on page 3 of this form). > Go to 23 on page 19

15 Residence Permit as an Au Pair n as an au pair (400) – The Appendix ‘Au Pair Awareness Declaration’ filled in completely and NB. At the time of submitting the application for the residence permit in the signed by you and your host family; Netherlands, you must at least be 18 years of age, but not yet 26 years of age. – The Appendix ‘Au Pair – Host Family Agreement’ filled in completely and Your application must be accompanied by the following supplementary evidence signed by you and your host family; and documents: – The Appendix ‘Sponsor Declaration’ filled in completely and signed by your – Copies of all pages of the identification documents of your host family (the host family; sponsor) if they are Dutch nationals, or of the front and back of the residence – A description about the manner in which you will become acquainted with permits or of all pages containing the identification details, stamps, travel the Dutch society and culture; stamps and endorsements in the border-crossing document in which the – Proof of the income of your host family, see Appendix ‘Proof of Income’. residence permits of your host family have been recorded. It is not necessary The income of the host family must at least be equal to the subsistence level to copy empty pages. applicable to the host family, supplemented by the subsistence level for a – An original extract (not a copy) from the Municipal Administration (GBA) single person of 21 years of age or older. showing the home address and composition of your host family (the > Go to 23 on page 19 sponsor). This extract may not be older than 6 months; – The Appendix ‘Declaration of Non-Impediment’ filled in completely and signed by you and showing that you are unmarried and that you do not provide for children of your own or for children that depend on you.

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16 Residence Permit to Stay in the Netherlands with a Religious or Ideological Organisation n On religious or ideological grounds (378) If the foreign national intends to stay with another organisation than the following: The monastery or convent or religious or ideological organisation must submit • The Stichting Jeugd met een Opdracht, in Heerde; or the following supplementary evidence and documents when the application is • The Kerk van Jezus Christus van de Heiligen der Laatste Dagen, in Dordrecht; submitted: or – A written explanation about the need for the foreign national to stay with • Centraal Missie Commissariaat, in The Hague; or the religious or ideological organisation; • The Syrian Orthodox Church, in Losser; or – Written evidence showing that the foreign national at the time of the • Stichting Congregatie FIC, in Maastricht; or application was already a member of the religious or ideological • Maharishi European Research University/Maharishi Vedic University, in organisation; Vlodrop; or – A detailed description of the activities the foreign national will perform at or • Stichting International Buddhist Progress Society Holland, in Amsterdam; or through the intermediary of the religious or ideological organisation; • An individual monastery or convent, – A written statement of the means by which the stay of the foreign national the religious or ideological organisation must then also submit the following: will be paid (which facilities will the foreign national receive at the expense – Evidence showing that in the five years preceding the effective date of this of the organisation); scheme (8 January 2004) a residence permit was granted to a foreign – The Appendix ‘Sponsor and Awareness Declaration Regarding a Stay with national on religious or ideological grounds in respect of the organisation Religious or Ideological Organisations’ filled in completely and signed by the where the foreign national intends to stay. In this context, the reason for organisation; applying for a residence permit is not for study purposes or to work as an – The Appendix ‘Awareness Declaration Regarding the Transitional Regime on employee. Religious or Ideological Grounds’ filled in completely and signed by you; > Go to 23 on page 19 – Written evidence by which the organisation or the monastery or convent shows that it has sufficient financial means and that it is capable of providing for the foreign national’s living expenses.

17 Residence Permit for Re-entry Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n You are a former Dutch national and you were born and raised in the n You are a former Dutch national and you renounced your Dutch nationa- Netherlands (362) lity to be able to rely on the provisions of the Dutch Remigration Act (your Your application must be accompanied by the following supplementary piece of situation before remigration) (364) evidence: Your application must be accompanied by the following supplementary evidence – Documents and information regarding the duration and nature of your and documents: previous stay in the Netherlands; – A certificate from the Social Insurance Bank (SVB) stating that the decision > Go to 23 on page 19 on your application for remigration provisions will, in principle, be positive, provided that you renounce Dutch nationality; n You are a minor and your accommodation and legal representation in the – A copy of your 'Declaration of Renunciation of Dutch Nationality'; Netherlands have been arranged and you were a lawful resident of the – A certificate from the Population Affairs official that your 'Declaration of Netherlands (or as a Dutch national) from the age of 4 years for a period Renunciation of Dutch Nationality' has been received. of 10 years (360) > Go to 23 on page 19 Your application must be accompanied by the following supplementary evidence and documents: n You qualify for re-entry on the basis of Article 8 of the Dutch Remigration – Documents and information regarding the duration and nature of your Act (your situation after remigration) (315) previous stay in the Netherlands; If one of following situations applied to you immediately prior to your – Documents and information showing that your accommodation and remigration from the Netherlands: representation in the Netherlands have been arranged. • You were a lawful resident in the Netherlands for a continuous period of at > Go to 23 on page 19 least 3 years and you had a Regular Residence Permit; • You stayed in the Netherlands with a valid residence permit as a minor child n You are a minor and your accommodation and legal representation in of a person who himself or herself qualifies for re-entry on the basis of the the Netherlands have been arranged and you were a lawful resident of Dutch Remigration Act, insofar as you both remigrated from the Netherlands the Netherlands (or as a Dutch national) for a period of 5 years before at the same time and you are submitting an application for re-entry at the submitting the application and the Netherlands is the most appropriate same time; or country for you (360) • You stayed in the Netherlands with a valid residence permit as a minor child Your application must be accompanied by the following supplementary evidence of a person who himself or herself had lawful residence, you remigrated and documents: together with this person from the Netherlands on the basis of Article 8 of the – Documents and information regarding the duration and nature of your Dutch Remigration Act and you came of age within one year after remigration previous stay in the Netherlands; and you are submitting an application for re-entry within that year.) – Documents and information showing that your accommodation and Your application must be accompanied by the following supplementary evidence representation in the Netherlands have been arranged. and documents: NB. For the purpose of assessing whether the Netherlands is the most appropriate – A copy of the decision of the SVB awarding the right to the basic provisions country of residence for you, it is important that your ties with the Netherlands or the remigration provisions and stating the departure date; are stronger than your ties with your country of origin. In this assessment, the – A copy of the Appendix to the decision of the SVB showing the entrance date following factors may be included: of the residence permit granted previously for a non-temporary purpose • The reason for remigration; and the continuous duration of your previous stay in the Netherlands. • The duration of your stay in the Netherlands and in the country of origin; NB. Under specific conditions, you may qualify for a permanent residence permit • The education/schooling received in the Netherlands and abroad; (if immediately prior to your remigration you stayed in the Netherlands as a • The work experience gained in the Netherlands and abroad; Dutch national, as a holder of a permanent residence permit, or as a holder of • Knowledge of the Dutch language. a Regular Temporary Residence Permit for a continuous period of at least five You must accompany your application with as much information as possible. years). In that case, use the form 'Application for or Change of a Temporary > Go to 23 on page 19 Regular Residence Permit' > Go to 23 on page 19

IND5007_M35A/11B 17 of 19 Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay Immigration and Naturalisation Service Ministry of the Interior and Kingdom Relations n You lived outside the Netherlands due to imprisonment or military service n You are a former Dutch national because you renounced your Dutch (360) nationality yourself because it would otherwise have been withdrawn Your application must be accompanied by the following supplementary evidence because of the failure to renounce your original nationality (313) and documents: Your application must be accompanied by the following supplementary evidence – Copies of the front and back of your last residence permit; and documents: – Documents and information on your imprisonment abroad and the – Documents and information regarding the duration and nature of your termination of this, or on doing military service and the termination of this. previous stay in the Netherlands; > Go to 23 on page 19 – A copy of the notice of naturalisation; – Letters from the Minister of the Interior and Kingdom Relations in which your n You have submitted an application to the District Court in The Hague to attention is drawn to the obligation to renounce your original nationality; establish your Dutch nationality (361) – An original extract (not a copy) from the Municipal Administration (GBA) Your application must be accompanied by the following supplementary piece of showing the date on which you renounced Dutch nationality. evidence: NB. Under specific conditions, you may qualify for a permanent residence permit – A complete copy of your application to the District Court concerning the (if you had had lawful residence in the Netherlands for a continuous period of establishment of you Dutch nationality (pursuant to Article 17 of the at least 5 years before the date of becoming a Dutch national). In that case, use Netherlands Nationality Act). the form 'Application for or Change of a Temporary Regular Residence Permit' > Go to 23 on page 19 > Go to 23 on page 19 n You are a former Dutch national, you have lost your Dutch nationality n You are a former Dutch national, you are 18 years of age or older, and because it was withdrawn because you did not renounce your original you do not live in the country of which you are a national, and you have nationality (if you had had lawful residence in the Netherlands for a special ties with the Netherlands (360) continuous period of at least 3 years before the date of becoming a Dutch Your application must be accompanied by the following supplementary evidence national) (314) and documents: Your application must be accompanied by the following supplementary evidence – Documents and information regarding the duration and nature of your and documents: previous stay in the Netherlands; – Documents regarding the duration and nature of your previous stay in the – Documents and information showing that you do not live in the country of Netherlands; which you have the nationality; – A copy of the notice of naturalisation; – Documents and information showing that you received at least half of your – Letters from the Minister of the Interior and Kingdom Relations in which your primary school education in the Netherlands, the Netherlands Antilles, or attention is drawn to the obligation to renounce your original nationality; Aruba, or that when you were a minor you attended an education course – A copy of the decision by which the Dutch nationality has been withdrawn. that was focused on the Netherlands in a manner that was more than usual NB. Under specific conditions, you may qualify for a permanent residence permit at the time, or that you have established close ties with the Netherlands (if you had had lawful residence in the Netherlands for a continuous period of due to other circumstances, such as upbringing, social position and/or at least 5 years before the date of becoming a Dutch national). In that case, use employment. the form 'Application for or Change of a Temporary Regular Residence Permit' > Go to 23 on page 19 > Go to 23 on page 19

18 Residence Permit for Medical Reasons n To undergo medical treatment (410) If you yourself do not have sufficient means of existence, also submit the following: Your application must be accompanied by the following supplementary evidence – The Appendix ‘Sponsor Declaration’ filled in completely and signed by a and documents: family member, relative or other relation of yours; – The Appendix ‘Declaration on Your Medical Situation’ filled in completely – Proof of the guarantor’s income and, if applicable, his/her spouse or partner and signed by your doctor. This declaration may not be older than 1 month. or registered partner, see Appendix ‘Proof of Income’; Any changes in your medical situation that may be relevant to the decision – Copies of all the pages containing the identification details of the to be made must be declared in a new ‘Declaration on Your Medical Situation’. guarantor’s Dutch passport or identity card. Also make copies of the pages – The Appendix ‘Medical Information Disclosure Consent Form’ filled in containing travel stamps. If the guarantor does not have Dutch nationality, completely and signed by you. If several doctors are in charge of your please make copies of the front and back of the Dutch residence permit or of treatment, the consent to contact these doctors must be given separately the pages containing the identification details of the valid border-crossing for each doctor. This consent must be given with respect to the doctor(s) document (e.g. a passport) in which the residence permit has been recorded. in charge of your treatment in the Netherlands as well as the doctor(s) in Also make copies of the pages containing travel stamps and the residence charge of your treatment in the country of origin; permit. It is not necessary to copy empty pages. – Proof of insurance for medical expenses incurred in the Netherlands or any If you are a national of Surinam, also submit the following: other evidence showing that financing the costs of the medical treatment – A copy of a visa issued on medical grounds. has been arranged adequately; > Go to 23 on page 19 – A written explanation of why the Netherlands is the most appropriate country to undergo the relevant medical treatment(s). Accompany your application with as many pieces of evidence as possible. – Evidence showing that you have sufficient means of existence for the duration of your stay in the Netherlands.

