Application for admission and residence as a ‘start-up’ working

on a self-employed basis

To be filled in by the Dutch embassy or consulate

Application submitted Passport photo

at embassy/consulate:
size 35 x 45 mm
(width x height)
Date Day Month Year

Name and initials

embassy employee

File password (if

applicable)

Please note! If you have received a printed version of this information form, please check out the digital version,
including direct links, on www.ind.nl.

With this form, you apply for admission and residence in the Netherlands as a ‘start-up’ working on a self-employed
basis. You can only use this form if you are a foreign national staying outside the Netherlands. You submit the
application to the Dutch embassy or consulate in the country of origin or the country of continuous residence.* Please
check www.netherlandsworldwide.nl to find out whether and how you can make an appointment for this.

* In case there is no Dutch consulate or embassy in your country of origin or permanent residence, please turn to the
nearest Dutch representation.

Appointment at the Dutch embassy or consulate

Please take this application form, your passport photo and valid passport with you to the appointment at the Dutch
embassy or consulate. The embassy or consulate employee will register your application and fill out the information box
above. You will also receive a confirmation letter with your registration number (V-number). Please keep this letter:
you will need it later. After submitting the application to the embassy or consulate, you will receive this application
form back.

If you give your consent to communication by e-mail (see section ‘7 Declaration of consent’), the embassy or consulate
employee will provide you with a file password. This password will be written in the box at the top of this page. It is
very important that you keep your password safe and it is strongly recommended that you keep a copy of this
application form for your records.

After the appointment

To be able to assess your application, the Immigration and Naturalisation Service (IND) in the Netherlands needs
information from you. Please complete and send this form, with all the necessary documents mentioned in section
‘5 Means of evidence’, to the IND within three weeks from the date of your application (see the date above). Please
also enclose the confirmation letter you received from the embassy or consulate. If you do not send all the necessary
documents, the assessment of your application will be delayed. If the IND does not receive the information and
documents in time, your application will be rejected.

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1 Your personal details Write in block letters

1.1 V-number

Please note! It is imperative that your V-number is mentioned above. Without

this number, your application can not be processed. The embassy or consulate
will give you this number.

1.2 Dutch Citizen service number

(if applicable)
The Dutch Citizen service number (BSN) is a unique number for everyone who
has dealings with the Dutch government.

1.3 Name Surname

(as stated in the passport)

First names

1.4 Sex  Male

 Female

1.5 Date of birth Day Month Year

1.6 Place of birth

1.7 Country of birth

(as stated in the passport)

1.8 Nationality at birth

1.9 Current nationality

1.10 Civil status  unmarried

 married
 registered partnership
 divorced
 widow/widower

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1.11 Home address Street

Number

Postcode

Town

Country

1.12 Telephone number

1.13 E-mail

1.14 Type of travel document  National passport

 Diplomatic passport
 Service passport
 Official passport
 Special passport
 Other type of travel document, namely:

1.15 Specifications of the travel Travel document number

document

Date of issue

Day Month Year

Valid until

Day Month Year

Issued by

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2 Details of the facilitator

2.1 Name facilitator

2.2 Name contact person

2.3 Correspondence address Street

Number

Postcode

Town

2.4 Telephone number

2.5 E-mail

2.6 Chamber of Commerce registration

number

3 Details of your representative in the Netherlands (if applicable)

Please enclose an authorisation if the representative is acting on your behalf. If the authorised representative is
a lawyer, no authorisation needs to be submitted.

3.1 Name Surname

(as stated in the passport)

First names

3.2 Nationality

3.3 Address Street

Number

Postcode

Town

3.4 Telephone number

3.5 E-mail

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4 Declaration of intent to undergo a TB test

In order to obtain a residence permit, you must be prepared to undergo a tuberculosis (TB) test in the
Netherlands and - if necessary -treatment. If you are granted a residence permit, you will actually have to
undergo a TB test within three months after having received your residence permit.

When you are in the Netherlands, you should make a TB test appointment with the Municipal Health Service
(GGD) in the area where you live or will be living (for further information visit the website www.ggd.nl).

Should it become clear after the issue of a residence permit that - despite signing the declaration of intent -
you failed to undergo a TB test within the period of three months, this may result in a cancellation of the
permit that was granted.

Please note! The obligation to undergo the test does not apply if you are a national of one of the countries
listed in the appendix ‘Exemption from the obligation to undergo a tuberculosis (TB) test’.

> Please check either one of the following two boxes

 I hereby declare that I am prepared to cooperate in a tuberculosis test and any treatment. I am aware of
the fact that I must undergo a TB test within three months after the residence permit has been received.
If I fail to do so, this might have consequences for my right of residence in the Netherlands.
 I do not need to undergo a TB test because I am a national of one of the countries listed in the appendix
‘Exemption from the obligation to undergo a tuberculosis (TB) test’.

5 Means of evidence

Requirements of foreign means of evidence

Documents must be in Dutch, English, French or German. In case the documents are drafted in another
language, you need to have these translated by an authorised translator. Send a copy of the original documents
together with a copy of the translation.

