Expatrio form to request the release of blocked amount

after the expiration of the 06 blocked amount confirmation document

I hereby request to release the funds from the Expatrio blocked account opened with
the below account holder details:

First name
Last name
Date of birth
Passport ID
Expatrio user ID

I confirm that to my best knowledge the expiration date on the latest version of the
'06 blocked account confirmation' document, which has been issued for the Expatrio
blocked account opened with the above details, has passed.
I also confirm that this blocked account was not used for any pending or approved
visa or residence permit application.

I also confirm that (please choose the option that is true for you):

I am the blocked account holder

I am acting on behalf of the blocked account holder

Place and date (dd.mm.yyyy) Signature of requester

Name of requester in block letters

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