19 Residence Permit for a Victim of Human Trafficking or

for a Witness Reporting Human Trafficking n As a victim of human trafficking or as a witness reporting human trafficking (420) Go to the police with this application form, and report human trafficking to the police or render your cooperation in the criminal investigation and prosecution investigation of human trafficking. The police will help you with your application for a residence permit. If you submit this application without having been to the police and you did not report the human trafficking or you did not cooperate, your application will not be handled. > Go to 23 on page 19

IND5007_M35A/11B 18 of 19

20 Residence Permit through no Fault or Action of Your Own n Residence Permit through no Fault or Action of Your Own (491) – Documents showing that you have applied to the International Organisation Your application must be accompanied by the following supplementary evidence for Migration to facilitate your departure, and that this organisation informed and documents: you that it is not capable of realising your departure due to the fact that you – Documents showing that you have tried to realise your departure from the claim that you cannot obtain any travel documents, or that this organisation Netherlands independently and that you did not succeed in this. You must has declared to be able to facilitate your departure as soon as you have prove that you have applied to the diplomatic representation of your country, obtained the travel documents. or other countries where you had a residence permit and/or countries which – Documents showing that you have applied to the Repatriation and Departure may be expected to give you permission to enter, and that the request Service with the request to assist you in submitting an application for a to issue travel documents has not been granted. You can prove this, for replacement travel document, a so-called laissez passer. The Repatriation & example, by declarations of the relevant authorities showing that you have Departure Service will also be willing to provide assistance at one or more demonstrably applied to those diplomatic representations and stating that a diplomatic representations to obtain the required travel documents. request to issue travel documents has not been granted. > Go to 23 on page 19

21 Residence Permit for Continued Residence Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n You have Turkish nationality and you have a residence permit for seeking – Evidence showing that compelling humanitarian grounds are involved. and performing work, whether as an employee or on a self-employed > Go to 23 on page 19 basis, after the termination of the marriage (304) Your application must be accompanied by the following supplementary evidence n Marriage, partnership, or registered partnership: after the death of and documents: your spouse or partner or registered partner (302); or – Evidence showing that - no later than the date that the period of validity of n Minor child after the death of a parent or adoption parent or foster your residence permit will expire - you have employment for at least 1 year, parent (302); or > Go to 23 on page 19 n Adult child after the death of a parent (302) Your application must be accompanied by the following supplementary evidence n Pursuant to Article 7 of the EEC-Turkey Association Agreement - and documents: Association Council Decision No 1/80 (301) – Appendix ‘Declaration of Circumstances’ filled in completely and signed by you Your application must be accompanied by the following supplementary evidence – Evidence showing that a health insurance policy has been taken out in your name and documents: – An original extract (not a copy) from the Municipal Administration (GBA) – Evidence showing that the principal person was a Turkish employee when showing your home address and composition of the family. This extract may you cohabited with him or her for a period of three years; not be older than 6 months; – Evidence showing that a health insurance policy has been taken out in your name – The death certificate of your marriage partner, registered partner, or partner, – An original historical extract (not a copy) from the Municipal Administration or of your parent or adoption parent or foster parent. (GBA) showing your home address and composition of the family. This > Go to 23 on page 19 extract may not be older than 6 months. > Go to 23 on page 19 n To undergo medical treatment (301) Your application must be accompanied by the following supplementary evidence n After a residence period of 3 years or more with your spouse or partner or and documents: registered partner (301); or – Evidence showing that a health insurance policy has been taken out in your name n After a residence period of 3 years as an adult child with a parent (301); or – Appendix ‘Declaration of Circumstances’ filled in completely and signed by you n After a residence period of 3 years as a parent with a child (301) – Appendix ‘Declaration of Your Medical Situation’ filled in completely and Your application must be accompanied by the following supplementary evidence signed by your doctor. This declaration may not be older than 1 month. Any and documents: changes in your medical situation that may be relevant to the decision to be – Appendix ‘Declaration of Circumstances’ filled in completely and signed by you made must be declared in a new 'Declaration on Your Medical Situation'. – Evidence showing that a health insurance policy has been taken out in your name If several doctors are in charge of your treatment, each doctor must fill in – An original extract (not a copy) from the Municipal Administration (GBA) and sign a separate Appendix; showing your home address and composition of the family. This extract may – Appendix ‘Medical Information Disclosure Consent Form’ filled in completely not be older than 6 months; and signed by you. If several doctors are in charge of your treatment, the – Appendix 'Civic Integration Requirement’ (continued residence after three consent to contact these doctors must be given separately for each doctor. years of family reunification or family formation) filled in completely and This consent must be given in respect of the doctor(s) in charge of your signed by you. treatment in the Netherlands as well as the doctor(s) in charge of your > Go to 23 on page 19 treatment in the country of origin; – Evidence showing that the financing of the medical expenses to be incurred n After a residence period of 1 year as a minor child with a parent or in the Netherlands has been arranged adequately; adoption parent or foster parent (301); or – A written explanation of why the Netherlands is the most appropriate n After a residence period of 3 years as an unaccompanied minor foreign country to undergo the relevant medical treatment(s). national (301); or > Go to 23 on page 19 n After a residence period of 3 years, if you were unable to leave the Netherlands through no fault or action of your own (301) n As a victim of domestic violence (303) Your application must be accompanied by the following supplementary evidence Your application must be accompanied by the following supplementary evidence and documents: and documents: – Appendix ‘Declaration of Circumstances’ filled in completely and signed by you – Evidence showing that a health insurance policy has been taken out in your name – Evidence showing that a health insurance policy has been taken out in your name – Evidence showing that you have demonstrably experienced domestic – An original extract (not a copy) from the Municipal Administration (GBA) violence: showing your home address and composition of the family. This extract may - a copy of the official record of the report to the police, and a declaration of not be older than 6 months. a doctor, confidential doctor or other professional; or > Go to 23 on page 19 - a declaration of the Public Prosecution Service or the Commissioner of Police showing that ex officio prosecution investigation has been instituted n Marriage, partnership, or registered partnership: compelling against the offender, and a declaration of a doctor, confidential doctor or humanitarian grounds (301); or other professional. n Residence with a partner: compelling humanitarian grounds (301) > Go to 23 on page 19 Your application must be accompanied by the following supplementary evidence and documents: n As a victim of human trafficking or as a witness reporting human – Appendix ‘Declaration of Circumstances’ filled in completely and signed by you trafficking (301) – Evidence showing that a health insurance policy has been taken out in your name If you are a victim of human trafficking, your application must be accompanied – An original extract (not a copy) from the Municipal Administration (GBA) by the following supplementary evidence: showing your home address and composition of the family. This extract may – A copy of the Court judgment following your report of human trafficking or not be older than 6 months; following your cooperation in the criminal investigation and prosecution

IND5007_M35A/11B 19 of 19 Application for a Regular Residence Permit without a Regular Provisional Residence Permit, or for a Change of Purpose of Stay Immigration and Naturalisation Service Ministry of the Interior and Kingdom Relations

investigation of human trafficking and by which judgment the accused has If you are a witness of human trafficking, your application must be accompanied by the been convicted (a conviction for one of the other charges made against the following supplementary evidence: accused in the criminal proceedings is also relevant, provided that human – A copy of the conviction following your report of human trafficking; trafficking was one of the charges made); or – Evidence showing that you cannot return to your country of origin because – A copy of the Court judgment following your report of human trafficking or of the risk of reprisals. following your cooperation in the criminal investigation and prosecution > Go to 23 on page 19 investigation of human trafficking and by which judgment the accused has not been convicted (a conviction for one of the other charges made n After 1 year of residence, on the basis of honour-related violence or the against the accused in the criminal proceedings is also relevant, provided threat thereof (303); or that human trafficking was one of the charges made), but the judgment is n After 1 year of residence, on the basis of domestic violence or a real otherwise; and if you have been in possession of a residence permit for a threat thereof (303) period of less than 3 years on the basis of the B9 scheme, you must also Your application must be accompanied by the following supplementary evidence submit evidence showing that you cannot return to the country of origin and documents: (e.g. because you may become the victim of revenge) or evidence showing – Evidence showing that the threat, on the basis of which the permit had been that there are compelling humanitarian grounds that, in your opinion, granted, is continuing. should justify continued residence (e.g. because you have psychological – Accompany your application by a separate letter in which you provide a problems for which you are being treated in the Netherlands, or because you description of the situation you are in and the reason why you cannot return must provide for children who were born in the Netherlands or who attend to the country of origin. Enclose as many pieces of evidence with your letter an education course here); to substantiate this. – If you have been in possession of a residence permit for a period of more > Go to 23 on page 19 than 3 years on the basis of the B9 scheme and the criminal investigation is still before the court, a copy of the declaration of the police or the Public n After 1 year of residence, as a victim of human trafficking who cannot Prosecution Service that the criminal investigation is still before the court. or does not want to report this to the police or who cannot or does not If your report to the police or your cooperation in the criminal investigation or criminal want to render his/her cooperation in the criminal investigation and prosecution of human trafficking resulted in a decision not to prosecute, also submit the prosecution of the human trafficker (301) following: Your application must be accompanied by the following supplementary evidence – Evidence showing that you cannot return to the country of origin (e.g. and documents: because you may become the victim of revenge) or evidence showing that – Evidence showing that the threat, on the basis of which the permit had there are compelling humanitarian grounds that in your opinion should been granted to you, is continuing or evidence showing that you, given your justify continued residence (e.g. because you have psychological problems medical or psychological condition, are still not capable of rendering your for which you are being treated in the Netherlands or because you must cooperation in the criminal proceedings. provide for children who were born in the Netherlands or who are attending – Accompany your application by a separate letter in which you provide a an education course here). description of the situation you are in and the reason why you cannot return to the country of origin. Enclose as many pieces of evidence with your letter to substantiate this. > Go to 23 on page 19

