[REVM]

Application for a re-entry visa for minors,

including minors with Stamp 6

Who is this form for?

You should use this application form if:

 You wish to apply for a re-entry visa for a child who is aged under 16
 The application must be made by the child’s parent, guardian or person acting in loco parentis
 You can only apply for a re-entry visa for one child using this form.

How to complete this form:

 Please complete this form in CAPITAL letters and place a tick in the relevant box
 You must complete all sections of this form fully

Where to send your completed application form

• You must send your completed application form and supporting documents to the address below

Re-entry visa division

Irish Naturalisation and Immigration Service
13/14 Burgh Quay
Dublin 2
D02 XK70

 You must send your application by Registered Post

 Registered Post can be tracked on the An Post website www.anpost.ie
 You must keep a note of the registered post tracking number - you will need this if you need to
contact us about your application
Data Privacy Notice

1. The data you provide in this form is collected by the Irish Naturalisation and Immigration
Service (INIS), a part of the Department of Justice and Equality. The data controller for the
information you provide is the Department of Justice and Equality.
The data controller’s contact details are:

Re-entry Visa Unit,

Irish Naturalisation and Immigration Service,
The Department of Justice and Equality,
13 – 14 Burgh Quay,
Dublin 2,
D02 XK70

2. You can contact the Data Protection Officer for the Department of Justice by writing to:
The Data Protection Officer, the Department of Justice and Equality, 51 St. Stephen’s Green,
Dublin 2, D02 HK52. Or by email – dataprotectioncompliance@justice.ie

3. We will use the personal data you provide in this form for the following purposes:

- To assess you and/or your families eligibility for a Re-entry Visa. We may also use the personal
data you provide in this form and in associated correspondence as part of any future
considerations regarding your immigration or citizenship status.

4. We collect and process this data in order to comply with our legal obligations or to perform
tasks in the public interest. The specific basis for collecting and processing this data is as follows:

- To fulfil the function of the Minister for Justice and Equality, Section 17 of the Immigration Act,
2004.

5. The personal data provided here will be stored securely in INIS’s databases and the Garda
National Immigration Bureau’s databases. It may be shared, if necessary, with the following third
parties:

1.1. Government Departments and Agencies;

1.2. An Garda Síochána;
1.3. EEA competent authorities;
1.4. EEA police forces;
1.5. 3rd parties who have provided documentary evidence by or on behalf of the application,
e.g. employers and landlords (with the consent of the data subject);
1.6. 3rd party service providers in the areas of data handling and storage and in the
production of IRP cards.

6. The personal data you provide in this form is necessary for us to determine if you meet the
criteria for this scheme. If you do not provide this data, your application for this scheme cannot be
processed.

7. This data may be retained until INIS can be sure that you will not have any further contact with
the immigration services. This is an indeterminate period as your immigration history in the State
may span a full lifetime. It will be referred thereafter to the Director of National Archives for
appraisal under the National Archives Act 1986.
8. You have the right to request access to, and a copy of, your personal data that we process.
You can do this by filling in a Subject Access Request form, available at www.justice.ie, and
sending it to subjectaccessrequests@justice.ie You may be required to verify your identity
before we send the information to you.

9. You have the right to request us to rectify any errors in your data or to erase your data, as well
as to seek a restriction of the processing of your data or to object to the processing of your data in
certain circumstances. To do this you should write to Re-entry Visa Unit, Irish Naturalisation and
Immigration Service, the Department of Justice and Equality, 13 – 14 Burgh Quay, Dublin 2, D02
XK70 explaining what errors need to be rectified or erased or your reasons for seeking the
restriction of, or objecting to, the processing.

10. You have a right to lodge a complaint with the Data Protection Commission if you believe your
personal data is being processed by us unlawfully. Information about how to make a complaint
can be found on www.dataprotection.ie

I acknowledge that I have read and understood the information provided above by the
Department of Justice and Equality for the purposes of ensuring fair and transparent
processing of my personal data.

Name:_______________________________________________________________________

Signature: ____________________________________________________________________

Date:

D D M M Y Y Y Y

OR

Name of Parent/Guardian: _______________________________________________________

(for data subject aged under 18)

Signature of Parent/Guardian: ____________________________________________________

Date :

D D M M Y Y Y Y
 Official use only
In this section you will need to provide details about the child who needs a re-entry visa

Valid to__________

For Official Use Single ___ or Multi ___

only
Documents checked by ___________________

Date ________________________

[Box above to be standard passport photo sized]

Please complete this form in CAPITAL LETTERS

Section 1 Details of child on whose behalf application is made

In this section you will need to provide details about the child who needs a re-entry visa

1.1 Surname(s)

1.2 Forename(s)

1.3 Date of birth

D D M M Y Y Y Y

1.4 Gender ( )
Male Female Other
1.5 Nationality

1.6 Document name (eg passport, travel document)

1.7 Document number (eg passport, travel document)

1.8 Date of issue

D D M M Y Y Y Y

1.9 Date of expiry

D D M M Y Y Y Y

1.10 Current address

1.11 Eircode

1.12 Reason child needs a re-entry visa

 Section 1A Evidence that child is resident in Ireland

A child must be living in Ireland to qualify for a re-entry visa.

This section must be completed by a doctor with whom the child (if under 5 yrs) is registered or
principal of a school attended by the child (if over 5 yrs). (Please note that Pre-schools are
not acceptable).

1.14 Name of school, medical practice or doctor

1.15 Address of school, medical practice or doctor

1.16 Statement from school principal or doctor:

The child for whom this application for a re-entry visa is being made,
_________________________________________ is a pupil in my school OR is registered with
my medical practice (delete as necessary) and is, to the best of my knowledge, resident in
Ireland.

I have stamped the back of two passport photos of this child.

Signature

School or medical practice stamp:

1.17 Date signed
D D M M Y Y Y Y
 Section 2 Details of the adult applying on behalf of the child

In this section you will need to provide some personal details about yourself.

2.1 Surname(s)

2.2 Forename(s)

2.3 Date of birth

D D M M Y Y Y Y

2.4 Gender ( )
Male Female Other

2.5 Nationality

2.6 Current address

2.7 Eircode

2.8 Phone

2.9 GNIB ID (if you have one)

2.10 PPS number (if you have one)

 Section 2 A Adult’s supporting documentation

If you are not an EEA national, you need to provide information on your IRP or GNIB card in this
section.
If you are an EEA national, you need to provide information on your State issued ID, eg driving
licence, passport or national ID card.

2.11 Document name (eg IRP card, passport, driving licence etc)

2.12 Document number (eg IRP card, passport etc)

2.13 Date of issue

D D M M Y Y Y Y

2.14 Date of expiry

D D M M Y Y Y Y

2.15 Relationship to child

 Section 3 Document checklist

In this section you will need to provide a list of which supporting documents you have
supplied……..

Tick if you have Number of

Document description submitted pages
Documents relating to the child
Original Passport of the child

2 Irish passport photos (no more than 6 months old), stamped by

the child’s school principal (if over 5 yrs) or doctor (if under 5 yrs).
Documentation from Pre-Schools is not acceptable.

Documents relating to the adult applying on the child’s behalf

In the case of a non-EEA national, your original IRP or GNIB card

In the case of a non-EEA national, a photocopy of the following

pages from your passport: biographical information and visa to enter
Ireland
In the case of an EEA national, a photocopy of the biographical
pages of your passport and your national ID or driving licence
Proof of relationship between the adult and child

Child’s original birth certificate

If an application is being made by a guardian, proof of guardianship,

in the form of a notarised document granting guardianship by the
child’s parents or a state body, with certified original translation if not
in English or Irish