UTLD-110
ÚTLENDINGASTOFNUNDIRECTORATE OF IMMIGRATION

Móttekið:Málsnúmer:OTHER RESIDENCE PERMITSAPPLICATION FOR FIRST PERMIT
Please duly complete the application and be sure to sign it.
An incomplete application may lead to delays in processing or rejection of the application.

ApplicantName
Date of birth (dd.mm.yy.)

I am applying for the following residence permit:
Working Holiday/Youth Mobilityfor volunteers

for missionaries

on grounds of legitimate and special purpose

based on special ties to Iceland

Other, what?

For whom is the form intended?
The form is for adult individuals who are applying for aresidence permit for which there is no separate application
form. It is necessary to select which residence permit isapplied for. If „Other, what?“ is selected, it must be specified
on what other basiss the application is made.

What documents must be included with the first
application?
Information on necessary supporting documents anddocument requirements can be found on the Directorate’s
website.
It is important to read the information thoroughly. Please
note that different requirements are made for different typesof residence permits.
You can also use the checklist at the end of this form forcommon requirements.

reception in Dalvegur 18, 201 Kópavogur. It is necessary to
first pay the processing fee by bank transfer and submit thepayment receipt with the application for confirmation. An
unpaid application will be returned to the applicant.
Applications can also be handed in and paid for in the Director­
ate’s reception or at the offices of District Commission­ers
outside the capital area.

Application processing
It is the applicant’s responsibility to submit satisfactory
documents with an application. If satisfactory documents
are not received, this may lead to delays in processing orre­jection of the application.
Applications and supporting documents are not assessed
upon reception and registration. The Directorate of Im­mi­grat­­ion contacts the applicant or his/her agent if furtherdoc­u­­­ments or information is needed for pro­cessing theapplication.

Applications can only be submitted in paper form.

The Directorate of Immigration forwards an application for awork permit and employment contract to the Directorate ofLabor for processing, if applicable.

They can either be sent by regular mail to the Directorate ofImmigration or delivered to the drop box in the Directorate’s

Information about processing time can be found on theDirectorate ‘s website.

How to apply?

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1. Residence permit
Provide information on whether you are applying for a first residence permit or a change on the basis of a residence permit.
Generally, first residence permits are granted for one year.
I am applying fora) A first residence permitb) A permit on a new ground

2. Ties with Iceland or other Schengen countries
If your application will be denied and you are still in Iceland the Directorate of Immigration is obligated to issue an expulsion. Witha decision on expulsion the Directorate generally issues a period of voluntary departure. If you do not leave the country within thegiven period of voluntary departure an entry ban is activated, which is usually valid for the entire Schengen-area. Hereby you aregiven the opportunity to provide information that may be relevant to the expulsion decision and to object to that decsision. If you
do not fill in this part of the application form, it is regarded as you do not object to an expulsion if your application will be denied.
If there are any changes in you circumstances, it is important that you inform the Directorate as soon as possible so thatcan be taken into account.
Do you have any ties with Iceland or other countries within the Schengen-area?

Yes



No



Yes



No

If yes, what ties?

Are there any reasons that could lead to that a decision on an expulsion and an entry ban to theShcengen-area would be considered an unfair measure towards you or other members of yourfamily?
If yes, what reasons?

3. Applicant’s details
Given nameSurname
Former names (if applicable)
Gender (as in passport)

Marital status



FemaleCohabitation

Married

Male

Unmarried

Widow/widower

Non-binary/Other

Separated

Divorced

Place of birth (city)
Country of birth
Current nationality/nationalities
Are both or one of your parents Icelandic citizens?