22 Victims of violence Please state below the specific purpose for applying for a residence permit and follow the instruction written there. Tick the most important purpose. You may not tick more than one purpose of stay. If you tick more than one purpose of stay, your application will only be assessed on the purpose ticked first. n You are a victim of domestic violence (300) letter after having submitted this form. Your application must be accompanied by the following supplementary evidence > Go to 23 on page 19 and documents: – Recent information from the police, for example, the recent report of an n You are a victim of human trafficking and you cannot or you do not want incident, or a recent official record of the report; and to report this to the police or render your cooperation in the criminal – Recent information from a doctor, confidential doctor or other professional; investigation and prosecution of the human trafficker due to serious it is not necessary for the confidential doctor to be your own general threats and/or a medical or psychological impairment (420) practitioner; or Your application must be accompanied by the following supplementary evidence – Recent information about your stay in a women’s refuge; or and documents: – Other recent information, insofar as it concerns objective information from a – A declaration from the police showing that you are a victim of human reliable source. trafficking; and – Evidence showing that you cannot withdraw from the violence by taking up – If applicable, a declaration from the police showing that you cannot be residence in the country of origin. expected to render your cooperation in the criminal proceedings in > Go to 23 on page 19 connection with serious threats issued by the human trafficker in the Netherlands; or n You are a victim of honour-related violence (300) – If applicable, medical information showing that a physical or psychological Explain in a separate letter for which purpose you are submitting an application condition prevents you from rendering your cooperation in the criminal for a residence permit. You must accompany your application by this letter proceedings. The medical information must be provided by a professional together with as many pieces of evidence and documents of the special who is listed either in the BIG register or in the NIP register. circumstances. If the IND has any further questions, you will receive a separate > Go to 23 on page 19

23 Submitting your application > Place your colour passport photo and your signature on the Appendix ‘Photo Card’ you will find enclosed with this form. Your passport photo may not have been used for a residence permit before, it must bear a clear resemblance, and it must meet the Dutch passport requirements (see www.paspoortinformatie.nl/nederlands/reisdocumenten/pasfoto). > Check whether you have filled in the form completely. > Please accompany your application by all enclosures, evidence and documents that have been requested. Do not use any staples or paperclips. > Now place your signature on the front page of this form. > First call 0900 1234561 (€ 0.10 per minute plus any additional costs charged by your operator if you are calling from a mobile phone) or +31 20 8893045 from outside the Netherlands to make an appointment to visit the IND desk in your region. You must also make an appointment if you downloaded this form from www.ind.nl. Once you have made an appointment, you can hand in the application at the IND desk. IND5007_M35A/11B Appendix Proof of income M35A / M35A-1

This list states which items of evidence that demonstrate proof of income are required by the NB. The IND may verify the correctness of the enclosed wage, employment and benefit IND for the assessment of the application. The application form states in which cases and details at another government agency (e.g. the Netherlands Employees Insurance Agency from which person(s) you must enclose these items of evidence to prove the income. In most (UWV) or the Tax and Customs Administration). cases, this proof of income must be provided by you (the person providing residence) and your sponsor. The pieces of evidence you are submitting as a proof of your income may be copies, unless stated otherwise.

If you or your sponsor has an employment agreement which is valid for a If you or your sponsor has received invalidity benefits under the Work and Income (Capacity period of at least 1 year at the time of submitting your application; or for Work) Act (WIA benefit) since 1 January 2006 If you (the foreign national) will perform activities as an employee (in the – The confirmation of benefits awarded that shows on the basis of which context of an EU action programme or an international agreement to which regulations you are receiving the relevant benefits (Full Invalidity Benefit the Netherlands is a party) Regulations (IVA) or Return to Work (Partially Disabled) Regulations (WGA)); – Your current employment agreement(s); – (If available) the most recent reassessment; – The Appendix ‘Employer’s Declaration’ filled in completely and signed (not If you or your sponsor is permanently unfit for work and you or your sponsor does not older than 3 months); receive occupational disability benefits (WAO benefits), invalidity benefits under the Work – Pay slips over the past 3 months. and Income (Capacity for Work) Act (WIA benefits), benefits under the Invalidity Insurance Only if you earn structurally more than is apparent from your employment agreement (e.g. (Self-Employed Persons) Act (WAZ benefits), or benefits under the Invalidity Insurance because of overtime) (Young Disabled Persons) Act (Wajong benefit) – Pay slips over the past 12 months. – A declaration from the Municipal Health Service, or the company doctor, or the medical examiner showing that you are wholly unfit for work, the date If you or your sponsor has an employment agreement which is valid for a on which you became wholly unfit for work, and what the expected duration period for less than 1 year at the time of submitting your application of the incapacity for work is; – Your current employment agreement(s) showing that you will have work; If you or your sponsor receive(s) social assistance benefits and it is permanently impossible – The Appendix ‘Employer’s Declaration’ filled in completely and signed (not for you or your sponsor/partner to work again older than 3 months); – All grant decisions of the past 5 years and any correspondence with the – Over the past 3 years: Municipal Executive about the exemption of the obligation to seek work, - All salary statements; and and evidence showing that integration into the workforce is not to be - All annual income statements; and expected within a reasonable period of time. - All employment agreement(s) and temporary employment agreement(s) (through an employment agency); and If you or your sponsor is a self-employed person - grant decision(s) and benefit slip(s). – The Appendix ‘Declaration of Income as a Self-Employed Person’ filled in completely and signed by you and a registered accountant, an auditor, an If you or your sponsor works as an agency employee or on the basis of an accounting consultant, a tax adviser of the Dutch Federation of Tax on-call contract, a seasonal work contract, a zero-hours contract, or any Advisers (NFB), or an accountant with a BECON number issued by the Tax other employment agreement with a deferred duty of performance and Customs Administration, together with the required appendices. – Your current employment agreement(s) or temporary employment – A recent original extract from the registration of the enterprise/company at agreement(s) (through an employment agency) showing that you will have the Chamber of Commerce (unless registration is not possible). work; – The Appendix ‘Employer’s Declaration’ filled in completely and signed (not If you or your sponsor is a director-major shareholder older than 3 months); – The official documents showing the percentage of your interest in the – Over the past 3 years: company (percentage of ownership); - All salary statements; and – A copy of your employment agreement (or agreements, if you have several - All annual income statements; and jobs); - All employment agreement(s) and temporary employment agreement(s) – An original Appendix ‘Employer’s Declaration’ filled in completely, stating (through an employment agency); and the date and provided with a signature of the employer and a company - grant decision(s) and benefit slip(s). stamp (not older than 3 months); – Information about the 3 months prior to the date of your application If you or your sponsor receives supplementary or full benefits showing that you received a monthly salary (salary slips, bank statements); If you or your sponsor receives a supplementary or full benefit payment (e.g. an – Proof that the wage tax that was withheld by the company was paid to the unemployment benefits (WW), sickness benefits (ZW), old age benefits (AOW), dependant's Tax and Customs Administration (bank statement). benefits (ANW), or a reintegration benefit payment (REA)) – The letter of your benefits agency granting your benefit; As an unpaid research worker – The most recent benefits statement; – If you receive sponsor money: evidence showing the amount of money you If you or your sponsor receives occupational disability benefits (WAO benefits), benefits receive and the duration of the sponsor agreement; or under the Invalidity Insurance (Self-Employed Persons) Act (WAZ benefit), or benefits under – If you receive periodic payments to pay for your stay in the Netherlands: the Invalidity Insurance (Young Disabled Persons) Act (Wajong benefit) proof of these payments; or – The grant decision showing that you are unfit for work (and which – If you have paid work abroad: a copy of an employment agreement with the percentage); current employer abroad. – The most recent benefits statement (over a period of at least 1 year following the grant decision);

BE01/11B Appendix Employer’s Declaration M35A / M35A-1

If you have several employers, please copy this appendix. Fill in and sign one copy for each NB. The IND may verify the correctness of the enclosed wage, employment and benefit employer. The application form states in which cases and from which person(s) you must details at another government agency (e.g. the Netherlands Employees Insurance Agency enclose the Employer’s Declaration. (UWV) or the Tax and Customs Administration).

1 Details of the employee

1.1 Citizen Service Number (BSN) Surname as it appears in your passport or on your identity papers First names 1.2 Name | |

1.3 Gender n Male n Female Street Number 1.4 Home address | Postal code City/Town

| Day month year 1.5 Date of birth

1.6 Place of birth |

1.7 Country of birth |

1.8 Nationality |

2 Details of the company/institution 2.1 Name | Street Number 2.2 Visiting address | Postal code City/Town

|

2.3 Withholding tax number

3 Employment details 3.1 Employee’s job title | Day month year 3.2 Date of employment

3.3 Type of employment n Fixed employment n On-call contract n Ongoing temporary work

n 3.4 Employment period Indefinite period, or Day month year Day month year n Definite period from to

BE02/11B 2 of 2

3.5 Is there a provision for continued n No n Yes payment of wages during the term of the agreement if there is not any work? Day month year 3.6 Trial period n No n Yes, until Hours per week (contractual) Hours per week (actual)

3.7 Working hours per week All amounts rounded to the nearest full euro 3.8 Gross salary (excluding holiday allowance) n Per month, or n per 4 weeks € All amounts rounded to the nearest full euro 3.9 Wage for social security purposes (excluding holiday allowance) n Per month, or n per 4 weeks € All amounts rounded to the nearest full euro 3.10 Net salary (excluding holiday allowance) n Per month, or n per 4 weeks €

3.11 Percentage of holiday allowance %

4 Signature of the employer I declare that the above-mentioned employee has been employed by the above-mentioned company/institution. I have filled in this form truthfully.