Please gather the following documents:

• Copy of your passport (page with your identity details as well as the pages with travel stamps, do not send
copies of empty pages);
• a ‘Antecedents certificate’ appendix that you have fully completed and signed.
• A step-by-step plan that contains information on:
 your role and tasks in the start-up company (the organisation); You must have an active role. This
means that you are not just a shareholder or financier.
 the activities (steps) that you will take in the first year in order to move from idea to business.
 the innovative nature of the product or service; why the product or service is innovative. The product or
service is innovative if it has at least 1 of the following 3 aspects:
1. The product or service is new to the Netherlands.
2. It involves new technology for production, distribution or marketing.
3. It involves an innovative organisational set-up and working method.
Examples include (but are not limited to):
o activities stimulated within the context of the Top Sectors policy.
o self-developed new products or services.
o original approach to energy conservation.
o original approach to sustainability problems.
o clever and creative adjustments or combinations for the purpose of cross-sector
applications.
o new product-market combinations.
o creative or innovative market approach.
o social innovation.
o introduction to corporate social responsibility.

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• The signed agreement between you and your facilitator. The agreement has been signed by both of you.
Your facilitator must be authorised to sign the agreement. The agreement in any case includes information
on:
 the nature of the facilitation. The facilitation must be tailor-made. This means that the facilitator is able
to facilitate you to get your idea to a business.
 the conditions of the agreement. These may not adversely affect or prevent a healthy development of
your business. It may not concern a ‘unconscionable contract’.
 the facilitator’s interest in the start-up company. The facilitator may not have a majority interest in the
start-up company.
• Evidence of means of support
If you are (partially) financing the means of support yourself:
 a copy of a Dutch bank account that is in your name or your company’s name, showing the balance
that is available; or
 a statement from the foreign bank where you have your account, detailing the amount (monthly) which
is paid into the account in the Netherlands in your name or your company’s name;
If your facilitator is (partially) financing the means of support:
 a contract between you and your facilitator, detailing the financial resources that will be provided to
you.
If the means of support are being (partially) financed by a third financier:
 an original statement from the bank that shows the amount that will be paid each month to your
personal Dutch bank account, during your period in the Netherlands; or
 an original statement from the financier, which states the monthly amount that will be paid to your
personal Dutch bank account during your period in the Netherlands; and
 a copy of your financier’s passport; and
 a recent bank statement or bank specification which shows your financier’s bank balance.
• Evidence on the reliability and expertise of the facilitator.
Please note! If, in the year before you submit your application, the RVO gave a positive recommendation
with respect to the facilitator, you need not produce any evidence on the reliability and expertise of the
facilitator. In that case, the RVO will assume that the facilitator is reliable and an expert.
I declare the RVO has given a positive recommendation in the year before I submitted my application.

> Please tick

 Yes
 No

If the RVO has not given a positive recommendation before or gave a positive recommendation more than
one year ago, enclose with your application:
 As many means of evidence as possible showing the expertise of the facilitator:
o The facilitator offers you a tailor-made package of facilities. A tailor-made package means that the
facilitator is able to facilitate the start-up entrepreneur in developing the idea into a business. This
depends on the facilitation required by the start-up entrepreneur. The facilitator may, for example,
assist in the business operations, marketing, conducting of research and search for investors in
order to set up the innovative company. The agreement between you and your facilitator must
include arrangements in this respect.
o The facilitator is experienced. Experience means at least 2 years’ experience with facilitating
innovative start-up entrepreneurs. At least 2 persons should be able to facilitate you. They can do
this either jointly or alone with an equivalent substitute. You can demonstrate this by means of, for
example, a business plan, examples of previously facilitated start-up entrepreneurs, references and
CVs. If several persons act as facilitator, information about all facilitators will be required.
 As many means of evidence as possible showing that the facilitator is reliable. The facilitator must be
financially sound. In any case, the facilitator has not been granted a moratorium, has not been declared
insolvent. He has a healthy solvency and liquidity ratio (no negative shareholders’ equity). For the
facilitator must support you for at least 1 year. You can demonstrate this by means of, for example,
recent financial statements (the RVO can inspect the financial statements of organisations that have a
filing obligation with the Chamber of Commerce), agreements with or guarantees by financiers, audit
opinions, bank statements and/or substantiated financial prognoses.

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6 Payment of fees

Before your application can be assessed, you must pay a fee. The fee for an application for admission and
residence in the Netherlands as a ‘start-up’ working on a self-employed basis, submitted on or after 1 January
2021, is € 342. This amount has to be paid by all applicants, except for citizens of Turkey, San Marino and
Israel. The fee for citizens of Turkey is € 69. The application is free of charge for citizens of San Marino and
Israel. You can also find this information on www.ind.nl.

Please transfer the fee for the application to the bank account of the IND referred to below. Please quote the
V-number, which you will receive from the Dutch embassy/consulate where you apply, as your payment
reference.

