Admission and Residence

MVV issue form

This form is free of charge

Passport photo
35 by 45 mm
(width by height)

1 Personal details
1.1 Surname (family name)

1.2 S urname at birth

(previous family name)

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

|
Day

month year

1.4 Date of birth

Place Country

1.5 Place of birth

1.6 Nationality

Current nationality

Nationality at birth

1.7 Sex

Male

1.8 Marital status

Single

Married

Widow(er)

Other (please specify)

1.9 Home address

1.10 Telephone number(s)

1.11 Email address

1.12 If the applicant is a minor, details of

person excercising parental
responsibility/guardian

1.13 Are you residing in a country other

than the country of your current
nationality?

Female
Separated

Divorced

Surname

First name

Address Nationality

No.

Valid until

No

Yes. Residence permit or equivalent

13BUZ623121|E

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1.14 Type of travel document

Ordinary passport

Diplomatic passport

Service passport

Special passport

Other travel document (please specify)

Number of travel document

1.15 Details of travel document

Official passport

Date of issue

|
Valid until

Issued by

2 Purpose of stay in the Netherlands

2.1 Employment

Employment

2.2 Family

2.3 Study

2.4 Other

Self-employment

Employment as highly skilled migrant

Highly educated migrant seeking employment

EU Blue card holder

Employment as researcher

Employment as cleric/teacher of religion

Live with partner

Live with spouse or registered partner

Live with adoptive parents

Live with foster parents

Family life under art. 8 ECHR

Other humanitarian grounds

Study

Cultural exchange, secondary school pupils

Work placement/learning on the job

Working holiday programme/scheme and YWEP, Australia, Canada, New Zealand

Au pair

Medical treatment

Wealthy foreign national

Readmission to the Netherlands, previously lived in the Netherlands

2.5 Date of intended departure
for the Netherlands
2.6 Name and address of your
host in the Netherlands

Live with parents

Day

Resettlement/quota refugee

month year

Name

|
Address

|
2.7 Has your host applied for your
MVV with the Immigration and
Naturalisation Service (IND) in
the Netherlands?

Yes

No

I will pay the fees myself

2.8 If not, who will pay the

MVV fees into the INDs Dutch
bank account?
2.9 If your host is not a Dutch national,
is he/she an EU, EEA or
Swiss citizen living in
the Netherlands?

Yes

No

2.10 Have you previously applied for

an MVV?

Yes

No

2.11 If so, are there any new facts/

circumstances?

Yes

No

My host will pay the fees

N/A (no fees due)

If you have answered Yes: please explain in writing on a separate sheet

3 Signature
3.1 Please tick the box below

I have completed this form truthfully. I am aware that the personal details I have provided will be passed on to
official agencies in the Netherlands, which require this information in order to implement the Aliens Act 2000.
Place

3.2 Place and date

3.3 Signature

> If the applicant is a minor, the signature

of the person exercising parental
responsibility/guardian

Day

month year