NLDMFAVEN2504378223257
RECENT COLOUR
PHOTO
3 x 4 cm
Caribbean Visa Application - Short-Stay
Application
Application Details
Country of Application Venezuela
Main Destination Bonaire
First Entry Bonaire
Personal Details
Identity
Surname(s) Benitez Romero
Given name(s) Rebeca Josefina
Nationality Venezuelan
Gender Female
Marital status Married
Birth
Date of birth 17-04-1974
Place of birth La Guaira
Country of birth Venezuela
Contact
Telephone number +584149288868
Email address rebecajbenitez@hotmail.com
I hereby declare that I wish all correspondence regarding my visa Yes
application for the Caribbean parts of the Kingdom of the Netherlands
to be conducted via the email address as provided by me.
Address
Address BOULEVARD NIZA, PALMAR ESTE, QUINTA LA VENTURERA,
CARABALLEDA. LA GUAIRA
Additional address information
Postal code 1165
City La Guaira
Country Venezuela
Insurance
Do you have travel insurance that includes medical cover and/or Yes
health insurance?
Valid until 30-04-2025
Page 1 of 6
NLDMFAVEN2504378223257
Occupation
Occupation Self-employed
Employer Bekys_Beaute
Phone number +584124398453
Address Caraballeda. La Guaira
Additional address information
Postal code
City La Guaira
Country Venezuela
Journey
Travel Document
Type of travel document Normal passport
Document number 164302141
Valid from 04-12-2021
Valid until 03-12-2031
Country of issue Venezuela
Issuing authority SAIME
Type of Visa
Number of entries Single entry (for a specific purpose of travel), valid for 90 days
Travelling with Registered Partner
Travelling with Registered Partner No
Note: For every individual traveler, a separate application needs to be submitted.
Travelling with Children
Travelling with Children No
Note: For every individual traveler, a separate application needs to be submitted.
First Entry
Country or island of first entry Bonaire
Destination(s)
Destinations that you will visit -Bonaire
Main destination Bonaire
Page 2 of 6
NLDMFAVEN2504378223257
Destination: Bonaire
Travel Dates
Date of arrival in Bonaire 16-04-2025
Date of departure from Bonaire 30-04-2025
Number of days in Bonaire 15
Main Purpose of Visit
Main purpose of visit to Bonaire Visit family or friends
Invitation
Have you been invited to Bonaire? By a person
Surname(s) Winklaar Dirksz
Given name(s) Marisol Cleophatra Petra
Relationship to inviting person Friend of the family
Email address Marisol.dirks@sssbonaire.com
Phone number +5997010662
Inviting Person Home Address
Address Kaya Akuario. 18
Additional address information
Postal code
City Bonaire
Country Bonaire, St. Eustatius, Saba
Guarantor's Details
Is this person acting as a guarantor? Yes
Date of birth of guarantor 27-04-1975
Nationality of guarantor Dutch
Travel document type of guarantor Normal passport
Travel document number NUF2952R7
Accommodation
Where will you be staying during your visit to Bonaire? Staying with the person who invited you
Funding
Means of Support
Who is funding the travel and living expenses? Fully sponsored by someone else
Who will be sponsoring your travel or stay? - Bonaire: Marisol Cleophatra Petra Winklaar Dirksz
The sponsor's or financial guarantor's means of support - Accommodation provided
- All expenses covered
- Prepaid transport
Page 3 of 6
NLDMFAVEN2504378223257
Previous visit: Bonaire
Previous Visit Details
Date of arrival most recent visit 28-11-2019
Duration in days 13
Main purpose of visit Tourism
Page 4 of 6
NLDMFAVEN2504378223257
Declaration:
- I have read and understood the information in the explanatory note and the guidelines for completing the form and have completed the
form in full, correctly and truthfully;
- I understand that the visa is a condition for entry to the Caribbean countries but does not give absolute right of entry. At each border
control I will need to be able to show that I satisfy all the requirements for the intended purpose of travel in the country in question. If I do
not satisfy all the conditions I will be refused entry;
- I will use the visa granted on the basis of this application correctly and lawfully. I will not overstay (exceed the permitted period of stay (for
each visit)). Misuse of the visa may mean my removal from the country. It may also mean that I may not be admitted to the Kingdom of the
Netherlands in the Caribbean in the future.
I am aware of and consent to the following:
The collection of the data required by this application form, including my photograph, is mandatory for the processing of the visa application.
Any personal data concerning me that appears on the visa application form, as well as my photograph, can be supplied to the relevant
authorities of the Caribbean parts of the Kingdom of the Netherlands and processed by those authorities, for the purposes of taking a
decision on my visa application.
Such data, as well as data concerning the decision taken on my application or a decision whether to annul, revoke or extend an issued visa,
will be stored and will be accessible to the visa authorities, the authorities competent for carrying out checks on visas at external borders
and to immigration and asylum authorities in the (Caribbean parts) of the Kingdom of the Netherlands. This data will enable these
authorities to verify whether the conditions for the legal entry, stay and residence have been met, and identify persons who do not or who no
longer fulfil these conditions. The authority responsible for processing the data is: Ministry of Foreign Affairs, Consular and Visa Affairs
Department (HDCV), PO Box 20061, 2500 EB THE HAGUE.
I am aware that I have the right to obtain data relating to me, to request that data relating to me which is inaccurate be corrected, and to
request that any data relating to me that has been processed unlawfully be deleted. At my express request, the authority processing my
application will inform me how I may exercise my right to check data relating to me and have it corrected or deleted, including the related
remedies under national law. The national supervisory authority will hear claims concerning the protection of personal data. For the
Netherlands this is: the Dutch Data Protection Authority (Autoriteit Persoonsgegevens) PO Box 93374, 2509 AJ The Hague.
Declaration of consent: use of email
I hereby declare that I wish all correspondence regarding my visa application for the Caribbean parts of the Kingdom of the Netherlands to
be conducted via the email address as provided by me.
Please be aware that the use of email is subject to security risks. You should be aware of these risks if you choose to have correspondence
regarding your visa application sent by email. The Ministry of Foreign Affairs cannot guarantee the reliability of sending or receiving
messages by email, or the confidentiality and integrity of email correspondence via the internet and therefore accepts no responsibility for
any email messages which are subject to delay in delivery or which fail to reach you. All email messages received are processed in
accordance with Dutch legislation on privacy and security. If you believe the risks to be too great, correspondence regarding your
application can be sent by conventional mail. In this case please be aware that it may take longer to send and receive relevant
correspondence.
Place and date Signature (for minors: the signature of the person(s) with parental
responsibility/the legal guardian)
Page 5 of 6
NLDMFAVEN2504378223257
Visa application number:
Submitted on:
Processed by:
Supporting documents
Standard:
[ ] Valid travel document
[ ] Financial means
[ ] Means of transport
[ ] Health insurance
Optional (depending on purpose of travel):
[ ] Invitation
[ ] Guarantee/guarantor's declaration
[ ] VTA / landing permit / letter of notification / MVV-BES
[ ] Other:
Referral (yes/no): [ ] No, independent decision
[ ] Yes, referred to: (fill in: country and authority)
Visa: [ ] Granted
[ ] Territorially Limited Visa due to:
[ ] Entry for specific purpose of travel
[ ] Public order
[ ] National security
[ ] Public health
[ ] Refused
Code for ground of refusal:
Code for explanation:
Number of entries: [ ] Multiple
[ ] Single (for specific purpose of travel)
Period of stay for each visit:
days (maximum of 90 days)
Valid from
To
Page 6 of 6
