You are strongly advised to read and follow these instructions carefully and in their entirety.

Transcription

1 Starting June 27 th till June 30 th, 2016, the Royal Netherlands Embassy in cooperation with the Netherlands Consulate General in Chicago will use a mobile station to hold a Dutch passpt application session at the Consulate General in Chicago on address: 303 E. Wacker Drive, Suite 2600, Chicago, IL Initially this service is offered to passpt applicants who cannot reasonably be expected to visit one of the designated offices f physical medical (e.g. elderly disabled people). Secondly this service is offered to the remaining passpt applicants in the area. If you would like to request an appointment at this location and take advantage of this opptunity, you need to respond by, complete and return the fms and documents mentioned below a.s.a.p. and no later than June 3rd, You are strongly advised to read and follow these instructions carefully and in their entirety. APPLICANTS Enter the members of your household who need to apply f a Dutch passpt in the table below. Use the Notes field to indicate any special circumstances that suppt your appointment and approval request. APPLICANT LAST DUTCH PASSPORT US IMMIGRATION STATUS FIRST NAME LAST NAME AGE YEAR ISSUED AVAILABILITY HOLDER OF VALID NOTES: If renewing Dutch passpt after having acquired another nationality, please indicate here, mentioning date of US naturalization. APPLICANT CONTACT INFORMATION The Consular Offices of the Royal Netherlands Embassy and the Consulate General will infm you a.s.a.p. IF your application is admissible. If approved, you will receive infmation on setting an appointment and any further instructions if necessary. Please enter your contact infmation in the table below. STREET ADDRESS CITY STATE ZIP ADDRESS HOME PHONE CELL PHONE THIS FORM HAS BEEN COMPLETED BY COMPLETED ON

2 PROCEDURE Again, we urge that you closely read the instructions below to assure what will be expected from applicants befe the appointment can be confirmed. Failure to do so might result in a rejection of your appointment request. Every applicant will be required to send by mail (post) courier, the following documents pri to the appointment and no later than June 3 rd, 2016: Original, filled out and completed passpt application fm, signed, but not dated. Signature must match the one in current Dutch passpt. Click below link f the fm. 84_paspotaanvraagfmulier-nieuw.pdf Copy of the holder page of the most recently issued Dutch passpt. If this passpt is lost stolen, in case of a first time passpt application, a valid picture ID is required. Copy of valid proof of immigration status. F example: valid visa, residence permit, US Canadian passpt. An application cannot be accepted without valid proof of status! 1 col passpt size photograph that meets the specifications as mentioned on the website. 1 photo must be mailed in f pre-approval so the size can be checked and measured using the passpt application software to ensure it meets the strict Dutch specifications. PLEASE HAVE TWO PHOTOs MADE, AND KEEP ONE PHOTO AND BRING THE 2ND TO THE APPOINTMENT FOR THE FINGERPRINTING PROCESS. Dutch passpt photos are very specific. To avoid delays and having your application rejected, you are very strongly advised to have your photos taken by one of the recommended photographers mentioned here: We recommend using one of these photographers. Once you infm him that the photos are f a Dutch passpt application, he will be aware of the specific requirements and will use measuring equipment we provided him. If you will be submitting a first time passpt application, please confirm first that you have the documents mentioned on this site, pri to mailing your application in. Please pay particular attention to the Apostille legalization that is required f all US issued certificates Copies of any other nationality passpts held. F children s applications, please add a birth certificate and copies of parents passpts and immigration status f each and every application. Plus Notarized parental consent fm attached below: Copies of statements of possession of Dutch nationality previously issued to you, if any. Original filled out and signed approval to communicate by fm. Attached. Pre-paid return envelope must be FEDEX UPS. Please see the following mailing instructions. Original filled out and signed release of liability f shipping fm. Attached.

3 This statement is to be dated and authenticated at the Honary Consul, the May of your City at a Notary Public, who will request you to present sufficient evidence of your identity. DECLARATION OF PARENTAL CONSENT The undersigned, father and/ mother * of the following min child(ren)*: LAST NAME GIVEN NAME(S) DATE OF BIRTH PLACE OF BIRTH (CITY) herewith give(s) authization to the Netherlands Embassy/Netherlands Consulate General: 1. to issue a Netherlands passpt in the name of above mentioned child(ren) 2. to include the min(s)* in the Netherlands passpt of the father and/ mother* (only possible when the min(s) are under the age of 16) signature father and/ signature mother full name in print full name in print The above mentioned person(s)* has/have* presented to me sufficient evidence of identity and has/have* signed this document in my presence. Signed on: at * = Please cross out what is not applicable Notary / Official s signature, stamp and title

