Registration Form – Mr. Berendsen Advocaten B.V.

Full given names (e.g. John Sebastian George)* Field is Required! Please enter fullname [e.g. John Sebastian George]

Surname (e.g. Johnson)* Field is Required!

Male/Female

Male

Female

Mobile phone number Invalid phone number!

Landline phone number Invalid phone number!

Country* Field is Required!

Address*Field is Required! To many rows!

Postcode* Field is Required! Allow only 0000XX, i.e. four digits and two letters in capitals

Town* Field is Required!

Bank account Invalid account!

BIC (Swift) Field is Required!

Qualify for subsidized legal aid or discount*

Yes

No

Field is Required!

Date of birth* Field is Required!

BSN (Dutch Social security number) Invalid BSN no

Foreigners number (only in case you have no BSN and if IND has given you one!)

Is the address which you entered also the address know by the local government as your registered address?*

Yes

No

Field is Required!

Why is your registered address not the same as the address where you actually live?* Field is Required!

Registered address* Field is Required! To many rows!

Postcode* Field is Required! Allow only 0000XX, i.e. four digits and two letters in capitals

Town* Field is Required!

Do you live with minors*

Yes

No

Field is Required!

Do you have a partner with who you share your residence*

Yes

No

Field is Required!

Full given names (e.g. John Sebastian George)* Field is Required!

Surname (e.g. Johnson)* Field is Required!

Male/Female*

Male

Female

Field is Required!

BSN (Dutch Social security number) Invalid BSN no

Foreigners number (only in case you have no BSN and if IND has given you one!)

Note: Max size: 2mb, Allowed pdf format only

Choose File Field is Required!

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