(see section 5.3)

The [name of diplomatic mission or consular post] presents its compliments to the Embassy of the Kingdom of the Netherlands in [country] and has the honour to inform the Embassy that the partner of [name of staff member], who is working for the [name of diplomatic mission or consular post] in the Netherlands as [position], will apply for a visa for the Netherlands for the purpose of joining [name of staff member].

Name of partner:
Address:
Date and place of birth:
Passport number:
Date and place of issue:
Expiry date:

The [name of the diplomatic mission or consular post] and [name of staff member] hereby declare that [name of partner]:

• will form part of the household of [name of staff member] in the Netherlands;
• has an exclusive relationship with [name of staff member];
• is of age (older than 18);
• is not under any legal constraint;
• is not a relative of [name of staff member].

In addition, the [name of the diplomatic mission or consular post] and [name of staff member] declare that [name of staff member] and [name of partner] will conclude a cohabitation agreement (samenlevingsovereenkomst) or enter into a registered partnership (geregistreerd partnerschap) in the Netherlands within the period of the validity of the visa (90 days). [Name of staff member] and [name of partner] are aware that registration with the Ministry of Foreign Affairs (DPG) and issuance of a Ministry of Foreign Affairs identity card for the partner must also take place within the period of validity of the visa; that registration with the Ministry of Foreign Affairs and issuance of an identity card cannot take place without a cohabitation agreement or registered partnership; and that failure to comply within 90 days will result in illegal stay through expiration of the visa and possible expulsion.

Signed:

Name of staff member:
Place:
Date:

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