MainBASIC INFORMATIONDETAILSqEmployee Number:qSurname (family Name) - As per passport:qChristian Name (first Name) - As per passport:qMaiden Name (name of female before marriage):qSex:qDate of Birth (DD-MM-YYYY e.g. 11-Sep-2012):qCountry of Nationality:qCountry of Residence:qBSN / SOFI number (or provide the date of appointment for BSN/SOFI number):qPassport Number:qType of AssignmentqDate of landing in the Netherlands (DD/MM/YYYY)qE-mail IDqMarital StatusqResidential Address of NL(Mandatory)qPlease fill the below details if the dependants are also travelling.qSurname of the spouse (Family Name):qChristian Name of the spouse (Given Name):qMaiden Name of spouse (Surname of female before marriage):qDate of Birth of the Spouse (DD-MM-YYYY e.g. 11-Sep-2012):qSex:qBSN / SOFI number (or provide the date of appointment for BSN/SOFI number):qNumber of dependent children:qChild - 1 - Surname and Name:qChild - 1 - Date of Birth (DD-MM-YYYY):qSex:qBSN / SOFI number (or provide the date of appointment for BSN/SOFI number):qChild - 2 - Surname and Name:qChild - 2 - Date of Birth (DD-MM-YYYY):qSex:qBSN / SOFI number (or provide the date of appointment for BSN/SOFI number):qChild - 3 - Surname and Name:qChild - 3 - Date of birth (DD-MM-YYYY):qSex:qBSN / SOFI number (or provide the date of appointment for BSN/SOFI number):NON EU CITIZENS / WORK PERMIT / RESIDENCE PERMITDETAILSqDate of Landing Spouse in the Netherlands:qDate of Landing child -1 in the Netherlands:qDate of Landing child -2 in the Netherlands:qDate of Landing child -3 in the Netherlands:qAny comments:Please mailNoteqWhen not applicable - menition NAqSome lines of information contain pre-defined dropdowns - please selectqMore than 3 children you can give additional information in 'Any Comments' cellqAny change in the above after submission of this form.

&C&8Page &P of &N - &FBSN: if you work and live in Netherlands

SOFI number: when working in Netherlands but living in other country (e.g. Belgium, Germany)BSN: if you work and live in Netherlands

SOFI number: when working in Netherlands but living in other country (e.g. Belgium, Germany)BSN: if you work and live in Netherlands

SOFI number: when working in Netherlands but living in other country (e.g. Belgium, Germany)BSN: if you work and live in Netherlands

SOFI number: when working in Netherlands but living in other country (e.g. Belgium, Germany)BSN: if you work and live in Netherlands

SOFI number: when working in Netherlands but living in other country (e.g. Belgium, Germany)

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