UTL ÚTLENDINGASTOFNUNDIRECTORATE OF IMMIGRATION



Yes



No

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Address, email and telephone number in home country
The information will be used to contact the applicant; therefore it is important that the information is correct. If the information
changes during the processing of the application, the Directorate of Immigration should be notified by email utl@utl.is.
Address
Postal code and place
Country
Telephone number
Email address
Address and telephone number in Iceland
A condition for the issuance of residence permits is that applicants state their place of stay in Iceland. The stated address will beregistered as their legal domicile by Registers Iceland. The information will also be used to contact the applicant; therefore it isimportant that the information is correct. If the information changes during the processing of the application, the Directorate of
Immigration should be notified by email utl@utl.is. After a permit has been issued any changes of address must be reported toRegisters Iceland.
Address and apartment
number (if applicable)
Postal code and place
Telephone numberAddress not yet known. Notification of residence in Iceland will be handed in after arrival in Iceland (e.g. when theapplicant attends the required photoshoot).

4. Residence
Residence abroad
Where have you lived during the past five years?
CountryDate from (dd.mm.yy.)

Date to (dd.mm.yy.)

123456Residence in Iceland
When do you intend to come to Iceland?
Have arrived in Iceland

State the date (dd.mm.yy)
When did you arrive? (dd.mm.yy)

Have you ever applied for a visa to come to Iceland?

Yes



No

Have you previously applied for a residence permit in Iceland?

Yes



No

Have you been in Iceland before? If yes, then when and how long? (If you need more space forfurther information, please use section 11 in this form).

Yes



NoUTL ÚTLENDINGASTOFNUNDIRECTORATE OF IMMIGRATION

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5. Applicant’s spouse
I do not have a spouse.

Given name
Surname
Former names (if applicable)
ID number / Date of birth
Citizenship

Email address

Date of marriage (dd.mm.yy.)

Date of the registration ofcohabitation (dd.mm.yy)

6. Applicant’s children under the age of 18
I do not have children under the age of 18

Gender (as in passport)
Given name

SurnameID number /Date of birth

CitizenshipIs the childin Iceland?

BoyGirl

Nonbinary/
otherYes

No1.





2.

3.





4.



5.









6.







7. Applicant’s parents
Parent 1
Gender (as in passport)

Male

FemaleNon-binary/other

Given name
Surname
Former names (if applicable)
Date of birth (dd.mm.yy.)
Date of death, if applicable(dd.mm.yy)
Citizenship
Address
Postal code and place
Country

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Parent 2
Gender (as in passport)

Male

FemaleNon-binary/other

Given name
Surname
Former names (if applicable)
Date of birth (dd.mm.yy.)
Date of death, if applicable(dd.mm.yy)
Citizenship
Address
Postal code and place
Country

8. Applicant’s relatives in Iceland
Provide information about relatives in Iceland, if applicable.
I have no relatives in Iceland

I have the following relatives in Iceland:
Given nameDate of birth(dd.mm.yy.)

Surname

Citizenship

Please state kinship

1.
2.
3.
4.
5.
6.

9. Language skills and education
Language skills
Native language
Other languages
Education
Please check all the applicable boxes, only stating education that is completed.
None or less than primary school

Primary school

Year of graduation:

Secondary school

Year of graduation:

Secondary school, additional levels

Year of graduation:

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University, less than BA/BS degree

Year of graduation:

University, BA/BS degree

Year of graduation:

University, master´s degree

Year of graduation:

University, doctor´s degree

Year of graduation:

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Fields of study, highest education
Check only one box.
General studies

It and communication

Education

Civil engineering, production and constructionArts and humanities



Agriculture, forestry, fisheries and veterinary studies

Social science, journalism and information theoryHealthBusiness, administration and law



Welfare

Science, mathematics and statistics

Service

10. Criminal record
Applicants must submit a criminal record certificate issued by their country of residence. The certificate may not be older than 12months when submitted.
A. Have you been fined or sentenced to imprisonment?
No



Yes

State the offence:

In what country?

When?

What penalty did you receive?

B. Do you have the status of a suspect in a police investigation?
No



Yes

State the offence:

In what country?

When?

C. Have you been subjected to a re-entry ban into the Schengen Area?
No



Yes

If yes, in what country?