4 Declaration of consent f crespondence If you would like to receive all crespondence regarding your travel document application by , you must give your explicit consent. You can do this by completing and signing the declaration below. Your details Initials and last name:... Postal address: address:... I hereby declare that all crespondence regarding the above travel document application should be sent to the address supplied and that I can be readily contacted at this address. Please tick the following check box: only. I agree to receive the crespondence regarding my travel document application by Signed Place: Date: Your signature:... Please be aware that the use of is subject to security risks. You should be aware of these risks if you choose to have crespondence regarding your travel document application sent by . The Ministry of Feign Affairs cannot guarantee the reliability of sending receiving messages by , the confidentiality and integrity of crespondence via the internet and therefe accepts no responsibility f any messages which are subject to delay in delivery which fail to reach you. All messages received are processed in accdance with Dutch legislation on privacy and security. If you believe the risks to be too great, crespondence regarding your application can be sent by conventional mail via the Netherlands diplomatic mission abroad. In this case please be aware that it may take longer to send and receive relevant crespondence.

5 Release of Liability f Passpt Mailing DISCLAIMER: The Netherlands Embassy/Consulate is not responsible f the loss damages of a passpt once it has been mailed to the applicant, making use of the provided selfaddressed, pre-paid/stamped envelope. (the APPLICANT) wishes to have his/her passpt mailed to him/her. The APPLICANT consents and agrees to the following: I, the APPLICANT, understand that the Netherlands Embassy/Consulate is NOT responsible f the loss damage of my passpt once it has been mailed while making use of the self-addressed, pre-paid/stamped envelope I have provided. I, hereby declare that I am assuming all risks of damages loss of any kind of my passpt once it has been mailed. Furtherme, I understand that the embassy/consulate shall not be responsible liable f any consequential loss damage caused to me, the Applicant, due to loss of my passpt and suppting documents once it has been mailed by their office making use of the envelope provided by me.. APPLICANT (signature).. (date)

6 Mail in post the above fms and documents as soon as possible to: Att: Orlean Chimbewa Consular Section Royal Netherlands Embassy 4200 Linnean Avenue Washington, DC F any questions, call in the afternoons was-visa-passpt@minbuza.nl ********************************* After your application has been deemed admissible, you will receive a link infmation on how you can set an appointment slot of your choice. ******************************** After setting the appointment, prepare and bring the following documents f submission on the day of the appointment: Original last issued Dutch passpt. Original valid proof of immigration status. 1 col passpt size photo. Please take time to read the infmation mentioned above. Photos that do not meet the requirements will not be accepted. IF a different photo other than an exact copy of the pre-approved mailed photo is submitted, the application will not be accepted. Passpt fees payable in exact cash only. These fees are subject to change and the rate in effect on the day of actual processing in Washington, DC (1 st week of July) will be used. F that, you will need to submit: US$150 (adults) US$135 (mins) in cash. This is in slightly excess of current rate. However, receipts will be given at the time of submitting the payment, any change surplus, if any, will be mailed back with new passpt after processing. Clean fingers f fingerprinting, unless younger than 12 years of age. Any other documents requested by the Consular Office.

7 Please Note: Every applicant will be required to appear in person, including children. Incomplete application will not be accepted under any circumstances. ADDITIONAL INFORMATION F me infmation about Dutch nationality, passpt applications, and other consular matters please visit the website of the Royal Netherlands Embassy in Washington DC at call the Netherlands 24/7 help desk toll-free at 1(202) You will be connected to the help desk in the Netherlands. F a first time passpt renewal after having acquired another nationality: please visit the following link first to collect the appropriate documentation: Documents listed on this link are in addition to the documents mentioned already in this package. DigiD If you are interested in applying f a Digid, please have your (actual printout) with the balie code on hand at time of the appointment, an extra copy of the Dutch Identity document you used to register f the DigiD, and proof of your BSN number. Your activation code will be mailed to your along with your passpt. You should therefe, wait until as close to the appointment date as possible as it is only valid f 30 days. F me infmation on what DigiD is, please click here: F me infmation questions about the appointments f fingerprinting, please contact the Consular desk at the Royal Netherlands Embassy in Washington on: Tel: in the afternoons was-visa-passpt@minbuza.nl the Consulate General in Chicago at chi-ca@minbuza.nl