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Application for short stay in Hollands Midden
 
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 local authority.

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 IND. If you are staying on an official campsite or in a hotel, you do not have to register with the Foreign Police, unless the visa explicitly states that you have to register with the chief constable (Foreign Police).

You can only use the form if you are staying in the area covered by the Hollands Midden police. This consists of the following municipalities:

Noordwijk, Noordwijkerhout, Hillegom, Katwijk, Teylingen, Lisse, Waddinxveen, Boskoop, Bodegraven-Reeuwijk, Gouda, Ouderkerk, Vlist, Nederlek, Bergambacht, Schoonhoven, Zuidplas, Kaag en Braassem, Rijnwoude, Alphen aan den Rijn, Nieuwkoop, Zoeterwoude, Leiderdorp, Oegstgeest, Voorschoten, Leiden. 

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 Foreign Police within 3 working days; the date the form is sent is the date of registration. 
Failure to register within 3 workingdays 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 50 to 700 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.

If you have any questions, please call the general telephone number (+31)71-545 8673 (ask for Foreign Police Leiderdorp).

I would like to apply for compulsory registration for short stay.

 
 *Onderwerp:
 A. PERSONAL DETAILS (USE DETAILS IN PASSPORT) 
* Surname (as shown in passport): 
*Sex: 
  
* First name(s): 
* Date of birth (dd-mm-yyyy): 
* Place of birth: 
* Country of origin: 
* Nationality: 
* E-mail address: 
 B. ADDRESS (within the police district covered by Hollands Midden) 
* Street: 
* Number: 
* Postcode: 
* Town / city: 
* Telephone number: 
 C. PASSPORT DETAILS 
* Number: 
* Valid until (dd-mm-yyyy): 
* Country of issue: 
 D. INFORMATION CONCERNING (GREEN) VISA STICKER (IF VISA REQUIREMENT) 
 Do you have a visa? 
  
  Number of visa sticker: BNL: 
 Valid for: 
  
  Other: 
  Valid from date (dd-mm-yyyy): 
  Valid until date (dd-mm-yyyy): 
 Number of entries: 
  
 Length of stay: 
  
  
  Other: 
  Issued at (place): 
  Issued on (dd-mm-yyyy): 
 E. 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): 
  
  
  Other: 
*Purpose of stay: 
  
  
  Other: 
* Name of referee: 
* Address and telephone number of referee: 
* Date of departure (dd-mm-yyyy): 
 F. 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 
 
 


Laatst gewijzigd 25-11-2011 13:06 |  © Regio Hollands Midden |  Privacy |