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	APPLICATION FOR SHORT STAY IN GELDERLAND-ZUID
	Dear Sir/Madam, Please find below the application form in connection with your compulsory registration in the Netherlands. This makes your stay a maximum 90 days. If you intend to stay in the Netherlands for more than 90 days, you will need to apply for a residence permit from the IND in Den Bosch. You can make an appointment by telephone: 0900-1234 561 (€ 0,10 p/m). Note: you will require a temporary residence permit or MVV for this (unless you are exempt), which you can only apply for in your own country. For further information, please go to www.ind.nl. NB If you are staying on an official campsite or in a hotel, you do not have to register with the Aliens Police, unless the visa explicitly states that you have to register with the chief constable (Aliens Police). You can only use the form if you are staying in the area covered by the Gelderland-Zuid police. This consists of the following municipalities: Beuningen, Buren, Culemborg, Druten, Geldermalsen, Groesbeek, Heumen, Lingewaal, Maasdriel, Millingen aan de Rijn, Neder-Betuwe, Neerijnen, Nijmegen, Tiel, Ubbergen, West Maas en Waal, Wijchen and Zaltbommel. You are kindly requested to fill in the form completely and clearly. Any comments you may have can be made at the bottom of the form. When completing the form, you must use the data from your passport and your visa sticker – otherwise you will not be able to register! According to the law, you must register with the Aliens Police within 3 days; the date the form is sent is the date of registration. NB Failure to register within 3 days is a punishable offence under article 4.48 Aliens Order (Vb). It is also a punishable offence “not to register if you are an alien with no legal residence”. Penalties in these matters range from 100 to 1000 euros. The following is also subject to punishment: “any person providing accommodation to an alien with no lawful residence in the Netherlands and who fails to notify the relevant chief constable without delay”. Upon receipt, all your details will be processed directly in the PSHV aliens records. After registration you will receive a letter of confirmation of your registration. You also will receive a exitcard. This card you must use when you are leaving the Schengenarea. Please give us your e-mailaddress (question F), so we can send you the letter and the card digitally. If you have any questions, please call the general telephone number 0900-8844 (ask for Aliens Police Nijmegen). I trust you have all the information you require and I look forward to your cooperation in this matter. Yours faithfully, Chief Constable Gelderland-Zuid. I would like to apply for compulsory registration for short stay.
*	Onderwerp:
	A. PREVIOUS REGISTRATION FOR SHORT STAY
*	Have you registered before with the Aliens Police in connection with a short stay?	Yes    No
	If so, what is your V-number (see application sticker from previous registration in your passport, usually starts with 08 or 27):
	B. PERSONAL DETAILS (USE DETAILS IN PASSPORT)
*	Surname (as shown in passport):
*	Sex:	M    F
*	First name(s):
*	Date of birth (dd-mm-yyyy):
*	Place of birth:
*	Country of origin:
*	Nationality:
	C. ADDRESS (within the police district covered by Gelderland-Zuid)
*	Street:
*	Number:
*	Postcode:
*	Town / city:
*	Telephone number:
	D. PASSPORT DETAILS
*	Number:
*	Valid until (dd-mm-yyyy):
*	Country of issue:
	E. INFORMATION CONCERNING (GREEN) VISA STICKER (IF VISA REQUIREMENT)
*	Number of visa sticker:
*	Valid for:	Schengen states    Benelux Other (please specify)
	Other:
*	Valid from date (dd-mm-yyyy):
*	Valid until date (dd-mm-yyyy):
*	Number of entries:	1    2 Mult
*	Length of stay:	90 days    60 days 30 days    Other (please specify)
	Other:
*	Issued at (place):
*	Issued on (dd-mm-yyyy):
	F. INFORMATION CONCERNING ARRIVAL, PURPOSE, REFEREE AND DEPARTURE
*	Arrival date in the Netherlands, or in Schengen area (see entry stamp) (dd-mm-yyyy):
*	Checkpoint (see entry stamp):	Schiphol    East frontier Slovenia Dusseldorf Airport    South frontier Spain Brussels Airport    Other (please specify)
	Other:
*	Purpose of stay:	Family visit    Visiting friends Short study programme    Other (please specify)
	Other:
*	Name of referee:
*	Address and telephone number of referee:
*	Date of departure (dd-mm-yyyy):
*	Would you like to receive the letter of confirmation by mail or e-mail?	Mail    E-mail
*	E-mailaddress:
	G. COMMENTS
*	Comments concerning short stay:
	H. SIGNATURE
	I hereby declare that I have provided a true record of my personal details. I know that the personal details supplied will be processed for the purpose of the implementation of the Aliens Act 2000 and will be passed on to the agencies that require it for this purpose. IT IS AN OFFENCE TO MISUSE THIS FORM.
*	Name:
*	Date (dd-mm-yyyy):
*	Place:
	Van Vugt Vertalingen

 

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