EU Long Term Form

DATA FOR THE EU LONG TERM APPLICATION

Disclaimer – Personal Data & Form Usage

This form is designed as a practical tool to help you prepare for your consultation and to make completing your application in the MOS 2 system more efficient. Please note that this form functions solely as a template. Any information you enter is not stored, saved, or transmitted through this website. Your data remains entirely under your control and is only used by you to complete, download, or print the document for your own use. While the form may request personal details, your privacy is respected and no data is retained by this site. We encourage you to use this tool to save time, stay organised, and feel fully prepared for both your consultation and application process.

Please fill in CAPITAL / PRINT letters.

Personal data

Surname (like in the passport)

Previous surname or surname before marriage

Names (like in the passport)

Father’s FIRST name

Mother’s FIRST name

Mother’s maiden name (her surname before she was married)

Date of birth (dd/mm/yyyy)

Sex

Male Female

Place of birth (like in the passport)

Country

City

Region (if applicable)

Nationality

Citizenship

Marital status -- select -- Single Married Divorced Widowed Separated

Current level of obtained education -- select -- PhD Masters Bachelor High school Other/Not applicable

Profession / Job title (in Polish if possible)

Height in cm

Colour of eyes

Special marks (if you have it)

PESEL number (if you have it)

Email

Polish phone number for communication

Address in the country of origin

Country

Voivodeship / District / Province / State

County / Region / District / Borough

Municipality

City/Town

Street

House number

Flat number

Postal code

Address in the previous country of residence

Country

Voivodeship / District / Province / State

County / Region / District / Borough

Municipality

City/Town

Street

House number

Flat number

Postal code

Current address in Poland

Voivodeship

District

Municipality

City/Town

Street

House number

Flat number

Postal code

Legal title to the apartment -- select -- Ownership Rental agreement Other

Please specify

Exact date of your FIRST entry into Poland (dd/mm/yyyy)

History of your stay in Poland

Please be very precise and make sure you write correct dates.

BASED ON:

Visa – day you entered → visa expiry date

TRC – date of positive decision → decision expiry date

From (date)	To (date)	Based on
		-- select -- Visa TRC

Add row

Exact date of your LAST entry into Poland (dd/mm/yyyy)

What is the purpose of your current stay (last TRC was given based on…)?

ALL (including your home country, except Poland) countries you have been in the past 5 years

Country	From (date)	To (date)

Add row

Do you have/did you have “EU Blue Card”, issued by the European Union Member State other than Poland?

YES NO

Do you have/did you have residence permit for the EU long term resident granted in another EU country?

YES NO

What type of residency do you currently hold?

Basic TRC Blue Card

What has been your source of income for the past 3 years?

Number of persons currently financially dependent on you (in Poland)

Currently dependent family members of a foreigner living in Poland
(Please skip if you wrote “zero” in the previous point)

Please write few sentences explaining why you wish to obtain EU long term residency.