4.1 Name |

4.2 Job title |

4.3 Telephone number City/Town Day month year

4.4 City/Town and date |

4.5 Signature |

4.6 Stamp of company/institution |

BE02/11B Appendix Declaration of circumstances M35A

Only fill in this declaration if you already have a residence permit for a specific purpose of stay and you want to use this application form to apply for a residence permit for another purpose of stay. Enclose this declaration with your application.

1 Declaration of Circumstances 1.1 Tick the situation(s) below that applies/ a. n Since the current residence permit has been issued, there has been no change in any facts or apply to you (the permit holder) since your circumstances that may have consequences for the residence permit; current residence permit has been issued. It concerns changes that may have b. n The person with whom I am staying in the Netherlands (the person providing residence) has a new consequences for your residence permit border-crossing document (e.g. a passport) > Please enclose copies of the pages containing the identity and possibly the residence permits of your details, stamps, travel stamps and endorsements with your family members. application. (It is not necessary to copy empty pages).

NB. Always accompany your application by declarations c. My own family situation (as the permit holder) or that of the person with whom I am staying in the and evidence. You must always inform the IND Netherlands (the person providing residence) has changed as follows: immediately of any changes in your personal situation n Married/registered partnership > Your application must be accompanied by a copy of the or of the situation of the person with whom your stay marriage certification/registration that relate to our residence permit. n New relationship > Do not send in this form. Contact the IND to ask them what to do n Termination of marriage/relationship > Do not send in this form. Contact the IND to ask them what to do

d. n Child was born > Your application must be accompanied by a copy of the birth certificate

e. n Someone has died > Your application must be accompanied by a death certificate

f. n The income situation of myself or of the person with whom I am staying in the Netherlands (the person providing residence) has changed. > Your application must be accompanied by the evidence as referred to in the Annexe ‘Proof of Income’.

g. n Otherwise, namely: |

2 Signature I have filled in this form truthfully.

2.1 Name of the foreign national | City/Town Day month year

2.2 City/Town and date |

2.3 Signature of the foreign national |

2.4 Name of the legal representative (if applicable)| City/Town Day month year

2.5 City/Town and date |

2.6 Signature of the legal representative |

BE03/11B Appendix Sponsor and Awareness Declaration Concerning the Stay with Religious or Ideological Organisations M35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay on religious or ideological grounds. Fill in and sign the declaration and submit it in together with your application.

1 Details of the foreign national The undersigned, further referred to as the representative of the organisation, hereby declares with regard to the foreign national’s intended stay at the organisation:

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | |

1.3 Gender n Male n Female Day month year Nationality 1.4 Date of birth 1.5 Nationality |

The representative of the organisation is aware of the following: – That the cost, excluding costs of social assistance, that are incurred by – A stay of the above-mentioned foreign national with the organisation in the the State and other public bodies in respect of the foreign national's stay, Netherlands will only be permitted for religious or ideological purposes; including the costs of the journey of the foreign national to a place outside – The foreign national is not permitted to perform work; the Netherlands where his/her admittance is guaranteed, up to an annual – By virtue of the restriction under which the residence permit is granted, maximum amount of € 5,000, may be recovered from the organisation; it is expected that the foreign national or the organisation will inform the – If the foreign national receives benefits pursuant to the Dutch Social Immigration and Naturalisation Service (IND) if the actual activities prove Assistance Act, or the Dutch Work and Social Assistance Act as from to be different from the envisaged purpose of stay; 1 January 2004 respectively, the costs of social assistance that will have – In the context of the monitoring of foreign nationals, the Aliens Police may been incurred in connection with the benefit payments to the foreign visit the organisation and the foreign national or call up the organisation national (related to the amount of the current benefits in accordance with or the foreign national for a specific cause or for a random check. the standard of the Dutch Social Assistance Act, or the Dutch Work and Social Assistance Act as from 1 January 2004, respectively), in addition to The representative of the organisation declares: the above-mentioned annual amount of € 5,000, will be recovered from the – That substantial recruiting activities have been performed as a result of organisation. which it became evident that it is necessary for the foreign national to stay in the Netherlands to meet the need of the organisation;

2 Details of the organisation 2.1 Name of the organisation | Street Number 2.2 Visiting address | Postal code City/Town

| Name Position 2.3 Name and position of the representative | | City/Town Day month year

2.4 City/Town and date |

2.5 Signature |

BE06/11B Appendix Awareness Declaration Regarding the Transitional Regime on Religious or Ideological Grounds M35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay on religious or ideological grounds. Fill in and sign the declaration and submit it in together with your application.

1 Details of the foreign national

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | |

1.3 Gender n Male n Female Street Number 1.4 Home address | Postal code City/Town

| Day month year 1.5 Date of birth

1.6 Place of birth |

1.7 Country of birth |

1.8 Nationality |

The undersigned hereby declares to be familiar with the fact that: The residence permit will only be granted to him/her for a definite period of time for a stay on religious or ideological grounds with:

1.9 Name of the organisation |

The residence permit will only be granted as long as he/she stays with the religious or ideological organisation for religious or ideological purposes, and he/she is to leave the Netherlands as soon as this purpose no longer exists; He/she is not permitted, during the stay in the Netherlands, to perform activities other than those for which he/she was granted a residence permit.

2 Signature I have filled in this form truthfully.

City/Town Day month year

2.1 City/Town and date |

2.2 Signature |

BE07/11B Appendix Questionnaire for stay with a partner M35A

Only fill in this declaration if you are submitting an application for a residence permit for Your partner wishes to stay with you in the Netherlands. Please answer the questions below a stay of your unmarried partner with you. Fill in and sign the declaration and submit it or tick the applicable box. You may submit the answers as an enclosure on a separate sheet together with your application. of paper. Please substantiate your answers with as many documents as possible.

1 Previous stay of your partner in the Netherlands 1.1 Did your partner stay in the Netherlands n Yes n No before? If so, what was the reason for this stay and | where did your partner stay?

2 Information about your relationship Day month year 2.1 Since when have you known your partner?

2.2 Where and how did you meet your partner? | > Please give as much information about this as possible. If necessary, you may use an additional sheet of paper. In that case, you must place your signature and date of signature on this sheet as well.

2.3 Are you family members or relatives? n Yes n No

If so, what is the family relationship? |

Day month year 2.4 Since when do you have a relationship with your partner?

2.5 How did the relationship come about? |

2.6 How do you currently maintain the | relationship with your partner?

2.7 Have your family members and friends been n Yes n No informed of your relationship? If not, why have they not been informed? |

BE09/11B 2 of 2

3 Previous marriages or (registered) partnerships of you 3.1 Have you been married before or did you n Yes n No have a (registered) partnership with a foreign national who is still residing in | the Netherlands?

If so, please give more detailed information.

4 Previous relationships of your partner 4.1 Has your partner been married before or n Yes n No did your partner have a (registered) partnership with a Dutch national or a | foreign national residing in the Netherlands?

If so, please give more detailed information.

5 Minor children of your partner 5.1 Does your partner have minor children? n Yes n No

If so, what are the personal details, and | temporary or permanent place of residence of these children?

5.2 Do the children travel with the partner to n Yes n No the Netherlands? If not, why do the children not travel with | the partner?

