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SLO IADOSTI/application number

PLATNOS POBYTU DO/validity of the residence permit

iados o udelenie prechodnho


pobytu1)/ Application for the
temporary residence1)

iados o udelenie trvalho pobytu


na 5 rokov1)/ Application for

VLASTNORUN PODPIS/signature

permanent residence for 5 years1)

iados o udelenie tolerovanho


pobytu1)/ Application for tolerated

FOTOGRAFIA/

residence1)

photo
33,5 cm

2)

1. PRIEZVISKO/

2. TITUL/

surname

title

3. MENO/
first name(s)

4. RODN PRIEZVISKO/
name at birth

5. PREDCHDZAJCE PRIEZVISK/

6. POHLAVIE/

all previous surnames

sex

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

9. TT NARODENIA/
country of birth

15. PLATN DO/


valid until

place of birth

10. TTNA PRSLUNOS/


citizenship

12. RODINN STAV/


marital status

8. MIESTO NARODENIA/

nationality

13. CESTOVN DOKLAD/

14. DTUM VYDANIA/

travel document number

16. VYDAL/
issued by

11. NRODNOS/

date of issue

17. EL POBYTU/
purpose of stay

18. KATEGRIA
POBYTU3)/

type of residence3)

rodina/family
platen /empl., business
tdium/study
in/other
19. NAJVYIE DOSIAHNUT VZDELANIE/
education

21.

20. POVOLANIE/
occupation

ZAMESTNANIE PRED PRCHODOM DO SR NZOV PODNIKU, RADU/


employment before arrival to the territory of the Slovak Republic name of the company, organisation

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 completed written by machine or in block letters (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 17./ 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 in point 17.
1)
2)

T MV SR 11-057

IV/2013

22. ZAMESTNANIE PO PRCHODE DO SR, FUNKCIA ADRESA PODNIKU, RADU,


KOLY/
employment after arrival to the Slovak Republic, position, address of the company, organisation, school

23. ADRESA TRVALHO BYDLISKA V CUDZINE NAPSAN LATINKOU/


24. TT/
25. DTUM
PRIHLSENIA/
permanent residence abroad

country

date of registration

26. ADRESA TRVALHO BYDLISKA V CUDZINE NAPSAN V RODNOM JAZYKU/


27. TT / country

permanent residence abroad written in native language

28. ADRESA POSLEDNHO BYDLISKA V CUDZINE/ 29. TT4)/


last permanent residence abroad

country

30. DTUM
PRIHLSENIA/

4)

date of registration

32. DTUM
PRIHLSENIA/

31. BYDLISKO V SLOVENSKEJ REPUBLIKE,


MENO UBYTOVATEA/
residence at the territory of the Slovak Republic
name of the accommodation provider

date of registration

33. PREDCHDZAJCI PRECHODN ALEBO TRVAL POBYT V SR (oddo, miesto pobytu)/


previous temporary or permanent stay at the territory of the Slovak Republic (from-until, place of residence)

34. MANEL/KA/
spouse

PRIEZVISKO/

MENO/

surname

first name(s)

RODN PRIEZVISKO/

PREDCHDZAJCE PRIEZVISK/

name at birth

all previous surnames

DTUM NARODENIA/

MIESTO A TT NARODENIA/

TTNA PRSLUNOS/

date of birth

place and country of birth

citizenship

TRVAL BYDLISKO/
permanent residence

BYDLISKO V SR/
residence in the Slovak Republic

35. RODIIA/
parents

PRIEZVISKO OTCA/

MENO/

father surname

first name(s)

DTUM NARODENIA/

TTNA PRSLUNOS/

date of birth

citizenship

BYDLISKO/
residence address

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 24/ Please name the State of the last previous residence abroad which lasted for at least 1 year
(State does not need to match, but it may coincide with the State of permanent residence abroad referred to in point 24).

PRIEZVISKO MATKY/
mother - surname

MENO/

RODN PRIEZVISKO/

first name(s)

name at birth

DTUM NARODENIA/

TTNA PRSLUNOS/

date of birth

citizenship

BYDLISKO/
residence address

36. DETI/
children

PRIEZVISKO A MENO/

DTUM A MIESTO
NARODENIA/

TTNA
PRSLUNOS/

surname and first name(s)

date and place of birth

citizenship

1.
2.
3.
4.
5.
6.
TRVAL BYDLISKO/

BYDLISKO V SR/

permanent residence address

residence address in the Slovak Republic

1.
2.
3.
4.
5.
6.
37. SRODENCI/
siblings

PRIEZVISKO A MENO/

DTUM A MIESTO
NARODENIA/

TTNA
PRSLUNOS/

surname and first name(s)

date and place of birth

citizenship

1.
2.
3.
4.
5.
TRVAL BYDLISKO/
permanent residence address

1.
2.
3.
4.
5.
38. DLHODOB POBYT V TTE EHP (TT)/
long- term residence permit at the territory of a country of the European Economic Community (EEC)
39. SLO DOKLADU O DLHODOBOM POBYTE/
long-term resident permit document number

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 to 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

Podpis zkonnho
zstupcu5)/ signature5)

IADOS PRIJAL
A PODA DOKLADOV
OVERIL/

SPRVNY POPLATOK V SUME/


the amount of the administrative charge

received and documentation


checked by

PEIATKA A PODPIS
PRIJMAJCEHO
ORGNU/
stamp and signature of competent
authority

DA/
date

SLO NOVHO DOKLADU/

DTUM PREVZATIA/

PODPIS CUDZINCA/

new document number

date of receiving

Alien signature

Overen podpis zkonnho zstupcu sa uvdza len v prpade iadosti maloletej osoby, ktor iada o prechodn pobyt na el tdia bez
prtomnosti zkonnho zstupcu. Overenie podpisu zkonnho zstupcu vykona na osobitn list! / Verified signature of the guardian is
required only in the case of minor who applies for temporary residence permit for study. The verification of signature is needed to carry out on
the separate sheet!
5)

Potvrdenie o prijat iadosti/ confirmation of receiving the application


.........................................................................................................................................
Titul/
title

Meno/
first name

Priezvisko/
surname

iados prijal (meno a priezvisko)/


Da/
application received by (First name and date
Surname)

Dtum narodenia/
date of birth

ttna prslunos/
citizenship

Peiatka a podpis prijmajceho orgnu/


stamp and signature of competent authority