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document from email On Wednesday, December 4, 2024, 1:20 PM, Zoya Immigrationua zoyaimmigrationua@gmail.com wrote:
Identyfikator w systemie central ZAS/24620/2024/0001553
organ wydający zaświadczenie ZCS/24620/2024/0001532 Bytom, 2024-11-26 sygnatura sprawy
ZCS/24620/2024/0001532
List intencyjny do UMOWA ZLECENIA
Formular online to fill up: http://wiki.itbs.selfhost.co/lib/exe/fetch.php?media=playground:about:lola_nationalvisa_fillout_abuja_system.pdf
Website of the Ministry of Foreign Affairs of the Republic of Poland Application for national visa Home page > Abuja > National visa - fill in the form 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. 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.
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)*
07-09-1975 1975-09-07
5. Place of birth*
IBADAN
6. Country of birth*
NIGERIA
7. Current nationality/ies*
NIGERIA
Original nationality (nationality at birth)*
8. Sex *
Male
Female
9. Martial status
Single
Married
Separated
Divorced
Widow(er)
Other
11.National identity number, where applicable ID 50012717150
A11976028a
12. Type of travel document
Ordinary passport
or Official passport
13. Travel document’s number (series and number)
A11976028a
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
X does not apply
Nationality
NIGERIA
17. Applicant’s home address and e-mail address
State OYO-STATE
NIGERIA
State/province
OYO-STATE IBADAN
Place
NIGERIA
Postal code
200282
Address
Number 13 TAXI PARK STREET OKE-ITUNU MOKOLA IBADAN,OYO-STATE NIGERIA
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.
E-mail remi adetunji remade85@yahoo.com
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
19. Current occupation
Civil servant
20. Employer and employer’s address and phone number. For students, name and address of school
Employer
School
21. Main purpose(s) of the journey:
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 3 Letter
ZAS
Visa requested for days (>90)
365
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.
Data of receiving person
→O Is the inviter a company/organization?
Type
Person Company
32. Name and address of the inviting company/organization Data of receiving person
34. Address Katowicka
Surname and name, business address, business telephone number and business e-mail address of the contact person in the company/organization:
33. Cost of travelling and living during the applicant’s stay is covered
Data of person covering expenses choose one
-O by the applicant himself/herself
By a sponsor (host, company, organisation), please specify
36. Means of support during your stay
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 Data of the document authorizing you to work
O does not apply
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. EU citizen data
X does not apply
→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.
* 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.
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