Annex 3 to the Implementing protocol to the Agreement between the Benelux States (the Kingdom of Belgium, the Grand Duchy of Luxembourg and the Kingdom of the Netherlands) and Mongolia on readmission Overeenkomst tussen de Benelux-Staten (het Koninkrijk België, het Groothertogdom Luxemburg en het Koninkrijk der Nederlanden) en Mongolië betreffende de terug- en overname van onregelmatig verblijvende personen (met Uitvoeringsprotocol met Bijlagen)
NOTIFICATION CONCERNING TRANSFER
(Art. 6 of the Agreement and Art. 8 of the Implementing Protocol)
DATE: .......... | CASE NO: ..........
YOUR POSITIVE REPLY OF (date): ..........
FROM: COMPETENT AUTHORITY (Requesting State)
..........
Tel: | E-mail:
TO: COMPETENT AUTHORITY (Requested State)
..........
Tel: | E-mail:
1 – PERSONAL DETAILS OF THE PERSON WHOSE TRANSFER IS ANNOUNCED
SURNAME | .......... | | GIVEN NAMES | ..........
.......... | | | ..........
..........
..........
DATE OF BIRTH | .......... | | PLACE OF BIRTH | ..........
NATIONALITY | ..........
SPOUSE
Name | ..........
Date of birth | ..........
Nationality | ..........
MINOR CHILDREN | .......... (number)
Name(s) | .......... | | Date of birth | ..........
.......... | | | ..........
.......... | | | ..........
.......... | | | ..........
.......... | | | ..........
2 – DOCUMENTS POSSESSED BY THE PERSON WHOSE TRANSFER IS ANNOUNCED
(NB – here one should include the date and place of issue, period of validity, etc.)
1. | LAISSEZ-PASSER
issued on | (date) | | .......... | at (place) | ..........
valid until | (date) | | ..........
2. | OTHER (TRAVEL) DOCUMENTS | | | ..........
...........
..........
..........
..........
(copies attached)
3 – DATE, TIME, PLACE AND MODALITIES OF TRANSFER
DATE AND TIME OF TRANSFER
PLACE OF TRANSFER
MODES OF TRANSPORTATION | AIR/LAND/SEA*
MEANS OF TRANSPORT
– CAR | YES/NO* REGISTRATION NUMBER ..........
– AIRPLANE | YES/NO* FLIGHT NO ..........
ESCORT: | YES/NO*
NUMBER OF ESCORTS | ..........
NAMES OF ESCORTS | 1. ..........
2. ..........
REASONS WHY THE READMISSION CANNOT BE EFFECTED BY AIR | ..........
STATE OF HEALTH (consent of person concerned required) | ..........
..........
..........
REQUIRED ASSISTANCE | ..........
..........
..........
REQUIRED PROTECTION OR SECURITY MEASURES | ..........
..........
..........
..........
* Strike out what does not apply.
4 – ANNEXES
NUMBER OF DOCUMENTS (incl. brief description) | 1. | ..........
2. | ..........
3. | ..........
4. | ..........
5. | ..........
6. | ..........
NAME OF OFFICIAL | STAMP AND SIGNATURE
CONFIRMATION OF RECEIPT OF NOTIFICATION
DATE: ..........
NAME OF OFFICIAL | STAMP AND SIGNATURE
- Regeling
- Overeenkomst tussen de Benelux-Staten (het Koninkrijk België, het Groothertogdom Luxemburg en het Koninkrijk der Nederlanden) en Mongolië betreffende de terug- en overname van onregelmatig verblijvende personen (met Uitvoeringsprotocol met Bijlagen)
- Soort
- Verdrag
- Geldend vanaf
- 01-02-2025
- BWB-id
- BWBV0007036
- Versie
- 2025-02-01_0