6 Signature I have filled in this form truthfully.

6.1 Name | City/Town Day month year

6.2 City/Town and date |

6.3 Signature |

BE09/11B Appendix n An International Baccalaureate Middle Years Certificate or an International Civic Integration Requirement General Certificate of Secondary Education or an International Baccalaureate. In addition, you must have passed the Dutch language course. n  Continued residence after three years of family reunification The Naturalisation Certificate with the endorsement that you have the required knowledge of the Dutch language. or family formation - M35A n A Civic Integration Certificate under the Civic Integration (Newcomers) Act, when the programme under this Act was completed not later than If you are at least 18 years of age or older, but not yet 65 years of age, you must have passed 31 December 2006. This must be accompanied by a declaration of the the civic integration examination. In some cases, you may be exempt from the examination, regional training centre (ROC). This declaration must state that you passed for instance on the basis of diplomas, certificates, or other documents. Tick the situation that the components 'Listening' and 'Speaking' at level NT2-2, the components applies to you. Please accompany your application by the following relevant evidence. 'Reading' and 'Writing' at level NT2-1, and the component 'Social Orientation' at level 2, or 80% if the test was taken after 31 August 2001 and 85% if the test was taken before 1 September 2001, respectively (the n You have passed the civic integration examination foreign national is a settled immigrant). – The original or legalised copy of the Civic Integration Certificate under n A Civic Integration Certificate under the Civic Integration (Newcomers) Act, the Civic Integration Act. Settled immigrants must have passed the civic when the programme under this Act continued in 2007 or 2008. This must integration examination at level A1; other foreign nationals must have be accompanied by a declaration of the regional training centre (ROC). passed the civic integration examination at level A2. This declaration must state that you passed the components 'Listening', 'Speaking', 'Reading', and 'Writing' at least at level NT2-2, and the component n You have Belgian or Luxembourg nationality 'Social Orientation' at level 2, or 80% if the test was taken after 31 August n You have the Turkish nationality or you are a family member of someone 2001 and 85% if the test was taken before 1 September 2001, respectively with the Turkish nationality (the foreign national is a newcomer). n You are younger than 18 years of age or you are 65 years of age or older n Settled Immigrants Civic Integration Certificate with: – level NT2-2 for the components 'Listening' and 'Speaking”; and n You lived in the Netherlands for at least 8 years during your compulsory – level NT2-1 for the components 'Reading' and 'Writing'. school age (from 5 years of age until the end of the school year in which n The decision of the Municipal Executive that it has been decided pursuant you turned 16 years of age) to Section 5(2) of the Civic Integration (Newcomers) Act not to implement a – An extract (with the historical address details) from the Municipal civic integration programme; Administration (GBA) showing that you lived in the Netherlands for a n A decision not to implement a civic integration programme, because the test minimum period of 8 years from the age of 5 years until the end of the as referred to in Section 5(4) of the Civic Integration (Newcomers) Act has school year in which your turned 16 years of age. been passed; n The document showing that you do not have to or did not have to take the You have one of the documents, diplomas or certificates mentioned below on Naturalisation Test pursuant to Section 4 of the Naturalisation Test Decree the basis of which you will be exempted form the civic integration requirement. (medical circumstances/efforts made). NB. If the diploma has not been issued in the Netherlands, the diploma or certificate must be provided with an Apostille stamp. In some cases, you will also be required to enclose a list of n You are permanently unable to take the civic integration examination for marks. This is only required if you were required to have passed the Dutch language course. medical reasons Please accompany the application by one of the following supplementary pieces – A letter from the Municipal Executive stating that you are not able to pass of evidence and documents or legalised copies thereof; tick the situation that is the civic integration examination due to a psychological disorder or physical applicable to you: or mental impairment; or n A letter from the Municipal Executive stating that the Municipal Executive – Medical advice provided by an independent doctor appointed to this end have arrived at the opinion on the basis of demonstrable efforts made by by the Municipal Executive. On the basis of this advice, the Minister of you that you are not reasonably capable of passing the civic integration Immigration and Asylum will determine whether you are permanently examination; unable to take the civic integration examination due to a psychological n The exemption test (Korte Vrijstellingstoets) under the Civic Integration Act disorder or physical or mental impairment. issued by DUO (formerly the Information Management Group) if integration is evident; Otherwise. You want to apply for a change of your purpose of stay into n A diploma of, for example, a university, Higher Professional Education continued residence and you did not pass the civic integration examination and (HBO), Upper Secondary Vocational Education (MBO), Pre-University you do not qualify for one of the above-mentioned grounds for exemption. Education (VWO), Senior General Secondary Education (HAVO), Junior Please accompany the application by one of the following supplementary pieces General Secondary Education (MAVO), or Pre-Vocational Secondary of evidence and documents; tick the situation that is applicable to you: Education (VMBO) after having attended an education course in the Dutch n It concerns a situation of special and individual circumstances. You want to language; You have such a diploma if the diploma states, for example: Wet qualify for continued residence without having passed the civic integration op het hoger wetenschappelijk onderwijs, Wet op het voortgezet onderwijs, examination. You will only be granted continued residence in this case if Wet educatie beroepsonderwijs, or Wet op het cursorisch onderwijs. you cannot be expected to have passed the civic integration examination. n State Examination Diploma in Dutch as a Second Language, (programme I or II); Explain in a separate letter why this is not possible for you. You must n A school diploma obtained in Belgium or Surinam The education course accompany your application by this letter together with as many pieces of must, however, have been taught in Dutch. In addition, you must have evidence and documents as possible to substantiate your reasons. passed the Dutch language course. The educational level must be higher n Despite the efforts made, you cannot reasonably be expected to pass the than primary school, and the diploma must be based on an Act. This Act civic integration examination due to the following facts and circumstances: need not necessarily be an Education Act; 1. You are illiterate, both in your own language and in the Dutch language, and n A diploma, certificate or other document obtained in education conducted 2. Your age and other circumstances that entail that you (at your age) cannot be in Dutch in Aruba, Curaçao, St. Maarten or Bonaire, St. Eustatius or Saba, expected to learn how to read and write Dutch within a period of five years. provided that the foreign national passed the Dutch language course. It In that case, you must submit a declaration from regional training centre in concerns the following diplomas: Junior General Secondary Education (MAVO), Amsterdam (ROC Amsterdam) containing the advice that - on the basis of a Senior General Secondary Education (HAVO), Pre-University Education (VWO), so-called 'feasibility test' - you will not be able to pass the civic integration Lower Secondary Vocational Education (LBO), Upper Secondary Vocational examination within a period of five years, due to the fact that you are illiterate Education (MBO), Higher Professional Education (HBO), and University. (possibly in combination with limited educational skills). You must also submit n The European Baccalaureate awarded by one of the European Schools. a document showing that you passed the Spoken Dutch Test at level A2 to You must have taken Dutch as a first or second language. In addition, you demonstrate that you can speak and understand Dutch at level A2. Please visit must have passed the Dutch language course. www.ind.nl for more information. BE11/11B Appendix Tuberculosis Test Reference Form M35A / M35A-1

In order to be granted a residence permit, you (or the person you are Please fill in the Reference Form before you make an appointment at the representing) must be willing to undergo a tuberculosis test (TB test) and - if Municipal Health Service (GGD). Please visit www.ggd.nl for more information necessary - to undergo treatment of tuberculosis. If you enclose the Declaration about the Municipal Health Service (GGD). The Municipal Health Service (GGD) of Intent to Undergo a Tuberculosis Test filled in by you with your application will fill in and sign the Reference Form, which shows that you have undergone a when you are submitting it to the IND (and you also comply with all other TB test. The Municipal Health Service (GGD) will send the Reference Form to the conditions), the IND will grant you a residence permit as quickly as possible. IND. The IND must have received the Reference Form from the Municipal Health Service (GGD) within three months after the date on which the application for a You will then receive this permit under the explicit condition that you will residence permit was submitted. actually undergo a TB test within three months. If it turns out after the issue of the residence permit that - despite the fact that you signed the Declaration of The obligation to undergo the TB test does not apply if you have the nationality Intent - you have failed to undergo a TB test within the period of three months, of one of the following countries: the Member States of the EU or the EEA, this may result in the withdrawal of the residence permit granted. Australia, Canada, Israel, Japan, Monaco, New Zealand, Surinam, United States of America, and Switzerland (including Liechtenstein). The obligation to In order to undergo the TB test, you must make an appointment with the undergo the TB test also applies if you have an EC residence permit for long- Municipal Health Service (GGD). At your appointment, you must hand over the term residents issued by another EU Member State or if you are a family Reference Form filled in by as completely as possible (part 1). member of the long-term resident and you have been admitted to another EU Member State as a family member of the long-term resident.

1 Details of the foreign national to be tested (the applicant) > The foreign national (the applicant) The Minister of Immigration and Asylum hereby requests the Director of the Municipal Health Service (GGD) to examine is to fill in this part (part 1) the person identified below for tuberculosis (of the respiratory organs) pursuant to the Aliens Act Implementation Guide- lines. 1.1 Application for a residence permit for work, as a trainee, for work n Yes n No experience or study purposes?

1.2 How did you come to the n With n Without a valid provisional residence permit (mvv) Netherlands?

1.3 V-number Surname as it appears in your passport or on your identity papers First names 1.4 Name | |

1.5 Gender n Male n Female Street Number 1.6 Home address | Postal code City/Town

| Day month year 1.7 Date of birth

1.8 Place of birth |

1.9 Country of birth |

1.10 Nationality |

1.11 Civil status | Type Number 1.12 Border-crossing document | |

BM38/11B 2 of 2

1.13 Do you have a spouse or partner n Spouse n (Registered) partner > Enter the requested data further or registered partner? Surname as it appears in your passport or on your identity papers First names – Name | |

– Gender n Male n Female Street Number – Home address | Postal code City/Town

|

– Nationality |

2 Declaration of the doctor of the Municipal Health Service (GGD doctor) > The doctor of the Municipal Health Service The undersigned, employed by the Municipal Health Service (GGD) as a doctor, states that he/she has tested the foreign is to fill in this part (part 2) national, referred to in this form by the number below, for tuberculosis (of the respiratory organs) on behalf of the Minister of Immigration and Asylum.

2.1 Name of the Municipal Health | Service (GGD)

2.2 Name of the doctor | Number Day month year

2.3 Test Number and test date City/Town Day month year

2.4 City/Town and date |

2.5 Signature of the doctor |

> The Municipal Health Service (GGD) forwards this declaration, completed in full and signed, to the Immigration and Naturalisation Service. Please use the address applicable to the situation of the foreign national.

Does the application of the foreign national relate to a purpose of stay for work, traineeship,  Yes Immigratie-en Naturalisatiedienst work experience or study? IND-loket kennis- en arbeidsmigratie Postbus 3022  2280 GA RIJSWIJK No

Did the foreign national enter the Netherlands with a valid provisional residence permit (mvv)?  Yes Immigratie-en Naturalisatiedienst afdeling vvr na mvv Postbus 226 5201 AE ’S-HERTOGENBOSCH

 No Immigratie-en Naturalisatiedienst afdeling vvr Postbus 3212 2280 GA RIJSWIJK

BM38/11B Appendix Declaration of Intent to Undergo a Tuberculosis Test M35A / M35A-1

In order to be granted a residence permit, you (or the person you are Fill in and sign the Declaration of Intent to Undergo a Tuberculosis test and send representing) must be willing to undergo a tuberculosis test (TB test) and - if it to the IND together with your application before you make an appointment necessary - to undergo treatment of tuberculosis. If you enclose the Declaration at the Municipal Health Service (GGD). By signing this form, you declare to be of Intent to Undergo a Tuberculosis Test filled in by you with your application willing to undergo a tuberculosis test and, if necessary, to undergo treatment of when you are submitting it to the IND (and you also comply with all other tuberculosis. At your appointment with the Municipal Health Service (GGD), you conditions), the IND will grant you a residence permit as quickly as possible. must hand over the Reference Form, filled in as completely as possible (part 1).

You will then receive this permit under the explicit condition that you will The obligation to undergo the TB test does not apply if you have the nationality actually undergo a TB test within three months. If it turns out after the issue of of one of the following countries: the Member States of the EU or the EEA, the residence permit that - despite the fact that you signed the Declaration of Australia, Canada, Israel, Japan, Monaco, New Zealand, Surinam, United States Intent - you have failed to undergo a TB test within the period of three months, of America, and Switzerland (including Liechtenstein). The obligation to this may result in the withdrawal of the residence permit granted. undergo the TB test also applies if you have an EC residence permit for long- term residents issued by another EU Member State or if you are a family member of the long-term resident and you have been admitted to another EU Member State as a family member of the long-term resident.

1 Details of the foreign national to be tested (the applicant) 1.1 Application for a residence permit for work, as a trainee, for work n Yes n No experience or study purposes?

