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MBES23 EN+Relatieverklaring+ (2020-06)

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32 views2 pages

MBES23 EN+Relatieverklaring+ (2020-06)

Uploaded by

ghostdonald01
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Declaration of Relationship

MBES23_EN | June 2020

Please note! This declaration must be filled in only if you are applying for residence with your unmarried
partner. You must enclose this fully filled and signed declaration with your application.

CRV-number: ________________

Details foreign national (the applicant)


(in accordance to valid passport)

Surname _____________________ Given names _____________________


Date of birth _____________________ Place of birth _____________________
Country of birth _____________________ Nationality _____________________
Civil status _____________________ Gender  male  female
Street _____________________ House number _____________________
Place _____________________  Bonaire  Sint Eustatius  Saba

I,the applicant, declare the following:


- the here under mentioned person is my partner;
- I am not married to my partner;
- with this partner I am maintaining an exclusive relationship since ___________________ (date);
- with this partner I am running a joint household and we are living together at the address above-
mentioned;
- I will immediately inform the IND Caribbean Netherlands Unit if my exclusive relationship with my
partner has ended;
- I will also immediately inform other relevant changes to the IND Caribbean Netherlands Unit;
- I know that if I complete this declaration in contrary to the truth, I am committing an offence and that
this will be reported to the police.

Details sponsor (the partner)


(in accordance to valid passport)

Surname _____________________ Given names _____________________


Date of birth _____________________ Place of birth _____________________
Country of birth _____________________ Nationality _____________________
Civil status _____________________ Gender  male  female
Street _____________________ House number _____________________
Place _____________________  Bonaire  Sint Eustatius  Saba
I,the sponsor (partner), declare the following:
- the above-mentioned applicant is my partner;
- I am not married to my partner;
- with this partner I am maintaining an exclusive relationship since ___________________ (date);
- with this partner I am running a joint household and we are living together at the address above-
mentioned;
- I will immediately inform the IND Caribbean Netherlands Unit if my exclusive relationship with my
partner has ended;
- I will also immediately inform other relevant changes to the IND Caribbean Netherlands Unit;
- I know that if I complete this declaration in contrary to the truth, I am committing an offence and that
this will be reported to the police.

Signature
This declaration has been completed truthfully

____________________________________ ____________________________________
Signature applicant Signature partner

____________________________________ ____________________________________
Place Date

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