Application for national visa

The 2 documents from email On Wednesday, December 4, 2024, 1:20 PM,
Zoya Immigrationua zoyaimmigrationua@gmail.com wrote:

1. Identyfikator w systemie central ZAS/24620/2024/0001553
2. List intencyjny do UMOWA ZLECENIA

uploaded PFD:Form to fill for Visa Formular to print use for manual write infos : http://wiki.itbs.selfhost.co/lib/exe/fetch.php?media=playground:about:lola_nationalvisa_fillout_abuja_system.pdf

online fillup here: https://secure2.e-konsulat.gov.pl/placowki/221/wiza-krajowa-formularz-bez-rejestracji

Home page > Abuja > National visa - fill in the form

1. Surname (s) (family name(s)) ADETUNJI

2. Surname (s) at birth (previously used surname (s))* ADETUNJI

3. First name(s)* ADEREMI

4. Date of birth (year-month-day)1975-09-07* 07-09-1975

5. Place of birth* IBADAN

6. Country of birth* NIGERIA

7. Current nationality/ies* NIGERIA
Original nationality (nationality at birth)* NIGERIA

8. Sex *

• Male
• Female

9. Martial status

• Single
• Married
• Separated
• Divorced
• Widow(er)
• Other

11.National identity number, where applicable ID 50012717150

12. Type of travel document

• Ordinary passport
• Diplomatic passport
• Service passport
• -O Official passport
• Special passport
• Other travel document (please specify):

Other travel document type

13. Travel document’s number (series and number) A11976028

14. Date of issue (year-month-day) 13.08.2021 2021-08-13

15. Valid until (year-month-day) 12.08.2026 2026-08-12

16. Issued by FEDERAL REPLUBLIC OF NIGERIAN

10.In the case of minors: Surname, first name, address
(if different from applicant’s) and nationality of parental authority/legal guardian ¹⁾

O does not apply

• Nationality NIGERIA
• First name
• Surname
• Required field
• State
• State/province
• Place
• Postal code
• Address

clik more for Guardian details 2

17. Applicant’s home address and e-mail address

• State OYO-STATE NIGERIA
• State/province OYO-STATE IBADAN
• Place NIGERIA
• Postal code 200282
• Address 13 TAXI PARK STREET OKE-ITUNU MOKOLA IBADAN

• E-mail²⁾ REMADE85@YAHOO.COM
• Phone area code +234
• Phone number 8034047860

18. Residence in a country other than the country of current nationality

• No
• Yes. Residence permit or equivalent

• Number
• Expiry date

• X indefinitely
  

19. Current occupation Civil servant

20. Employer and employer’s address and phone number. For students, name and address of school

• Employer
• School

• Name OYO-STATE HOSPITAL MANAGEMENT BOARD OYO-STATE
• State NIGERIA
• State/province OYO-STATE,IBADAN
• Place SECRETARIAT OYO-STATE IBADAN NIGERIA
• Postal code 200282
• Address SECRETARIAT OYO-STATE IBADAN NIGERIA
• Phone area code +234
• Phone 8075653282
• E-mail OYSHMB@GMAIL.COM
• Fax area code
• Number of fax

21. Main purpose(s) of the journey:

• Tourism
• Business
• Visit to family or friends
• Cultural
• Sports
• Official visit
• Medical reason
• Study
• X other (please specify)

Another purpose of the trip WORK PERMIT

22. Destination country POLAND

23. Member State of first entry POLAND

24. Number of entries requested

• Single entry
• Two entries
• Multiple entries

Visa requested for days should be > 90 and ⇐ 365 300

26. National visas issued during the past five years

• No
• Yes. Date(s) of validity

• to:
• from:

27. Fingerprints collected previously for the purpose of applying for a Schengen visa

• No
• Yes

28. Entry permit for the final country of destination, where applicable
does not apply

29. Intended date of arrival to the Republic of Poland (year-month-day) 2025-01-01

30. Intended date of departure from the Republic of Poland (year-month-day) 2025-10-01

31, 32. Surname and first name of the inviting person(s) in the the Republic of Poland. If not applicable, name of hotel(s) or temporary accommodation(s) in the the Republic of Poland.

→O Is the inviter a company/organization?

