Dutch Residence Permit (VVR) – change to study Dear student, This application form contains details of the documents and payment required in order to change your current Dutch residence permit (VVR) to a permit for study. It is not possible for us to submit your application with the Dutch Immigration (IND) until your admission and your language test have been confirmed and accepted by the HU enrolment office. We do recommend you to prepare the documents necessary for the VVR application during the admissions process and make sure we have received them before the visa deadline date. Financial proof The IND needs to know that you have access to sufficient finances during your stay. The methods available are given below and the documents that may be used as proof together with the minimum amount required by the IND are detailed on the Financial document information sheet available on our website. Please place a cross in the box beside the method of proof you wish to use.  1 – Student has own finance or financer outside the Netherlands (Refer to Table A on page 2 for fees & payment details) The student has own finances or another person is going to finance the student for the period of stay. Follow the instructions on the Financial document information sheet - (Student - Method A or Financer - Method B).  2 - Financer in the Netherlands (Refer to Table A on page 2 for fees & payment details) A person (legally resident) in the Netherlands is prepared to financially support the student. The financer must supply all the documents mentioned on the Financial document information sheet (method D). This option cannot be used in combination with other options. Guarantor email: ………………..……………………………………………. Mobile: ………………………………………………  I want HU to request Dutch Health Insurance for my further stay in the Netherlands as from ……/……/…….. (see payment method on page 2). I have read the Modern Migration law (MoMi). I am aware of the conditions when holding a Dutch residence permit for study and am prepared to prove to the HU that I have access to sufficient finances each year. I understand the HU is obliged by law to report any changes in my residence status to the Dutch Immigration and that I have to complete at least 50% study progress each year. Signature student: …………………………………………………………….. Date: …./…./……… Student ID: ……………………… Student Name : ……………………….……………………………………. 1/2 Payment table, Tuition fee and how to pay – Degree or Foundation student Table A – Option 1 and 2 Visa fee to pay Optional : Health Insurance(1) (12 months = € 480.00) Total fee (+) Payment and fees required € 304.00 € ___________ (=) € ___________ Table B – Tuition and Course fees February begin HU Foundation Course(2) HU Foundation Year(2) Degree programme (authorisation of payment in Studielink) € 3,950.00 Not applicable September begin € 7,900.00 Paid separately Tuition fee The tuition fee for a HU Foundation programme must be paid at the same time as the Visa payment. Degree students use the payment authorisation method available in Studielink. All tuition fee details are available on our website www.international.hu.nl How to pay Make the payment before the deadline to the HU bank account. Place the amount you are to pay in the column below and when applicable add the tuition fee. Do not forget to place your name as reference. € ___________ Total fee Tuition fee (+) € ___________ Total (=) € ___________ Bank: ABN-AMRO, Varrolaan 5, 3513 EX, Utrecht Account number Account name IBAN BIC code Reference 63.16.26.158 Stichting Hogeschool Utrecht NL21ABNA0631626158 ABNANL2A “Visa - <student name> <HU student ID>” Deadline date for documents & payment: 1st of December for February begin, 1st of August for September begin CHECKLIST – send the completed forms to our courier address before the deadline date. Your personal details on the forms must agree at all times with the information in your current passport.  This form “Dutch Residence permit – change to study”  Details of student - Section 4 - (section 5 shall be completed by HU)  Original - Antecedents certificate (place a tick when you accept and sign the form in pen)  Financial documents in accordance with the Financial document information sheet guidelines  Copy of the student’s passport (identification pages and all pages with a stamp), valid for at least 12 months.  Copy of the student’s current Dutch Residence permit (both sides)  Copy of bank payment transaction for visa fee to HU (at time of payment) to [email protected]. HU COURIER ADDRESS HU Utrecht University of Applied Sciences International Office, Oudenoord 330, 3513 EX Utrecht, the Netherlands (1) Health Insurance; HU can arrange a student health insurance (+/-€ 40.00 a month for a maximum of 12 months). It is the students own responsibility to have correct and sufficient Health Insurance at all times. Any unused amount shall be returned to the student. (2) The Foundation programme/course tuition fee shall not be reimbursed if cancellation is made after the start of the programme. Visa fees cannot be returned at any time. 2 of 4 4 4.1 V-number (if known) 4.2 Citizen Service Number (if known) Details of the student Surname as stated in the border-crossing document 4.3 | Name First names | > Please tick the applicable situation 4.4 Sex and Date of birth n Male n Female 4.5 Place of birth | 4.6 Country of birth | 4.7 Nationality | Day Month Year > Please tick the applicable situation 4.8 n unmarried Civil status n married n registered partnership Number 4.9 Details border-crossing document n divorced n widow/widower Country | | Valid from (date) to (date) | | Street 4.10Address outside the Netherlands, or, if the student already resides in the Netherlands, the address in the Netherlands | | Postcode Town | Country | 4.11 Telephone number 4.12 E-mail | 5 5.1 Name of degree programme Details of the degree programme | Day 5.2 Month Year Start of degree programme Years Months 5.3Duration of degree programme (years + months) | | Duration (no more than 12 months) 5.4 n Yes | Preparatory period If applicable, duration Number n No 7504 | f4 | 13-c Appendix Antecedents Certificate This certificate only needs to be completed if the foreign national is 12 years of age or older. 1 > Please tick the applicable situation Certificate n • • • • • • • • • • • I certify that: I have never been sentenced to imprisonment or a custodial measure for committing a crime; I have never been sentenced to perform community service for committing a crime; I have never been imposed an unconditional fine for committing a crime; I have never accepted an out-of-court settlement for committing a crime; I have never been imposed a penalty order by a public prosecutor for committing a crime; I am currently not subject to prosecution for committing a crime; I have never been responsible for one of the following categories of acts as referred to in Article 1F of the 1951 Refugee Convention: a crime against peace, a war crime, a crime against humanity, a serious non-political crime (for example murder or terrorism), or acts contrary to the purposes and principles of the United Nations (for example terrorist acts); and I am aware of the fact that a sentence for committing a crime may result in a refusal or termination of the right of residence. I have not submitted any incorrect data during earlier residence procedures; I did not reside in the Netherlands illegally in the past; I am not subject to any entry ban. n I am unable to certify the above for the following reasons: | 2 Signing (by the foreign national) I have completed this form truthfully. 2.1 Name | Place 2.2 Place and date | 2.3 Signature | Day Month Year Please note! If this antecedents certificate has not been completed truthfully, this will have consequences for your right of residence. b01