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Application form for MVV

This application form is free of charge

Take a loose extra Passport photo

passport photo with size 35 by 45 mm
you... just in case. (width by height)
You probably will not
need it as we already
applied for your Visa
with a photo card.

1 Personal

1.1 Surname (family name) | < your family name AS SHOWN ON YOUR PASSPORT>
1.2 S urname at birth | < your family name at birth (for married women using their husband's name >
(previous family name)

1.3 First name(s) (given name(s)) | < all your first name(s) AS SHOW ON YOUR PASSPORT >
Day month year

1.4 Date of birth < your date of birth as shown on your passport in format DDMMYY>
Place Country

1.5 Place of birth | < your place of birth > | < your country of birth >
Current nationality Nationality at birth

1.6 Nationality | < your current nationality > | < your nationality at birth >
1.7 Sex Male Female
Tick the right boxes
1.8 Marital status Single Married Separated Divorced (one per question)
Widow(er) Other, please specify

1.9 Home address | < your current home address >

1.10 Telephone numbers | < your 1st telephone number, e.g. land line > | < a 2nd number, e.g. mobile phone >
1.11 E-mail address | < your current email address >
Surname First name

1.12 In case of minors details of | |

parental authority / legal guardian Address DO LEAVE BLANK asNationality
you are not a minor
| |
No. Valid until

1.13 Residence in a country other No Yes. Residence permit or equivalent | |

than the country of current
Only tick Yes if you currently live in another country then the country of your nationality;
then also fill in the number and end of validity date if you hold a Residence permit or
equivalent. In all other cases 10BUZ010063|E
tick No

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1.14 Type of travel document Ordinary passport Diplomatic passport Service passport Official passport
Tick the right box
Special passport Other travel document, please specify
Passport number Date of issue

1.15 Passport details | < your passport number > < date of issue (format DDMMYYYY)
Valid until Issued by

< valid till date (format DDMMYYY) > |< organization who issued your passport >

2 Purpose of stay in the Netherlands

2.1 Employment Paid employment Self employment Highly skilled migrant

Highly educated migrant Leave in the Netherlands, worker on North Sea drilling platforms

2.2 Family Join spouse or registered partner Join partner Join parents
Join foster parents Join a child, single parent of 65 years or older

Join adoptive parents Visiting relatives, max. 6 months

Extended family reunification, children over 18 years

2.3 Study/exchange/work placement Study Cultural exchange, highschool students

Tick in 2.3 and 2.4 only
Work placement the 'Study'
Working holiday programme/scheme, Australia, Canada, box
New Zealand

2.4 Other Only tick the Au pair Medical treatment Special grounds
Re-admission box
if you lived in NL Readmission to the Netherlands, lived in the Netherlands before Resettlement of an invited refugee
before Day month year

2.5 I ntended date of arrival < intended date of arrival in the Netherlands in format DDMMYYYY >
in the Netherlands Name

2.6 N
 ame and address of your |
host in the Netherlands Address


2.7 H
 as your host started the Yes No
(Officially/legally TU Delft is not your host, although
mvv-procedure for you with we applied for your Visa nd will pay on your behalf)
IND in the Netherlands

2.8 I f not, who will pay the My host will pay the fees I will pay the fees myself
mvv-fees into the Dutch
bankaccount of IND You can still fill in this section at the Dutch embassy if they order you to do so.
ONLY THEN use TU Delft, Jaffalaan 9A, 2628 BX Delft.
2.9 I s your host an EU, EEA or Yes No
Swiss citizen, living in
the Netherlands, not a Dutch citizen

3 Signature
Place Day month year

3.1 Place and date | < your home town > <date of signing in format DDMMYYY>

3.2 Signature | < your signature >

> F or minors signature
of parental authority/legal guardian

010063_B57_Formulier_for_mvv.indd 2 29-03-10 14:01