Application for permission to remain in the State on the basis of parentage of an Irish Citizen Child

Transcription

1 DEPARTMENT OF JUSTICE AND EQUALITY IRISH NATURALISATION & IMMIGRATION SERVICE Application for permission to remain in the State on the basis of parentage of an Irish Citizen Child For a Non-EEA Parent 1. This form must be completed in BLOCK CAPITALS and in black ink. Where indicated, please place a tick ( ) in the appropriate box. 2. All sections must be completed. The declaration in Section 4 must be signed. Incomplete applications cannot be processed and will be returned. 3. Please refer to the checklist in Section 5 of this form for details of documents which must be submitted with this form. 4. If you are unable to provide any of the information or details requested please provide a written explanation indicating the reasons for this in Section 6 of this form. 5. It is your responsibility to advise the Irish Naturalisation and Immigration Service (INIS) of any change of circumstances in writing without delay. Section 1 Applicant Details 1.1 Surname / Family name (as in passport) 1.2 Forename(s) (as in passport) 1.3 Other name(s) (maiden name, name at birth, any other names by which you are or have been known by) 1.4 Date of Birth 1.5 Gender (please tick where applicable) Male Female 1.6 PPS Number (if applicable) 1.7 Person ID (if applicable) 1.8 Old Department Reference Number (if applicable) 6 9 1

2 1.9 Place of Birth 1.10 Country of Nationality 1.11 Address 1.12 Passport Number 1.13 GNIB Registration Number (if applicable) 1.14 Date of arrival in the State 1.15 Place of arrival in the State 1.16 Status on arrival in the State (please tick where applicable) Asylum Seeker Visitor Student No Status Employment Permit/Green Card Refugee Family Reunification EU Treaty Rights Other If No Status /Other, please provide details 1.17 Marital Status (please tick where applicable) Single Married Separated Divorced Cohabiting Widowed 1.18 Name of Spouse / Partner (if applicable) 1.19 Date of Birth 2

3 1.20 Country of Nationality of Spouse / Partner 1.21 Date of Marriage 1.22 Place of Marriage Section 2 Details of Irish Citizen Child 2.1 Surname / Family name (as on birth certificate) 2.2 Forename(s) (as on birth certificate) 2.3 Place of Birth 2.4 Date of Birth 2.5 Gender (please tick where applicable) Male Female 2.6 PPS Number 2.7 Passport Number 2.8 Is the child named above normally resident in the same household as you? (please tick where applicable) Yes No (if no, please provide details of where the child normally resides) Section 3 Details of other biological parent 3.1 Surname / Family name (as in passport) 3

4 3.2 Forename(s) (as in passport) 3.3 Other name(s) (maiden name, name at birth, any other names by which you are or have been known by) 3.4 Date of Birth 3.5 Gender (please tick where applicable) Male Female 3.6 Person ID (if applicable) 3.7 Old Department Reference Number (if applicable) 3.8 Place of Birth Country of Nationality 3.10 Current Address Section 4 Criminal Declaration 4.1 Criminal Record Have you ever been convicted of a criminal offence in this State or abroad? (please tick where applicable) Yes No (if yes, please provide details) Are there any criminal charges pending against you in this State or abroad? (please tick where applicable) Yes No (if yes, please provide details) 4

5 4.2 Family Law Are there, or have there ever been, any Court Orders in relation to Family Law matters to which you are/were party e.g. Barring Order, Care Order, Protection Order and Safety Order etc? (Please tick where applicable) Yes No (if yes, please provide details) Section 5 Document Checklist Please provide the following copies or original documentation as specified. Original documentation will be returned to you by registered post. Please note INIS may request further information/documentation during the course of processing the application. Evidence of applicant s identity Full colour photocopy of applicant s national passport. Two colour passport sized photographs, signed on the back by the applicant. Evidence of Irish Citizen Child s identity Colour copy of bio data page of the child s Irish passport. Child s original birth certificate. Evidence of the child s residency in the State Please provide as many of the following as possible Copy of Immunization Passport. Letter from doctor confirming attendance at medical appointments. Letter from school/crèche confirming attendance. Evidence of the applicant s residency in the State Please provide as many of the following as possible. Letter from rental agency, rental contract or tenancy agreement. Letter of Registration of Tenancy from the Private Residential Tenancies Board. Utility bills in the applicant s own name. Bank statements in the applicant s own name. Mobile phone bills in the applicant s own name. 5

6 Evidence of the applicant s role in the life of the Irish Citizen Child Please provide as many of the following as possible. Letter from school/crèche providing records of attendance at parent/teacher meetings. Letter from doctor confirming record of attendance at medical appointments. Access Orders/Agreements and letter from other biological parent confirming attendance to access appointments. Maintenance Orders/Agreements and proof of maintenance payments. Letter from child s social worker confirming applicant s role in the citizen child s life Sworn Affidavit from the child s other biological parent outlining the emotional and financial role the applicant plays in the life of the citizen child. Section 6 Additional Information Please provide any other information that you consider relevant to this application. Please be advised that if you are unable to provide any of the information or details requested within this form then please provide an explanation indicating the reasons for this. Please submit this application form along with supporting documentation/information by registered post to the following address, INIS, Residence Division Unit 4, Burgh Quay, Dublin 2. 6

7 Section 7 Declaration I hereby declare that the information I have given is complete and is true to the best of my knowledge. I also declare that the photographs submitted with this form are a true likeness of me. I confirm that I will inform INIS of any change in circumstances without delay. I understand that any false or misleading information or fraudulent supporting documentation submitted may result in the refusal of this application. I understand that, under Section 8 of the Immigration Act 2003, the data in this application may be disclosed to other Government Departments, Government Agencies, or An Garda Siochana for purposes connected with this application. I consent to INIS making enquiries to confirm any of the details or documents provided by me in this application. Signed by applicant Date 7