Date:

To,

The Netherlands Visa Application Center,

VFS Global Services Pvt Ltd.

Dear Sirs,

I_______________________________ under/over 18 years of age SO/WO/DO

____________________ provide my consent to VFS Global and its authorized Employees
and Business Partners as under:

I understand that in support of my Visa application made by me or through my authorized

representative to your Visa Application Centre at _________________ for onward submission
to the Netherlands Embassy in New Delhi, VFS Global and its authorized Employees and
Business Partners are collecting from me my personal data and my documents as per
requirements of the Netherlands Embassy in New Delhi.

I hereby give my consent to you to collect my personal data and my documents. I am aware that
the information and documents are required to be forwarded to the Netherlands Embassy in New
Delhi for Visa purposes. I have been informed that I have the option not to give the above
information and documents, in which case I understand that my application will not be
processed. I have also been informed that I can make corrections to any inaccurate or deficient
information and that I have an option to withdraw my consent prior to paying the requisite fees.

Full Name of the Applicant: Signature of the Applicant

______________________________

Address of the Applicant:

______________________________

______________________________

______________________________

______________________________