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Is the ban still in effect?
No

If no, when was it in effect?

Yes

If yes, when does the banexpire?

11. Additional information
If you have further information of significance regarding your application, please state it in the box below.

12. AgentYou only need to fill in this part of the application if you want to give power of attorney to an agent during the processing of
this application. You can only have one agent at a time. If you wish to cancel or change your agent, you must communicate
this in writing to the Directorate of Immigration.
Information about your agent
Name
ID number / Date of birth
Address
Phone number
Email address
Security number**A four digit security number must be provided for the purpose of obtaining information about the applicant’s case from theDirectorate of Immigration. The security number should be treated like a password and only be known to the person concerned.

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13. Did you remember everything?
The Directorate recommends that you use the checklist below to make sure your application is satisfactory.

ChecklistPayment receipt (if the application will be sent by mail or delivered to the drop box at Dalvegur 18 and therefore paid forin a bank).

Passport photo (35 mm x 45 mm).

Copy of passport (personal information page and signature page). The passport must be valid at least 90 days beyond thevalidity of the permit applied for.

Copy of criminal record certificate from country of residence. The certificate may not be older than 12 months whenapplication is submitted. (Does not apply to residence permits for volunteers).

Translation of the criminal record certificate by an authorized translator (only applies if foreign certificates are inanother language than English or a Nordic language). If the translator has not been legally certified in Iceland, the originalof the translation must be legally authenticated.



Health insurance confirmation, valid for six months, with a minimum coverage of ISK 2,000,000 (from an insurancecompany authorized to operate in Iceland).

Documents confirming secure means of financial support during the period of residence. Information about the amountrequired, valid means and documents required is available on the Directorate’s website.

Special data requirments of the residence permit applied for. See more information about data requirments on theDirectorate‘s website.

Applicant has signed the application.

I wish that the Directorate contacts me through:EmailUTL ÚTLENDINGASTOFNUNDIRECTORATE OF IMMIGRATION

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14. Date and signature
The Directorate of Immigration may obtain further information about you from domestic and / or foreign parties if this is necessary
for the application in order to ensure that the information is correct and / or to verify the validity of certificates. The Act no.
90/2018 on Data Protection and the Processing of Personal Data is always respected when gathering information. The Directorateof Immigration, the Immigration and Asylum Appeals Board, Registers Iceland, child protection authorities and the police arepermitted to process and combine personal information in accordance with the instructions of the Act on Foreigners and Act on
Data Protection and the Processing of Personal Data. In addition, the same parties may obtain information from the tax authorities,
the Directorate of Labor and municipalities’ social services to ensure that your stay is legal.
If a residence permit is granted, the Directorate of Immigration will forward information to Registers Iceland that is necessary forregistration in the National Registry.
Information about you may be used in the processing of later applications and / or applications from family members to ensurethat the information is correct. During the period of validity of a residence permit, the Directorate of Immigration may examine
your data if information about changed circumstances or the validity of documents is received. Incorrect or misleading information
can lead to a residence permit rejection, revocation and possibly an expulsion. Incorrect provision of information to the Directorateof Immigration is a violation of the Act on Foreigners and punishable under the General Penal Code no. 19/1940.
The Directorate of Immigration’s Data Protection Policy is available on the Directorate‘s website.
Applicants who move to Iceland from certain countries must undergo a medical examination within two weeks of arrival in Icelandin accordance with Icelandic law and instructions of the Directorate of Health. If you do not go for a medical examination, aresidence permit will not be issued.

I confirm that I have read the information above and that the information I have provided regarding the application fora residence permit is true and correct.
I agree to undergo a medical examination within two weeks of arrival in Iceland in accordance with Icelandic law andinstructions of the Directorate of Health, if applicable.

Place, date and signature
Place
DateApplicant’s signature
Who filled out the application?
Applicant

AgentOther

If other, who?

Connection to the applicant.

UTL ÚTLENDINGASTOFNUNDIRECTORATE OF IMMIGRATION

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