M1BBS.pdf
(365.58 kB, PDF)
… it will be extended for the same purpose before it expires 3. Emergency contact information 3.1 Relation to emergency contact (parent, family member, employer, etc.) 3.2 Telephone emergency contact 3.3 Email address emergency contact 4. Signing I, the foreign national, declare with my signature that: ✓ I will have continuous legal residence ✓ I am simultaneously submitting a copy of my current valid Dutch residence permit ✓ I will notify the UM Visa Office if my situation changes ✓ I authorize the UM Visa Office to exchange information with Dutch Immigration on my residence status 4.1 Name of foreign national 4.2 Date of birth of foreign national Date (dd/mm/yyyy) 4.3 Current place and date Place of signing Date (dd/mm/yyyy) 4.4 Signature of foreign national (2/2): End of this confirmation form …