Registration of Malaysians in The Netherlands
Name *
Gender *
Marital Status *
Date of birth *
MM
/
DD
/
YYYY
Place of birth *
IC Number *
Passport number *
Ethnicity
Clear selection
Religion *
Email *
Phone number *
Purpose of stay *
Name of company/university *
Residency status *
FAMILY MEMBERS (IF APPLICABLE)
Name of spouse + Passport No.
Name of first child + passport No.
Name of second child + passport No.
Name of third child + passport No.
Name of fourth child + passport No.
Name of fifth child + passport No.
ADDRESS IN THE NETHERLANDS
Address line *
Postal code *
City *
EMERGENCY CONTACT IN THE NETHERLANDS
Name *
Phone number *
E-mail *
Relation *
EMERGENCY CONTACT IN MALAYSIA
Name *
Phone number *
Relation *
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