(044849)

iPS Powerful People - NOK FORM

(update)
(date November 21, 2019)

Please fill in this form as complete as possible. If you are already registered with our company we have filled in your data in the 2 nd
column. We request you to change / add your data in the 3rd column (not in the 2nd column). Thank you for your cooperation.

Personal data: Data in our database: Please change / add your data:
(please do not change data in this column)
Surname Polovinkins
(Achternaam)
Given name(s) as in passport Vitalijs
(Voorna(a)m(en) volgens paspoort)
First name Vitalijs
(Roepnaam)
Gender Male
(Geslacht)
Address Meza prospekts 60-33
(Adres)
Zip code LV-2010
(Postcode)
City Jurmala
(Woonplaats)
Country Latvia
(Land)
E-mail address [email protected]
(E-mail adres)
Telephone number - Home +371
(Telefoonnummer thuis)
Telephone number - Mobile +37129875612
(Telefoonnummer mobiel)
Fax number +371
(Faxnummer)
LinkedIn

Skype name

Date of Birth March 31, 1986

(Geboortedatum)
Place of Birth Riga
(Geboorteplaats)
Country of Birth LV
(Geboorteland)
Nationality LV
(Nationaliteit)
Marital Status MARRIED
(Burgerlijke staat)
Dutch Social Security No. 576741000
(BSN/SoFi-nummer)
British National Insurance No. (NI)
(Brits National Insurance nummer
British Unique Tax No. No
(Brits fiscaal nummer)

Shoe size 46
(Schoenmaat)
Clothing size XL
(Kledingmaat)
Nearest airport for departure Riga
(Dichtsbijzijnd vliegveld voor vertrek)
Drivers license + no.) YES / NO Yes
(Rijbewijs + nr.)
Children? How many? 2
Heeft u kinderen? Hoeveel ?
 (044849)

Next of kin information Please fill in information of your next of kin

Who to warn in case of emergency What is your relation to the Telephone no. next of kin E-mail address next of kin
(next of kin) next of kin person? (Telefoonnr. van deze persoon) (E-mail adres van deze persoon)
(Bij nood waarschuwen) (Wat is uw relatie tot deze persoon?)
1 BROTHER +37128222806

Aleksejs Polovinkins

10000 WIFE [email protected]

Jevgenija Polovinkina +37129921652

For visa & SMB application Data in our database: Please change / add your data
we also need: (please do not change data in this column)
Height Height: 1,91
(Lengte)
Weight
(gewicht)
Color of eyes Eyes: brown / Hair: brown
(Kleur van de ogen)
Color of hair
(Haarkleur)
Physical peculiarities,
if any (scars, tattoos ..) where & what
(Lichamelijke bijzonderheden, indien van
toepassing (littekens, tatoeages …) waar & wat)
Full names father
(Volledige namen vader)
Full maiden name(s) mother
(Volledige meisjesnaam moeder)

Bank details Data in our database: Please change / add your data
(please do not change data in this column)
Name of the bank DNB BANKA
(Naam van de bank)
Full address of the bank
(Volledig adres van de bank) Riga

LV
Name beneficiary (account holder) V. Polovinkins
(Naam rekening houder)
IBAN no. LV13RIKO0001050271251
(IBAN nr.)
Account number LV13RIKO0001050271251
(Rekeningnummer)
Currency (account is in)
Valuta (muntsoort rekening)
Swift no. RIKOLV2X
(Swift nr.)
BIC code RIKOLV2X
(BIC code)

Please enclose a copy of your recent documents (such as passport, diplomas, certificates, endorsements etc.)

Thank you for updating your data. Please return this form to iPS Powerful People, e-mail: [email protected]