Type

• Person
• Company

• Name
• First name OLEKSANDR
• Surname SINELNYK
• Country POLAND
• Place BYTOMI
• Postal code 41-902
• 34. Address CZERWIONKA-LESZCZYNY
• House number 44-230
• Flat number 21a
• E-mail address AGENCJALINPEZ@GMAIL.COM
• Phone area code +48
• Phone number 728146741

32. Name and address of the inviting company/organization

• Name LINPEZ SP Z O O
• Country POLAND
• Place BYTOM
• Postal code→ 41-902
• 34. Address KATOWICKA
• House number 63 M.10
• Flat number M.10

Surname and name, business address, business telephone number and business e-mail address of the contact person in the company/organization:

• First name
• Surname
• Place
• Postal code
• 34. Address
• House number
• Flat number
• Phone area code +48
• Phone number 72814674
• E-mail AGENCJALINPEZ@GMAIL.COM

• Phone area code +48
• Phone number 72814674

33. Cost of travelling and living during the applicant’s stay is covered choose one

• -O by the applicant himself/herself
• By a sponsor (host, company, organisation), please specify
  • X referred to in field 31 or 32
  • other (please specify)

36. Means of support during your stay choose more

• X Cash
• Travellers cheques
• Credit cards
• X Accommodation
• X Prepaid transport
• All expenses covered during the stay
• Other: X

something

X Travel and/or health insurance. Valid until:YYYY-MM-DD

2025-10-01

34. Information on the work permit, certificate of entry of the application in the register of seasonal work applications, declaration of entrusting work to a foreigner or exemption from the obligation to have a work permit

O does not apply

• Type of the document entitling you to work
  • Number of the decision/resolution on the extension of the work permit for a foreigner in the territory of the Republic of Poland (type A, B, C, D, E)
  • Number of the decision/resolution on the work permit for a foreigner in the territory of the Republic of Poland (type A, B, C, D, E)
  • Number of the declaration on entrusting work to a foreigner
  • Number of the declaration of the entity acting as a temporary work agency on entrusting work to a foreigner as a temporary employee
  • Number of the certificate on entry of the application in the register of applications for temporary work
• Document number entitling you to work ZAS/24620/2024/0001553
• Date of issue (year-month-day) 2024-11-26
• Valid until (year-month-day) 2025-10-01
• Issued by
  • 00000 Ministerstwo Rodziny, Pracy i Polityki Społecznej
  • 00001 Ministerstwo Rodziny, Pracy i Polityki Społecznej- Wydział Księgowości
  • 00002 Węzeł centralny PWD
  • 00003 Węzeł PWD dla CBOP
  • 00004 Węzeł PWD dla KSMRP
  • 00005 Węzeł PWD dla Aplikacji Słownikowej
  • 24620 Powiatowy Urząd Pracy w Bytomiu
  • more lola_issuedby

35. Personal data of the EU or EEA citizen you depend on. This question should be answered only by family members of EU or EEA citizens.

X does not apply

• Surname
• First name
• Date of birth
• Nationality
• Number of passport (series and number)

Relationship:

• spouse
• child
• grandchild
• dependent ascendant

X I am aware that the visa fee is not refunded if the visa is refused.

X Applicable in case a multiple entry national visa is applied for (cf. Field No 24): I am aware of the need to have an adequate travel health insurance in the meaning of regulations on health care benefits financed out of public funds or travel health insurance for my first stay and any subsequent visits to the territory of the Republic of Poland.

X I declare that to the best of my knowledge all particulars supplied by me are correct and complete. I am aware that the submission of an application and/or supplementary documents containing untrue personal data or false information, declaration of untruth or the suppression of truth, forgery or tampering with a document with the intent of passing it off as genuine or the use of such a document as genuine will lead to my application being rejected or to the annulment of a national visa already granted, and may also render me liable to prosecution under Polish law. I undertake to leave the territory of the Republic of Poland not later than the last day of the national visa’s validity. I am aware that possession of a visa is only one of the prerequisites for entry into the territory of the Republic of Poland. The fact that a visa has been granted to me does not mean that I will be entitled to compensation if I fail to comply with the relevant provisions of the Law on Aliens and am refused entry. The prerequisites for entry will be checked again on entry into the territory of the Republic of Poland. I am aware that a granted national visa may be revoked if I no longer meet the requirement for its issuance.

X I hereby give consent for my personal data in the e-Konsulat registration form to be processed, in accordance with art. 6 sec. 1 lit. a Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free movement of such data, and repealing Directive 95/46 / EC (GDPR), by the Ministry Spraw Zagranicznych, with its seat in Warsaw, Al. J. Ch. Szucha 23. At the same time, I declare that I have read the information posted on the website https://secure.e-konsulat.gov.pl/rodo being the implementation of the information obligation specified in Art. 13 of the GDPR regarding the processing of my personal data, and I am aware of all my rights referred to in art. 15 - 19 GDPR.

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