Application for national visa

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

<note info> organ wydający zaświadczenie ZCS/24620/2024/0001532 Bytom, 2024-11-26 sygnatura sprawy </note>

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

<note important> 48 hour link from email

Your preliminary application has been successfully verified. In the next step, please complete the full application. https://secure2.e-konsulat.gov.pl/placowki/221/wiza-krajowa/rejestracja/wynik-weryfikacji/693a5418-8b6f-408d-b8de-afd0b5760011 </note>

online fillup here:

Website of the Ministry of Foreign Affairs of the Republic of Poland

Home page > Abuja > National visa - fill in the form <note warning> This template will allow for the filling out and printing of your visa application only. To make an appointment in a selected Consular office, you are required to register your visa application. </note> <note tip> Fields No: 1, 2, 3, 5, 11, 13, 16, 31, 34 should be filled in by using the Latin alphabet letters only (A, B, C, D, E, F, G, H, I, J, K, L, M, N, O, P, Q, R, S, T, U, V, W, X, Y, Z). Any erroneous entry shall make the application void. </note>

Personal data

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):

Guardian details 1

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

<note> Icon information Current email address. Other e-mail addresses than the one provided in the VISA Application Form shall not be used when contacting an applicant. </note>

E-mail remi adetunji REMADE85@YAHOO.COM
Phone area code +234
Phone number 8034047860

Other data

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

Travel data

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

Data of receiving person

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

Company/organization phone number

Phone area code +48
Phone number 72814674

Data of person covering expenses

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

Data of the document authorizing you to work

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

euro EU citizen data

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

Applicant's data

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.

<note> * Questions marked with * may be omitted by family members of EU or EEA citizens (spouse, child, or dependent ascendant). Family members of EU or EEA citizens have to present documents proving this relationship. </note>

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