Study: extension residence permitAcademic Year 2016-2017

You will need an extension of your residence permit if you want to continue your stay and studies in the Netherlands after the expiration date of your current residence permit. The International Service Desk (ISD) will apply for the extension of your residence permit with the Immigration and Naturalisation Service (IND).

In order to extend your residence permit you must submit this form and all the requested documents (see section 4) to the ISD (isd@rug.nl) as soon as possible.

Fill out form using block letters, and print out form single-sided (i.e. not duplex).

Make sure to sign with your initial or signature at the bottom right of each page.

1. Student declarations

> I am currently registered as a student at the University of Groningen.

> I will be registered as a student at the University of Groningen during the next academic year or semester.

> I have and intend on keeping a valid health insurance as long as I live in the Netherlands.

> I hereby declare that I have sufficient means in order to live and study in the Netherlands. I have access to at least

€900 per month for living costs. I also declare I have sufficient means to pay for my tuition fees. If asked by the

IND or ISD I can and will submit proof of this.

> I declare that I have paid the extension fee of €159 to the ISD bank account.

NB. Turkish nationals have to pay €51 for an extension application. Consult section 5 for the ISD bank details

> I declare that I am aware of the obligations of the Modern Migration policy as decribed on

http://www.rug.nl/education/international-students/visa-immigration/momistudents. I declare that I have

read this information and that I will report to my study advisor the moment I fear that I will fall behind on my

studies.

> I declare that I allow the University of Groningen to ask the Immigration and Naturalisation Service (IND)

about my (prior and future) legal residence.

> I hereby declare that I allow the University of Groningen to submit information about me, my residence permit

and my study progress to third parties such as the IND, the Public Health Department (GGD), and, if applicable,

the Housing Office, City Hall, and/or the bank.

NB. The University of Groningen does not sell, rent, or give away personal information to third parties for

commercial purposes.

> I hereby declare that I will always keep my personal details (e.g. address) up to date in the student administration

via Studielink.

> I am aware that failing to meet any of the above requirements may have consequences for my legal residence.

Initials student:

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3. Information on study programme* at the University of Groningen

Study programme name

Starting date (dd-mm-yyyy)

Duration in years

Estimated graduation date

(dd-mm-yyyy)

Currently obtained amount of ECTS: out of 60 / 120 / 180 / 240 (circle applicable)

4. Additional documents to be submitted

Please also make sure to submit the following documents, as incomplete applications will not be handled!

> a copy of your passport (pages with personal details and stamps and visas)

> a copy of your current residence permit (front and back)

> a signed Antecedents certificate (see page 4)

Initials student:

* If you will switch to or start a new study programme soon, please fill out the details in this section with your new

study programme in mind.

2. Student information

Family name (s)

First/Given name(s)

Marital status

Unmarried

Married

› Tick applicable

Current home address Street name and house number

Postal code City

Student number

S

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5. Payment details

You will need to pay for the extension fees yourself.

You have to transfer your application fees to the University’s bank account:

Bank account holder name: Rijksuniversiteit Groningen Bank account number:49.75.63.215 Bank ABN AMRO IBAN code NL49ABNA0497563215 BIC/SWIFT code ABNANL2A Bank address: Grote Voort 247 8041 BL Zwolle The Netherlands

Make sure to mention the following details in the payment reference (Dutch: Omschrijving): [student number]-[lastname] For example: 1234567-Jones

NB: the University of Groningen is not responsible if your transfer did not go through correctly.

6. Signing the form

I declare that I have filled out this form truthfully, and hereby ask the University of Groningen to apply for an extension of my residence permit for the purpose of ‘study’ on my behalf.

Full name

Place and date (dd-mm-yyyy)

Signature

Initials student:

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AppendixAntecedents Certificate

b01

1 Certificate

2 Signing (by the foreign national)

2.1 Name

2.2 Place and date

2.3 Signature

n I certify that:• Ihaveneverbeensentencedtoimprisonmentoracustodialmeasureforcommittingacrime;• Ihaveneverbeensentencedtoperformcommunityserviceforcommittingacrime;• Ihaveneverbeenimposedanunconditionalfineforcommittingacrime;• Ihaveneveracceptedanout-of-courtsettlementforcommittingacrime;• Ihaveneverbeenimposedapenaltyorderbyapublicprosecutorforcommittingacrime;• Iamcurrentlynotsubjecttoprosecutionforcommittingacrime;• IhaveneverbeenresponsibleforoneofthefollowingcategoriesofactsasreferredtoinArticle1Fof

the1951RefugeeConvention:acrimeagainstpeace,awarcrime,acrimeagainsthumanity,aserious non-politicalcrime(forexamplemurderorterrorism),oractscontrarytothepurposesandprinciplesof theUnitedNations(forexampleterroristacts);and

• Iamawareofthefactthatasentenceforcommittingacrimemayresultinarefusalorterminationoftherightofresidence.

• Ihavenotsubmittedanyincorrectdataduringearlierresidenceprocedures;• IdidnotresideintheNetherlandsillegallyinthepast;• Iamnotsubjecttoanyentryban.

n Iamunabletocertifytheaboveforthefollowingreasons:

|

Please note! Not completing this antecedents certificate truthfully is an offense of which in all cases a report will be made.

Ihavecompletedthisformtruthfully.

|Place Day Month Year

|

|

This certificate only needs to be completed if the foreign national is 12 years of age or older.

> Please tick the applicable situation

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