Bank ING
Account number 70.50.05.356
Name Min. van Justitie en Veiligheid 601/IND LEGES Storting Bank
IBAN number NL31INGB0705005356
SWIFT code INGBNL2A
Address Postbus 85449
Postcode 2508 CC
City Den Haag

You must transfer the fee within three weeks after the date on top of this form (filled in by the Netherlands
embassy/consulate). Your application will only be assessed when the whole amount has been received by the
IND. Please check whether your bank deducts a fee from the amount being transferred. If the assessment of
your application shows that you do not qualify for a residence permit in the Netherlands, you will not receive a
refund.

7 Declaration of consent

The IND will assess and decide on your application. If you wish communication with the IND to take place by e-
mail (instead of by post), you must consent to this first.

> Please check either one of the following two boxes

 I agree that communication with the IND will take place by e-mail. I want the email address I provided
above to be used for this (section 1.13). I access this email address on a regular basis.

 I do not agree that communication with the IND will take place by e-mail. I want correspondence to be
sent to the address I provided above (section 1.11).

If you give your consent to communication by e-mail, the IND will send the decision on your application to your
e-mail address. The message will be encrypted using the file password you received from the embassy or
consulate employee. You can open the encrypted document in the email with this password. Therefore, it is
very important that you keep your password safe and it is strongly recommended that you keep a copy of this
application form for your records.

Please note! The IND accepts no responsibility for any email messages that fail to reach you or are delayed.
The IND cannot guarantee the reliability of sending or receiving messages by email, or the confidentiality and
integrity of email correspondence sent over the internet.

8 What will happen with your application?

After receipt of your application, your documents and fee, the IND will assess your application. You will be
contacted by the IND if your payment or your documents are not received. You will also be informed once the
assessment of your application has been finalised. If your application is granted, you will also receive
information about the follow-up procedure.

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9 MVV and residence permit

In case your application is granted you will receive an MVV (entry visa) from the Dutch embassy/consulate.
When your application is granted you can make an appointment to collect your MVV via
www.netherlandsworldwide.nl. The IND aims to have your residence permit ready within a few weeks following
your arrival in the Netherlands. The IND will send you a letter indicating when you can collect your residence
permit. For this, you have to make an appointment online at the IND desk stated in the letter.

9.1 Intended date of Day Month Year

departure to the
Netherlands

9.2 Please indicate below where you will collect the residence permit:

 Amsterdam  Den Bosch  Den Haag  Maastricht (MIC)*

 Rotterdam  Utrecht  Zwolle

*MIC – Maastricht International Centre

You can also collect your residence permit at an expat center: (Some expat centers charge a fee for this service
and some expat centers require an appointment to collect the residence permit)

 Amsterdam  Den Haag  Eindhoven  Enschede

 Groningen  Maastricht  Rotterdam  Utrecht
 Wageningen

10 Registering in the Netherlands

You need your birth certificate (legalised and translated if necessary, please check www.ind.nl) for registering
in the Personal Records Database (BRP) at your local municipality after arriving in the Netherlands. This is a
mandatory procedure. When you are registered in the BRP, you will automatically obtain a citizen service
number (BSN), unless you already have this.

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11 Signing

Signing this form will bring you rights and obligations. If you do not know what these rights and obligations
are, then visit the website www.ind.nl.

I declare I have completed this form truthfully. I know that the personal details supplied will be processed in
connection with the Aliens Act 2000 and will be passed on to authorities that need these personal details
for that purpose. I will pass on any changes to my situation, which will affect my right of residence, within
4 weeks to the IND with the ‘Notification form for family members and relatives’. I am aware that if I do not
do this, it may affect my right of residence as foreign national. I know that I may incur an administrative fine.
I know what my rights and obligations are.

11.1 I submit this form and (number) of appendices/documents in evidence.

11.2 Name

11.3 Place and Date Place

Day Month Year

11.4 Signature

12 Submitting this form with the necessary documents

Sign and send the completed form, the appendices and the requested documents to the IND in the Netherlands
by post. Never send any original documents. You must send clearly readable and full copies of the original
documents. Do not use any staples or paperclips. Do not send any USB sticks, CD’s, DVDs and suchlike. Put all
the documents in a sufficiently stamped envelope. Send this to the following address:

Immigration and Naturalisation Service (IND)

P.O. Box 5
9560 AA TER APEL
The Netherlands

Processing of personal data

The Immigration and Naturalisation Service (IND) processes personal data when it processes your application,
notification, or request. This means that if needed the IND will request data from you yourself and other organizations
or persons. The IND also uses and stores data and shares them with other organizations. When doing so, the IND
strictly adheres to the stipulations of privacy legislation. For instance, the IND must treat data safely and with due care.
The law also gives rights. At your request, you are allowed to see which data on you the IND processes. You can also
get information on why the IND does so and to whom your data have been passed on. On www.ind.nl you can read
how the IND processes your data and which rights you have. You can also read how to use your rights.

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