SLO IADOSTI/

application number

SLO DOKLADU O POBYTE/

document residence number

PLATN DO/
valid until

iados o obnovenie prechodnho pobytu1)/

Application for renewal of the temporary residence1)

iados o trval pobyt na neobmedzen as/dlhodob pobyt1)/ Application for permanent

residence for an unlimited time /long-term residence1)

iados o registrciu prva obana nie/ prva na trval pobyt obana nie1)/ Application
for registration of right of residence of Union Citizen/ right for permanent residence of Union Citizen1)

FOTOGRAFIA/ VLASTNORUN PODPIS/signature

photo 33,5 cm

iados o vydanie dokladu rodinnho prslunka s prvom na pobyt/na trval pobyt1)/ Application for issue of document residence
of the family member with right for residence/for permanent residence 1) iados o vydanie dokladu1)/ Application for issue of residence document1)
2)

1. PRIEZVISKO/
Surname

2. TITUL/
title

3. MENO/
first name(s)

4. RODN PRIEZVISKO/
name at birth

5. PREDCHDZAJCE PRIEZVISK/
all previous surnames

6. POHLAVIE/
sex

ena/female mu/male
7. DE, MESIAC A ROK NARODENIA/
date of birth (ddmmyyyy)

8. RODN SLO/
personal number

9. MIESTO NARODENIA/
place of birth

10.TT NARODENIA/
country of birth

11. TTNA PRSLUNOS/

citizenship

12. NRODNOS/
nationality

13. RODINN STAV/

marital status

14. CESTOVN DOKLAD/

travel document number

15. DTUM VYDANIA/

date of issue

16.PLATN DO/
valid until

17. VYDAL/
issued by

18. EL POBYTU/
purpose of stay

19. KATEGRIA POBYTU3)//

type of residence3)

1) 2)

Nehodiace sa preiarknite./ Retain as appropriate. daje na iadosti musia by vyplnen psacm strojom alebo palikovm psmom v slovenskom jazyku./ The data to the application must be complete written by machine or in block letter (by hand) in the Slovak language. 3) Vyznate krikom len jednu kategriu, ktor je hlavnm elom/dvodom iadanho pobytu na zem Slovenskej republiky. Kategria pobytu svis s elom pobytu uvedenm pod bodom 18./ Select a cross for only one category, which is the main purpose/reason for the requested stay at the territory of the Slovak Republic. Type of residence is identical with the purpose of stay referred to under point 18.
T MV SR 11-056

 rodina/family platen /empl., business tdium/study in/other

T MV SR 11-056

20.NAJVYIE DOSIAHNUT VZDELANIE

education

21. ADRESA TRVALHO BYDLISKA V CUDZINE/

permanent residence abroad

22. TT4)/
country4)

23. DTUM PRIHLSENIA/

date of registration

24. ADRESA POSLEDNHO BYDLISKA V CUDZINE/ 25. TT4)/

last permanent residence abroad country4)

26. DTUM PRIHLSENIA/

date of registration

27. BYDLISKO V SLOVENSKEJ REPUBLIKE, MENO UBYTOVATEA/

residence at the territory of the Slovak Republic, name of the accommodation provider

28. DTUM PRIHLSENIA/

date of registration

Som si vedom a shlasm s nasledujcim: vetky osobn daje tkajce sa mojej osoby, ktor s uveden v tejto iadosti, bud poskytnut prslunm radom Slovenskej republiky a spracovan tmito radmi, ak to bude potrebn pre ely rozhodnutia o mojej iadosti. Tieto daje mu by vloen do alebo uloen v databzach dostupnch prslunm radom Slovenskej republiky, ak medzinrodn zmluva, ktorou je Slovensk republika viazan, neustanovuje inak. I am aware and I agree with the following: all personal information regarding my person, which are listed in this application, will be granted by the competent authority of the Slovak Republic and processed by those authorities, where necessary for the purposes of the decision on my application. These data can be inserted into or stored in databases available to the competent authorities of the Slovak Republic, if the international treaty, the Slovak Republic is bound provides otherwise. Svojm podpisom potvrdzujem plnos a pravdivos svojich dajov./ I declare that I have answered all questions in this application fully and truthfully.

V/ place

Da/ date Podpis cudzinca/ signature

IADOS PRIJAL A PODA DOKLADOV OVERIL/

received and documentation checked by

SPRVNY POPLATOK V SUME/

the amount of the administrative charge

PEIATKA A PODPIS PRIJMAJCEHO ORGNU/

stamp and signature of competent authority

DA/
date

SLO NOVHO DOKLADU/

new document number

DTUM PREVZATIA/
date of receiving

PODPIS CUDZINCA/
Alien signature

4)

Uvete tt poslednho predchdzajceho pobytu v cudzine, ktor trval minimlne 1 rok (tt sa nemus, ale me zhodova so ttom trvalho pobytu v cudzine uvedenho pod bodom 21). Vypln len iadate o registrciu obana nie/trval pobyt obana nie./ Please indicate the State of the last previous residence abroad for at least 1 year (State must not match, but it may coincide with a State of permanent residence abroad referred to under point 21).

Potvrdenie o prijat iadosti/ Confirmation about receiving of the application Titul/ title Meno/ first name Priezvisko/ surname Dtum narodenia/ date of birth ttna prslunos/ citizenship

iados prijal (meno a priezvisko)/ application received by (first name and surname)

Da/ date

Peiatka a podpis prijmajceho orgnu/ stamp and signature of competent authority