1.2 V-number Surname as it appears in your passport or on your identity papers First names 1.3 Name | |

1.4 Gender n Male n Female Street Number 1.5 Home address | Postal code City/Town

| Day month year 1.6 Date of birth

1.7 Place of birth |

1.8 Country of birth |

1.9 Nationality |

1.10 Civil status | Type Number 1.11 Border-crossing document | |

BM38/11B 2 of 2

1.12 Do you have a spouse or partner n Spouse n (Registered) partner > Enter the requested data further or registered partner? Surname as it appears in your passport or on your identity papers First names – Name | |

– Gender n Male n Female Street Number – Home address | Postal code City/Town

|

– Nationality |

2 Signature I hereby declare that I am prepared to cooperate in the tuberculosis examination and, if necessary, to undergo treatment for tuberculosis. I am aware of my obligation to undergo a tuberculosis examination within three months after the date on which the application for a residence permit was filed. Failure on my part to comply with this requirement will have consequences for my right to stay in the Netherlands.

2.1 Name of the foreign national | City/Town Day month year

2.2 City/Town and date |

2.3 Signature of the foreign national |

2.4 Name of the legal representative | (if applicable) City/Town Day month year

2.5 City/Town and date |

2.6 Signature of the legal | representative (if applicable)

BM38/11B Appendix Medical information disclosure consent form M35A / M35A-1

Information for the foreign national: If you have more than two doctors/professionals 1 2 If the applicant is 12 years of age or younger or incapable of performing legal acts, this in charge of your treatment, you are requested to copy this appendix, so that you can fill in appendix must be filled in by the legal representative. If the applicant is older than 12 years more than one consent form. of age but younger than 16 years of age, this appendix must be filled in by the foreign national and his/her legal representative. If the applicant is 16 years of age or older, this 1 The doctor(s)/professional(s) in charge of your treatment must be listed in the BIG-register appendix must be filled in by the foreign national. or in the register of the NIP.

1 Medical Examination 1. The undersigned hereby declares to have no objection to fact that the medical advisor of the Immigration and Naturalisation Service of the Ministry of the Interior and Kingdom Relations (hereinafter: "IND") will ask for information about his/her state of health from the doctor(s)/professional(s) in charge of his/her treatment in connection with an investigation into the medical circumstances around his/her residence status in the Netherlands. 2. The undersigned grants permission to send this completed consent form in copy form to the doctors/care workers to be contacted. 3. The undersigned also gives his/her consent to the medical advisor to provide his/her medical information to a medical specialist that may be engaged in any further investigation. 4. The undersigned authorises the following doctor(s)/professional(s) in charge of his/her treatment who are listed in the BIG-register (pursuant to the Dutch Individual Healthcare Professionals Act (BIG)) and/or at the NIP (the Dutch professional association of psychologists) (doctors, dentists, physiotherapists, midwives, nurses, pharmacists, healthcare psychologists, psychotherapists, and special educators) to provide information to the medical advisor of the IND. The undersigned declares to be aware that this consent form will be stored in digital form.

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | | Day month year 1.3 Date of birth

2 Signature 2.1 Name of the foreign | 2 national City/Town Day month year

2.2 City/Town and date |

2.3 Signature of the | foreign national

2.4 Name of the legal | 2 representative City/Town Day month year

2.5 City/Town and date |

2.6 Signature of the legal | representative

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3 Details of the doctor/professional in charge of the treatment 3.1 Name of the GP/ | n GP n COA-doctor n Specialist COA-doctor/specialist 1

3.2 Name of the hospital/ | practice/institution Street Number 3.3 Visiting address | Postal code City/Town

|

3.4 Telephone number

3.1 Name of the GP/ | n GP n COA-doctor n Specialist COA-doctor/specialist 1

3.2 Name of the hospital/ | practice/institution Street Number 3.3 Visiting address | Postal code City/Town

|

3.4 Telephone number

4 Passing on the medical advice The undersigned gives consent to the medical advisor of the IND to provide the medical advice to the civil servants of the Immigration and Naturalisation Service who are responsible for decision-making, to the civil servants of the Repatriation & Departure Service to enable medical arrangements to be made before, during or after removal, to the relevant legal experts of the office of the State Advocate, and to the bodies assigned by law for the administration of justice.

4.1 Name of the foreign | 2 national City/Town Day month year

4.2 City/Town and date |

4.3 Signature of the | foreign national

4.4 Name of the legal | 2 representative City/Town Day month year

4.5 City/Town and date |

4.6 Signature of the legal | representative

BM39A/11B Appendix Declaration of the Medical Situation of the Foreign National M35A / M35A-1

Information for the foreign national: Have your doctor/professional in charge of your Information for the doctor/professionals in charge of your treatment: By means of this treatment 1 fill in this appendix fully and sign it. If you have more than one doctor/profes- form, several questions are asked about the presence of a medical treatment of the foreign sional in charge of your treatment, you are requested to copy this appendix, so that every national mentioned by you below. With your answers, the foreign national can show that doctor or professional can fill in and sign a copy. Fill in and sign the appendix and submit it there are medical facts or that there is a medical treatment that may be important for the in together with your application. assessment of his/her application for a stay in the Netherlands. In answering these questions, you are not required to assess whether or not the foreign national is complying with the 1 The doctor/professionals in charge of your treatment must be listed in the BIG-register or conditions for a stay in the Netherlands. You only have to provide factual details in simple in the register of the NIP. terms that can be understood by non-medically qualified people. The non-medically qualified civil servants of the Immigration and Naturalisation Service (IND) will not form an independent medical opinion on the basis of your answers, but they want to be informed of any active medical treatment being given by you. If the foreign national is under treatment, they may request advice from an independent doctor of the Medical Advice Bureau of the IND. With reference to this advice, the Medical Advice Bureau will contact you, with the specific written consent to this end from the foreign national.

1 Details of the medical professional 1.1 Name |

1.2 Telephone number

1.3 Professional title |

1.4 BIG registration number | 1.5 Registered at NIP? n Yes n No Street Number 1.6 Visiting address | Postal code City/Town

| 2 Details of the foreign national

Surname as it appears in your passport or on your identity papers First names 2.1 Name | |

2.2 Gender n Male n Female Street Number 2.3 Home address | Postal code City/Town

| Day month year 2.4 Date of birth

2.5 Place of birth |

2.6 Nationality |

BM39D/11B 2 of 2

3 Details of the treatment 3.1 Does the foreign national have one or more medical complaints? n Yes n No

3.2 Is the foreign national currently receiving active medical treatment for these complaint(s) n Yes n No

3.3 If so, what is the nature of this/these complaint(s)? |

Day month year 3.4 If so, when was this medical treatment started? Day month year 3.5 When, according to expectations, will the treatment have been completed?

4 Signature The undersigned, medical care provider, hereby declares that the following foreign national, is currently receiving active medical treatment from him/her.

City/Town Day month year

4.1 City/Town and date |

4.2 Signature |

BM39D/11B Appendix Declaration of Non-Impediment M35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay – as a child of 15 years of age or older; – as an au pair; – for exchange purposes through a private exchange organisation. Fill in and sign the declaration and submit it in together with your application.

1 Details of the foreign national

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | |

1.3 Gender n Male n Female Day month year 1.4 Date of birth

1.5 Place of birth |

1.6 Country of birth |

> Tick the situation(s) that a. n I declare that I am unmarried and have never been married before nor have I ever entered into a registered partnership applies/apply to you. b. n I declare that - after the dissolution of my marriage with my former spouse - I did not get married again (nor did I enter into a registered partnership) Name ex-spouse |

c. n I declare that - after the dissolution of the registered partnership with my former registered partner – I did not get married again (nor did I enter into a registered partnership) Name of former registered partner |

d. n I declare that I do not have to provide for any children

2 Signature I am aware that completing this declaration untruthfully may have consequences for the right of residence.

City/Town Day month year

2.1 City/Town and date |

2.2 Signature |

BM41/11B Appendix Declaration of Relationship M35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay with your unmarried partner. Fill in and sign the declaration and submit it in together with your application. 1 Details of the foreign national (the applicant)

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | |

1.3 Gender n Male n Female Street Number 1.4 Home address | Postal code City/Town

|

1.5 Civil status | Day month year 1.6 Date of birth

1.7 Place of birth |

1.8 Country of birth |

1.9 Nationality |

The applicant declares as follows: He/she has maintained an exclusive relationship with the co-undersigned and that he/she has run a joint household to this end and has actually cohabited at the above-mentioned address as from: Day month year – Date

He/she undertakes to inform the Immigration and Naturalisation Service immediately of the termination of his/her exclusive elationship with the co-undersigned; He/she will also inform the Immigration and Naturalisation Service of any other relevant changes in this context

2 The sponsor (the partner)

Surname as it appears in your passport or on your identity papers First names 2.1 Name | |

2.2 Gender n Male n Female Street Number 2.3 Home address | Postal code City/Town

|

BM42/11B 2 of 2

2.4 Civil status | Day month year 2.5 Date of birth

2.6 Place of birth |

2.7 Country of birth |

2.8 Nationality |

The person providing residence declares that the undersigned is his/her life partner and that he/she is running a joint household with him/her and that he/she has actually been cohabiting with him/her at the above-mentioned address as from: Day month year – Date

3 Signature I have filled in this form truthfully.

City/Town Day month year

3.1 City/Town and date |

3.2 Signature of the | foreign national

3.3 Signature of the person | providing residence > Completing a declaration of relationship untruthfully is an offence and will be reported at all times.

BM42/11B Appendix Study Awareness Declaration M35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for study purposes. Fill in and sign the declaration and submit it in together with your application.

1 Details of the foreign national

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | |

1.3 Gender n Male n Female Street Number 1.4 Home address | Postal code City/Town

| Day month year 1.5 Date of birth

1.6 Place of birth |

1.7 Country of birth |

1.8 Nationality |

I declare that I am aware of the following: My stay in the Netherlands is only permitted for the following purpose:

– Name of study | programme

– Name of the | educational institution

- City/Town |

My stay will be permitted for one year and I will submit an application for an extension of the period of validity to the IND not later than one day before the expiry date of this period. Upon completion, interim termination of the study, or insufficient efforts spent on the study - as a result of which the study will take a disproportionately long time for me to finish it - the IND may decide to withdraw my residence permit or not to extend it. I have to leave the Netherlands at the end of my study.

2 Signature I have filled in this form truthfully.

City/Town Day month year

2.1 City/Town and date |

2.2 Signature |

> Completing a declaration of awareness (study) untruthfully is an offence and will be reported at all times.

BM43/11B Appendix Au Pair Awareness Declaration M35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay as an au pair. Fill in and sign the declaration and submit it in together with your application.

