APPLICATION FOR RESIDENCE PERMIT FOR INDEPENDENTS Art. 51 (1) n°3 of the law of 29 August 2008Form to be sent to Ministère des Affaires étrangères et del’ImmigrationDirection de l'Immigration B.P. 752L 2017 Luxembourg I. Informationrelating to the applicant and his/her family situation: 1. Lastname:2. Firstname(s) :3. Placeand date of birth :4. Sex: malefemale 5. Nationality:6. Nationalinsurance number* : (* if already registered with the Centre Commun de la Sécurité Sociale) 7. Residencein the countrySince//Single Married since//With civil partnersince//8. Maritalstatus : Separated since//Divorced since//Widower widow 9. Currentactivity :Number :Street :Town :Post code :Country :10.Legal address : Telephone :Fax :Email :Name of representative (if relevant) :Number :Street :11.Postal address : Town :Post code :Country :Telephone :Fax :Email :12.Last name of spouse/ civil partner: 13.First name(s) of spouse/ civil partner: Number :Street :14.Address of spouse/ Town :Post code :Country :civil partner: Telephone :Fax :(if different from applicant’s) 15.Activity of spouse/ civil partner: 16. Other people sharing or likely to share the applicant’s household: Last nameFirst name(s)Date of birthPlace of birthNationality RelationshipCurrent activity