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Schedule 33 to Decree No. 25/2007 (31 May) IRM of the Minitry of !utice and

"a# $nforce%ent

Application for Temporary Residence PermitAuthority receiving the application: Mechanical file number:

Body entering application data:

Photo

Issue of residence permit on the first occasion

place of entry:

date of entry:

(day) (month) (year)

Number and validity of residence visa:

H (day) (month) (year)

!pecimen signature of applicant" #he entire

signature must be $ithin the frame

Place of receipt of document:

#he applicant $ill receive the document at the issuing authority%

#he applicant re&uests sending of the document by mail:

'% Applicants personal data

!urname (as in the passport): *iven name(s) (as in the passport:

Birth surname: Birth given name(s):

Mothers birth surname andgiven name:

!e+:Male

,emale

Marital status: !ingle-ido$

Married .ivorced

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Date of birth:

(day)(month) (year)

Place of birth

(city/to$n/village):

0ountry:

0iti1enship: Nationality (not mandatory):

Last permanent residence outside Hungary:

2ualification: 3ducation:

primary secondary higher

4ccupation prior to arrival atHungary:

2. Applicant's passport data

assport number: .ate and place of issue:

(day) (month) (year)

!ype of passport:

private passport service diplomatic other

Date of "alidity:

(day)(month) (year)

#. lanned period and reasons for residence$or %hat period of time and reasons do you apply for the

permission of residence&

day month year

5% .ata of applicants accommodation in Hungary

6ip number: 0ity/to$n/village: Name of public area:

!ype of public

area:Housenumber:

Building (staircase7floor7 door):

#ype ofpublic area:

Housenumber:

Building (staircase7floor7 door):

Legal ground of residence at the accommodation:

o$ner tenant family member courtesy tenant other7 specify:

. Data relating to li"ing in Hungary:

A"ailable sa"ings: 4ther supplementary income/property securing living:

. onditions of return or further tra"el

*hat country %ill you tra"el bac+ or to upon the e,piry of

your la%ful residence&By $hat means of transport8

Do you ha"e thenecessary passport8 yesno "isa& yesno tic+et&yes no financial co"er&yes7 sum: no

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% 4ther data

Do you ha"e full health insurance for the period of your residence in Hungary&

yes no

Ha"e you already participated in the programme of tourists employed on a temporary basis in Hungary&

yes no

Has your pre"ious application for residence been re-ected&

yes no

Are you included in the criminal records& If yes in %hat country %hen for %hat criminal act and %hat

punishment %as imposed&

yes no

Ha"e you already been e,pelled from Hungary if yes %hen&

yes no

(day) (month) (year)

!o you +no%ledge do you suffer from the follo%ing infectious diseases in need of treatment: HI/0AID1 as

%ell as tuberculosis hepatitis lues leprosy typhoid or do you carry the pathogens of the follo%ing diseases

in your organi3ation: HI/ hepatitis and typhoid&

yes no

In case you suffer from the follo%ing diseases or are in pathogenic or pathogen4carrying status do you

recei"e mandatory and regular medical treatment&

yes no

ermanent or regular place of residence prior to your arri"al at Hungary:

0ountry:

0ity/to$n/village:

Name of public area:

*hat country %ill you tra"el to if your entitlement to residence terminates&

0ountry:

I hereby declare that the abo"e date are true. I ac+no%ledge that the disclosure of untrue data shall result in

the re-ection of the application.

.ated: %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% signature

Place of duty stamp:

#o be filled in by the authority:

;

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