Antecedents

Antecedents Certificate Example

This certificate only needs to be completed if the foreign national is 12 years of age or older.

1 Certificate

> Please tick the applicable situation

[ ] I certify that:

I have never been sentenced to imprisonment or a custodial measure for committing a crime;

I have never been sentenced to perform community service for committing a crime;

I have never been imposed an unconditional fine for committing a crime;

I have never accepted an out-of-court settlement for committing a crime;

I have never been imposed a penalty order by a public prosecutor for committing a crime;

I am currently not subject to prosecution for committing a crime;

I have never been responsible for one of the following categories of acts as referred to in Article 1F of the 1951 Refugee Convention: a crime against peace, a war crime, a crime against humanity, a serious non-political crime (for example murder or terrorism), or acts contrary to the purposes and principles of the United Nations (for example terrorist acts);

and • I am aware of the fact that a sentence for committing a crime may result in a refusal or termination of the right of residence.

I have not submitted any incorrect data during earlier residence procedures;

I did not reside in the Netherlands illegally in the past;

I am not subject to any entry ban. 

[ ] I am unable to certify the above for the following reasons:

2 Signing (by the foreign national)

I have completed this form truthfully.

2.1 Name

2.2 Place and date                                        Place                                                  Day Month Year

2.3 Signature

Please note!

If this antecedents certificate has not been completed truthfully, this will have consequences for your right of residence.