Crisis Contactform

You can fill in your details using the form below. Also fill in the details of your partner and/or children if you are travelling together. They will then not need to fill in a separate form. Also enter a contact person.

Please note! Fill in the form completely and correctly. Read which conditions you need to meet. Don’t forget to upload a copy or photo of your Dutch passport or valid residence permit of you and your travelling companions.

* = Mandatory field

Gesproken taal

Travel company

First name (as in passport) *

Last name (as in passport) *

Date of birth *

Do you live in the Netherlands? * Yes No

Postal code *

House number *

Country of residence *

Nationality *

Do you have a Dutch passport? * Yes No

Document type *

Passport number *

Expiration date *

BSN (if you have one)

In which country or region are you? *

What is your current location? *

Add new Traveler

Contact person

Fill in the details of the contact person of your travel group here. Please note: all communication about the trip goes through this person. You can assign yourself as a contact person, but you can also specify someone who is not traveling with you (for example a family member in the Netherlands).

First name *

Last name *

Email address *

Mobile number (including country code, e.g. +31612345678) *

Phone number (including country code, e.g. +31612345678)

Attach documents
Upload all documents here. Also those of your fellow travelers (max. 10 MB per file)

Upload a copy or photo of your Dutch passport or valid residence permit for the Netherlands. Also upload the travel documents of your fellow travelers.
Do your partner and/or children not have Dutch nationality? Add a document that proves their relationship to you, such as a marriage certificate, birth certificate or adoption certificate.

Onderwerp *

Remarks

Explanation:
Please give us additional information that may be relevant for your possible departure from the crisis area (max. 255 characters). Think of questions such as:

Are there any medical details (e.g. pregnant, less mobile)?
Do you have a fragile health condition?

I hereby declare that the above information has been provided truthfully by me. Incomplete or incorrect information may affect the assistance that the Dutch government can provide. I am aware that registration does not make me eligible to assistance from the Dutch government in leaving the crisis area. *

I hereby declare that I give permission to the Ministry of Foreign Affairs to share my personal data and those of my travelling companions, if any, with third-country authorities and other ministries and/or organisations in the Netherlands or other EU countries, if this is necessary for my possible departure and possible acquisition of a travel document. I am aware that my personal data in third countries may not be protected by the General Data Protection Regulation (GDPR) in the Netherlands and the EEA. For more information: see the privacy statement. * *

Crisis Contactform

Travel company

Main traveler

Contact person

Attachments