The undersigned parties, hereinafter referred to as the au pair and the host The au pair will be staying in the Netherlands to become acquainted with Dutch family, declare as follows: society and culture, and the host family will give the au pair the opportunity (within the meaning of free time) to realise this. The host family will assume the The au pair and the host family are aware that the stay as an au pair in the above-mentioned financial responsibility for the stay. In addition to board and Netherlands will only be permitted in the following cases: lodging, the host family will provide a monthly amount in pocket money, to be – At the time of submitting the application for the residence permit in the agreed upon in consultation. Netherlands, the au pair is at least 18 years of age, but not yet 26 years of age; – The au pair has never stayed in the Netherlands before on the basis of a In consideration for the facilities provided, the au pair will assist in the domestic residence permit. This does not apply if the au pair is only asking for a work of the host family alone and/or in looking after and caring for any children change of host family; present in this family. This consideration may not be in the nature of work, – The au pair has a valid Regular Provisional Residence Permit, if required; for which a work permit is required within the meaning of the Labour Act for – The au pair has never had an employment relationship with the host family Foreign Nationals. This means that the au pair may only perform activities for before, when living abroad; which an alternative is always available when she/he is absent. The supportive – All costs ensuing from the au pair's stay in the Netherlands (including an nature of the work also implies that the au pair will not be fully responsible for appropriate health insurance policy, and his or her departure from the the domestic chores, with the exclusion of the members of the host family. Netherlands (whether this departure is forced or not) will be paid by the host The au pair will, after all, stay in the host family on the basis of equality (with family, which has signed an Appendix 'Sponsor Declaration' for this purpose; the family members). In addition, the supportive nature implies that the au pair – The host family is capable of bearing the above-mentioned costs, which is will not perform any work for more than 30 hours a week. The division of those taken for granted if it is proved that - for the intended period - the host family 30 hours a week is free, on the understanding that the au pair is not permitted has an independent income that is at least equal to the applicable social to work for more than 8 hours a day (including babysitting activities in the assistance benefit level within the meaning of the Work and Social Assistance evening), and that she/he will have at least two days off a week. Act, plus the social assistance benefit level for single persons of 21 years of age and older within the meaning of this Work and Social Assistance Act. If the host family has the au pair perform activities for which a work permit is – If required, the au pair will undergo a tuberculosis test; required pursuant to the Labour Act for Foreign Nationals, the host family is – The au pair does not pose a danger to public order and national security; punishable, and the competent authorities in this matter will be notified hereof. – The au pair is unmarried and does not have to provide for any dependent By virtue of the restriction under which the residence permit is granted, it is family member and is not obliged to do so. expected that the au pair or the host family will inform the Aliens Department if the actual activities prove to be different from those envisaged for the purpose The au pair may stay with the host family for a maximum period of one year, to of stay. be counted from the arrival date in the Netherlands, if and for so long as the au pair has a residence permit for this period and the au pair continues to comply In the context of the monitoring of foreign nationals, the Aliens Department with the applicable conditions during the stay. The period of validity of the may visit or call up the au pair and/or the host family for a specific cause or for a residence permit will not be extended at the end of the year, and the au pair will random check. have to leave the Netherlands at that time.

1 Details of the au pair

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | | Day month year 1.3 Date of birth

1.4 Place of birth |

1.5 Nationality |

BM42/11B 2 of 2

2 Details of the heads /both heads of the host family

Surname as it appears in your passport or on your identity papers First names 2.1 Name of person 1 | | Surname as it appears in your passport or on your identity papers First names 2.2 Name of person 2 | | Street Number 2.3 Home address | Postal code City/Town

| 3 Signature

City/Town Day month year

3.1 City/Town and date |

3.2 Signature of the au pair | City/Town Day month year

3.3 City/Town and date |

3.4 Signature of person 1 |

3.5 Signature of person 2 |

BM42/11B Appendix Au Pair - Host Family Agreement M35A / M35A-1

Fill in this agreement as completely as possible together with your host family if you are applying for a residence permit as an au pair. Enclose this agreement with your application.

1 Details of the agreement

Day month year 1.1 The Au Pair - Host Family Agreement (hereinafter 'the Agreement') was concluded on > The au pair and the host family are collectively referred to as Parties.

1.2 between the parties | Name of the foreign national 1.3 the foreign national residing in the Netherlands for a period of | one year Day month year 1.4 born on Name(s) head(s) of family 1.5 (hereinafter to be referred to as 'the au pair'), and the family | providing free board and lodging to this foreign national Day month year Day month year

1.6 born on Street Number 1.7 (hereinafter to be referred to as 'the host family'), residing at | Postal code City/Town

| Telephone number 1.8 to be reached at Name of office or organisation 1.9 The intermediary services between the Parties was provided by | > This only needs to be filled in, of course, if intermediary services have been provided.

Considering that: Article 1 - Weekly Schedule The Parties have exchanged information during the past period. The au pair has In exchange for board, lodging, and pocket money, the au pair may not work stated that she/he wishes to become acquainted with Dutch society and culture more than 8 hours a day, with a maximum of 30 hours a week. The au pair is during a period of one year, and to realise this by staying with a Dutch host entitled to at least two twenty-four hours' periods of free time, and, in addition family as an au pair. The family has declared that it will provide facilities to the to this, to two evenings of free time a week. The au pair may only be asked au pair, in return for which the au pair will carry out light domestic work to assist to perform light domestic work. Examples of this are cleaning up the nursery, the host family. For this purpose, the au pair has submitted an application for a doing the laundry of the children's clothes, preparing light meals, babysitting, residence permit (in consultation with the host family, who will act as the family and doing some shopping now and then. The Parties undertake to comply with providing residence). The Agreement (signed by the Parties) will be included these stipulations. For this purpose, the Parties have filled in the table (weekly in the assessment of the above-mentioned application and must therefore be schedule and alternative) on the back of this appendix, in mutual consultation. submitted together with the application. The au pair and the host family have read the contents of the Appendix 'Au Pair Awareness Declaration' and have Article 2 - Alternative signed and submitted the declaration. The au pair will function as an equal member of the family. This means that the au pair is not allowed to perform any work for which he or she is indispensable. The au pair and the host family therefore agree as follows: The host family promises that the au pair will not be solely responsible for any light domestic work or otherwise, or for the care of the children, and that (if the au pair is absent) there will always be an alternative help or babysit present or this alternative help or babysit will be arranged. The host family will state in the table (weekly schedule and alternative) on the back of this appendix which family member will function or may function as the alternative for the au pair.

BM44A/11B 2 of 2

Article 3 - Cultural Exchange Article 4 - Pocket Money Being an au pair is aimed at cultural exchange. This means that the au pair is to The au pair is entitled to receive a payment for the work performed in the family participate in a number of leisure activities. These activities may include by the au pair. This payment will be made in the form of pocket money and will attending a course; learning a language; joining the host family on their outings; not be paid as wages, because the au pair is not permitted to perform work and participating in an organised trip (whether or not with other au pairs). within the meaning of the Labour Act for Foreign Nationals. The maximum The au pair and the host family undertake to comply at least with the following amount may not be higher than€ 340 a month. The host family promises to pay activities: the au pair an amount of:

€ a month 1. Article 5 - Validity This Agreement is valid from the time it was signed and will continue to be valid 2. until the date that the period of validity of the residence permit of the au pair will expire.

3. Article 6 - Au Pair Information Line The au pair has the possibility to report any complaints about his or her stay in the Netherlands at the Au Pair Information Line. Dependent on the type of 4. complaint, it will be passed on to the police or the labour inspection or to both institutions. The Information Line is not available for reports about physical and/or psychological abuse. The host family also has the possibility to contact 5. the Information Line. > For the time being, the Information Line has been incorporated with the IND. The telephone number of the Information Line is: +31 (0)70 779 48 88

Article 7 - Disputes This Agreement is subject to Dutch law. Any dispute about the interpretation of this Agreement will be settled the competent court.

2 Table. Week Schedule and Alternative Day Weekly activities Light domestic Taking care of Free time Stand-in work the children Enter the number Enter the number Tick the day(s) Enter the name of the family of hours of hours that apply to member who will act as a stand-in the au pair

Sunday | | |

Monday | | |

Tuesday | | |

Wednesday | | |

Thursday | | |

Friday | | |

Saturday | | | 3 Signature Drawn up in triplicate (the Parties and the IND each receive a copy)

City/Town Day month year

3.1 City/Town and date |

3.2 Signature of the au pair as | a party to this Agreement

3.3 Signature of the heads/ | head of the host family as a party to this Agreement

BM44A/11B Appendix Spiritual Leader/Teacher of Religious Knowledge Awareness Declaration M35A / M35A-1

Only fill in this declaration if you are submitting an application for a residence permit for a stay as a spiritual leader or a teacher of religious knowledge. Fill in and sign the declaration and submit it in together with your application.

1 Details of the foreign national

Surname as it appears in your passport or on your identity papers First names 1.1 Name | |

1.2 Gender n Male n Female Street Number 1.3 Home address | Postal code City/Town

| Day month year 1.4 Date of birth

1.5 Place of birth |

1.6 Country of birth |

1.7 Nationality |

I declare that I am aware of the following: My temporary stay in the Netherlands will be permitted for the purpose of performing activities as a spiritual leader or a teacher of religious knowledge for: |

My stay in the Netherlands will only be permitted for the duration of the activities. I have to leave the Netherlands after having finished my activities. I am not permitted to perform any other activities during my stay in the Netherlands.

2 Signature I have filled in this form truthfully.

City/Town Day month year

2.1 City/Town and date |

2.2 Signature |

> Completing a declaration of awareness (spiritual leader/teacher of religion knowledge) untruthfully is an offence and will be reported at all times.

BM45/11B Appendix Sponsor declaration M35A

Only have this declaration filled in if you are submitting an application for a stay: Fill in and sign the declaration and submit it in together with your application. – With your unmarried partner; If the guarantor and his/her partner are both Dutch nationals, please accompany your – With your child; application with copies of their valid identification documents. If either of the two has a – As a foster child; different nationality: a copy of the valid border-crossing document in which the residence – As a family member (other than child/parent); permit has been recorded or a copy of the front and back of the residence permit. If the – For a family visit; guarantor is not your sponsor /(person providing residence), please accompany a copy of the – For study purposes; valid identification document of this guarantor. This is not necessary if this guarantor fills in – As an au pair; and signs this sponsor declaration on behalf of an organisation or institution. – To undergo medical treatment – As an dependent family member of someone who is working for an international organisation and does not have sufficient means of existence himself/herself.

