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NATO UNCLASSIFIED/ RELEASABLE TO INTERNET - PERSONAL IN CONFIDENCE (WHEN COMPLETED) TO BE COMPLETED ELECTRONICALLY In-processing form (SF94 - JUNE 2016) is also available for download, at: http://www.shape2day.com/arriving--leaving-shape/inprocessing.aspx SF 94 - JUNE 2016 ANNEX SD 40-9 SHAPE ID CARD APPLICATION All personnel must be in possession a valid National Passport/Military ID Card when applying for a SHAPE ID Card Part 1 Personal Details (applicable to all) Name (Surname first) Marital Status (2) Maiden Name Date of Marriage Rank/Title Place of Marriage Gender Service (3) Country of Birth & Town Type of Member (4) Nationality (1) Date of arrival in Belgium Date of Birth Date of departure: State of Birth (US and Canada only) NATO Rank Part 2 Employment Details (not applicable for dependents) Authorized post number (PE) Branch Posting Start Date Bldg. Posting End Date Rm. Division Tel. Ext Part 3 For dependents only (tick as appropriate) - please attach supporting notes/official documentation* Name of the holder (titulaire) SHAPE ID CARD Nr./Post Number Relationship with the holder (titulaire) Spouse Son Daughter *Civil Partnership *Cohabitation *Other Part 4 Other details: complete where applicable Have you been registered in Belgium Yes No From: To: Do you hold any valid Belgium Id Yes No From: To: Do you intend to reside in Belgium? If “yes” please indicate your current or future address. If “no”, leave the box blank. Yes City/post code/name street Nr. No Last address abroad City/post code/name street Nr. Tel. number/and GSM Email address (official/personal) Part 5 Situation related to vehicles imported in Belgium where applicable. How many vehicles will you bring into Belgium and plate number Nr. Plate Nr: Plate Nr: Part 6 SHAPE Language Testing Centre, Linguistic Services (Bldg 101, Room M104/105) For Military Personnel Assigned to an ACO PE Post Language test Yes - No Presented him/herself with a valid English language proficiency certificate OR signed up for an English language proficiency test Date: Stamp & Signature, SLTC Applicant’s declaration ANY FALSE DECLARATION MAY RESULT IN THE LOSS OF SHAPE PRIVILEGES AND/OR IMMUNITIES. I UNDERSTAND THAT SHOULD ANY SUBSEQUENT INFORMATION ASCERTAINED BY SHAPE OR HOST NATION OFFICIALS REVEAL THAT I AM NOT ENTITLED TO RECEIVE SHAPE PRIVILEGES AND/OR IMMUNITIES, SUCH PRIVILEGES AND/OR IMMUNITIES CAN BE WITHDRAWN AND BELGIAN AUTHORITIES ARE EMPOWERED TO DEMAND REIMBURSEMENT OF APPLICABLE TAXES. Applicant’s signature Certified by Stamp/Date/Signature (NMRs/SU/J1 CHRM/SHAPE NCIA/ACTSEE) (stamp of entitled authority) See SD 40-9 (Annex A1) Determination Individual’s Legal Status and Classification SHAPE BSG - FSCEP - REGISTRATION SECTION (BLDG 210 - RM.110) TO BE COMPLETED BY BSG/FSCEP/RGN Personnel ONLY Type of Member Type of Card Stamp/Date/Signature Matrix Status & Entitlements. APMS - Nr. Remarks: Nr. (to be numbered in order to permit a MIN FIN verification). BEL SID - Mod P or S. Request Nr. (if applicable): 1 of 2
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