比利时长期签证申请表(最新版).pdf

USAGE INTERNE - N5 - INTERN GEBRUIK PHOTO Application for a visa for a long stay in Belgium This application form is free 1. Surname (Family name) (x) FOR OFFICIAL USE ONLY 2. Surname at birth (Former family name(s)) (x) Date of application: Visa application number: 3. First name(s) (Given name(s)) (x) Application lodged at □ Embassy/consulate □ CAC 4. Date of birth 5. Place of birth 7.Current nationality □ Service provider (day-month-year) □ Commercial intermediary Nationality at birth, if □ Border 6. Country of birth different: Name: 8. Sex 9. Marital status □ Other □ Male □ Single □ Married □ Female □ Separated □ Divorced □ Widow(er) File handled by: □ Other (please specify)