The undersigned acts as a guarantor for the costs incurred by the State and foreign national to a place outside the Netherlands where his/her admittance is other public bodies as a result of the foreign national’s stay in the Netherlands guaranteed, up to an annual maximum amount of € 5,000, may be recovered for a period of five years. The guarantee will end if sufficient security has been from the guarantor. In addition, the undersigned declares to be familiar with provided otherwise, if the foreign national has left the Netherlands permanently, the fact that, if the foreign national receives a benefit payment pursuant to the if the foreign national has been granted a residence permit for another purpose Dutch Work and Social Assistance Act, the costs of social assistance that will or a permanent residence permit, or if the foreign national has become a Dutch have been incurred in connection with the benefits paid to the foreign national national. In addition, the undersigned declares that the cost, excluding costs of (related to the amount of the current benefits in accordance with the standard social assistance, that are incurred by the State and other public bodies in of the Dutch Work and Social Assistance Act) in addition to the above- respect of the foreign national's stay, including the costs of journey of the mentioned annual amount of € 5,000, will be recovered from the guarantor.

1 Details of the foreign national

1.1 V-number Surname as it appears in your passport or on your identity papers First names 1.2 Name | |

1.3 Gender n Male n Female Day month year 1.4 Date of birth

2 Details of the guarantor

Surname as it appears in your passport or on your identity papers First names 2.1 Name | | Street Number 2.2 Home address | Postal code City/Town

|

3 Signature

City/Town Day month year

3.1 City/Town and date | Guarantor Partner guarantor 3.2 Signature of the guarantor| | > If you are a marriage partner or registered partner, your partner must also sign for approval BM47/11B Appendix Exchange Organisation Sponsor Declaration M35A / 35A-1

Only fill in this declaration if you are submitting an application for a residence permit for exchange purposes. Fill in and sign the declaration and submit it in together with your application.

The undersigned, as a representative of the exchange organisation, guarantees The organisation acts as a guarantor for the following: that the following cumulative conditions are fulfilled in view of the stay in the – The costs ensuing from the foreign national's stay in the Netherlands and Netherlands of the foreign national (mentioned below) in the context of its his/her departure from the Netherlands (whether this departure is forced or exchange programme: not); – The foreign national is not younger than 15 years of age, but not older than – Taking out adequate insurance against medical expenses and insurance 26 years of age; against third-party liability; – The foreign national will have a valid passport during the stay; – Informing the Aliens Police and the Immigration and Naturalisation Service – The foreign national has never stayed in the Netherlands before on the basis (IND) immediately of any change (e.g. change of address or change of host of a residence permit; family); – The foreign national has never had an employment relationship with the – Ensuring that the foreign national is not permitted to perform paid work and host family before, when residing abroad; that any voluntary work will not be performed without a work permit (for – The foreign national is unmarried and is not providing for dependent family non EU citizens) having been issued; members; – The timely return of the foreign national, which return may in any case – The foreign national does not pose a danger to public order and national not be later than one year after the arrival of the foreign national in the security; Netherlands. – The foreign national will undergo an tuberculosis test (if applicable).

1 Details of the foreign national

Surname as it appears in your passport or on your identity papers First names 1.1 Name | | Day month year 1.2 Date of birth

1.3 Nationality |

2 Details of the exchange organisation

2.1 Name of the organisation |

2.2 City/Town |

2.3 Name of the contact | person

2.4 Employee’s job title |

3 Signature

City/Town Day month year

3.1 City/Town and date |

3.2 Signature of the | exchange organisation

BM48/11B Appendix Declaration of Income as a Self-Employed Person M35A / M35A-1

Only have this declaration filled in and signed by an accountant if you are submitting an By means of this form, several questions are asked about the income of the application for a residence permit and you or the person providing residence has an income foreign national or of the person who has an interest in the fact that a residence as a self-employed person. Accompany the declaration filled in and signed by you and your permit is granted to a foreign national. On the basis of your answers, a decision accountant with your application. will be made on whether the person involved permanently and independently NB. The IND can verify the correctness of this declaration at another government agency has sufficient means of existence within the meaning of the Dutch Aliens Act (e.g. the Netherlands Employees Insurance Agency (UWV) or the Tax and Customs 2000. Administration).

1 Details of the accountant 1.1 Professional title n Tax Advisor from the Netherlands Tax Consultants Association n Tax Advisor from the Dutch Federation of Tax Advisors n Chartered accountant n Accounting consultant n NOAB Advisor n Other, namely: |

1.2 BECON number Tax Office | 1.3 Telephone number Street Number 1.4 Visiting address | Postal code City/Town

| 2 Details of the self-employed person

2.1 V-number Surname as it appears in your passport or on your identity papers First names 2.2 Name | | Street Number 2.3 Home address | Postal code City/Town

| Day month year 2.4 Date of birth

2.5 Place of birth |

2.6 Nationality |

2.7 Name of the enterprise | Street Number 2.8 Visiting address | Postal code City/Town

|

2.9 Registration number with the Chamber of Commerce

BM57/11B 2 of 2

NB. The profit of the past financial year or the current financial year of the profit must be made on the basis of the so-called ‘permanence’ rule. enterprise is calculated by decreasing the sum of the operating income by the This involves the stipulation that both the operating income and the operating sum of the operating costs. The income and costs must be calculated in costs must be attributable to the relevant period. If the enterprise has the form accordance with the commercial principles. Please also note the following in of a partnership, a general partnership, or a limited partnership, the profit is this respect. If there is no past financial year, the calculation of the monthly distributed among the relevant partners.

3 Income from business activities Current financial year, immediately preceding the date on which the application was submitted Day month year Day month year 3.1 The data included at 3.2 and 3.3 relate to the period (from-to)

3.2 Profit or profit share from the business activities over the € above-mentioned period (see explanation) 3.3 Amount to mentioned at 3.2 divided by the number of € months stated

Last closed financial year, immediately preceding the date on which the application was submitted Day month year Day month year 3.4 Financial year (from-to)

3.5 Profit or profit share from the business activities € in conformity with the annual accounts (see explanation) 3.6 Amount mentioned at 3.5 divided by the number of € months in the last closed financial year 3.7 Adjustments to the above-mentioned profit or profit € share from the business activities before taxable profit* 3.8 Taxable profit* €

3.9 Processing status of return by Tax and Customs Administration n Proof that the tax return has been received by the Tax and Customs Administration > Tick one situation only and enclose the relevant document with your application > For a sole-trader, attach IB-60 n Provisional assessment > Attach provisional assessment n Final assessment > Attach final assessment 3.10 If the Tax and Customs Administration has already imposed an assessment, did it base its assessment on the profit from business n Yes activities stated? n No > Attach an explanation on a separate annex

Second but last closed financial year Day month year Day month year 3.11 Financial year (from-to)

3.12 Profit or profit share from the business activities € in conformity with the annual accounts (see explanation) 3.13 Amount mentioned at 3.5 divided by the number of € months in the last closed financial year 3.14 Adjustments to the above-mentioned profit or profit € share from the business activities before taxable profit* 3.15 Taxable profit* €

3.16 Processing status of return by Tax and Customs Administration n Proof that the tax return has been received by the Tax and Customs Administration > Tick one situation only and enclose the relevant document with your application > For a sole-trader, attach IB-60 n Provisional assessment > Attach provisional assessment n Final assessment > Attach final assessment 3.17 If the Tax and Customs Administration has already imposed an assessment, did it base its assessment on the profit from business n Yes activities stated? n No > Attach an explanation on a separate annex

(*required only for verification purposes by the IND)

4 Signature The accountant hereby truthfully declares that the worker on a self-employed basis has earned an income from business activities in accordance with the data filled in on this form

City/Town Day month year

4.1 City/Town and date |

4.2 Signature Entrepreneur | City/Town Day month year

4.3 City/Town and date |

4.4 Signature Accountant |

BM57/11B Bijlage fotokaart Appendix Passport Photo Form

The Passport Photo De pasfoto Stick a new and unused passport photo on the designated frame at the bottom of Onder aan deze pagina moet u een nieuwe, nog niet eerder gebruikte this page. If the application is meant for your child, please use a new and unused pasfoto van uzelf plakken. Als de aanvraag bedoeld is voor uw kind, passport photo of your child. Your passport photo has to meet the Dutch passport dan moet u een nieuwe, nog niet eerder gebruikte pasfoto van uw kind requirements. Always have your passport photo made by a professional plakken. Uw pasfoto moet voldoen aan de Nederlandse paspoorteisen. photographer who is acquainted with the Dutch passport requirements. Laat daarom altijd een nieuwe pasfoto maken door een beroeps­ No residence document can be issued to you if your passport photo does not meet fotograaf die bekend is met de eisen die in Nederland aan pasfoto’s the Dutch passport requirements. It is therefore very important to supply a good worden gesteld. Als uw pasfoto niet aan de Nederlandse paspoort­eisen passport photo with this form. voldoet, kan er geen verblijfsdocument aan u worden uitgereikt. Het is dus belangrijk dat u een goede pasfoto meestuurt.

How to append a photo to this form? Hoe plakt u de foto op dit formulier? • Pull away the paper cover, start at the arrow; • Trek het niet-plakkende vel papier los, begin bij de pijl; • Place your photo straight on the grey area below; • Leg uw foto recht op het grijze kader; • Tightly press the photo on the paper; • Plak de foto en druk stevig aan; • Place your signature within the frame on the lower left side. • Zet uw handtekening in het vak linksonder. Doe dit met een pen Use a pen with dark, preferably black ink. If your signature is not clearly met een donkere kleur inkt, het liefst zwarte inkt. Als uw handteke- visible, a residence permit can not be created. ning niet duidelijk is, kan geen verblijfsdocument worden gemaakt.

> Invullen in blokletters Complete in capital letters

1. Voorna(a)m(en) en achternaam First name(s) and surname | Straat Street Nummer Number 2. Woonadres Home address | Postcode Postcode Plaats City/Town | Dag Day maand month jaar year 3. Geboortedatum Date of birth

4. Nationaliteit Nationality |

5. V-nummer V-number

6. Handtekening Signature

> Plak hier uw pasfoto Your passport photo here

IND4014_BE04/11A