APPLICATION FORM

FORM N3

Changes to Application for
Nomad Residence Permit
Lost/Stolen/Damaged Card
Please read the document list and checklist
prior to completion of this form

Residency Malta Agency
Zentrum Business Centre, Level 2,
Mdina Road, Qormi, QRM 9010, Malta

Form N3 – Changes to Application for Nomad Residence Permit. Lost/Stolen/Damaged Card

nomad.residencymalta@gov.mt
Page
Page
11ofof44Please type in your response. Handwritten forms will not be accepted. Use blue ink only for signatures, tick boxes and strikethroughs.

PART A - APPLICANT’S DETAILS
A1. Residence Permit Number (ending with an ‘A’)

A2. Date of Birth

A3. Surname and Name

A4. Nationality
A5. Email address
A6. Phone number
A7. Mobile Phone Number

PART B - TYPE OF CHANGE
Change of address (copy of previous residence card and copy of new purchase/rental agreement
attached, together with application fee of EUR 27.50)

Lost/stolen card (within 3 working days of losing one’s residence card applicants need to provide a local
police report, together with application fee of EUR 27.50)

Damaged card (against application fee of EUR 27.50)



Other changes to the application (against application fee of EUR 27.50)

PART C - CHANGE IN ADDRESS Tick if not applicable

C1. Previous addressLine 1
Line 2District
Province
StateCity
PostcodeCountry

Form N3 – Changes to Application for Nomad Residence Permit. Lost/Stolen/Damaged Card

Page 2 of 4

C2. New addressLine 1
Line 2District
Province
StateCity
PostcodeCountry

PART D - OTHER CHANGES Tick if not applicable

D1. List details to other changes here

PART E – DECLARATION OF APPLICANT
I hereby declare that the information given in this application and all supporting documentation are true,correct and up to date in every detail. I understand that if I supply false/incorrect and/or omitted information, myapplication will be refused, and permit will be revoked.
I also confirm that I have read and fully understood the contents of the attached Form N4 -General Data
Protection Regulation EU 2016/679 (GDPR) Declaration Form and declare that I consent to my personal data
being processed, under the grounds and for the purpose of this application, and that I have consciously signedthe said Form N4 in the appropriate section in acceptance thereof.
I understand that Residency Malta Agency reserves the right to verify any personal information relating to me andmay carry out due diligence exercises for the purpose of this application both prior to and following, the grantingof such application.
I am also aware that during such verification process, Residency Malta Agency may:• disclose to third parties any personal information about me and/or my family members and/ordependants; and• obtain from public sources, government bodies and/or any other kind of records deemed necessary,
about me and/or my family and/or my dependants;
and to this effect I hereby release Residency Malta Agency from any responsibility and/or liability.
Signature of applicant

Date of signature

Form N3 – Changes to Application for Nomad Residence Permit. Lost/Stolen/Damaged Card

Page 3 of 4

Note to applicants:
Fee Schedule
Form NumberTitle

Residency Malta
Agency Fee

Identity Malta
Agency Fee

Form N1

Nomad Residence Permit

EUR 300

EUR 27.50

Form N2

Nomad Family Member Residence Permit

EUR 300

EUR 27.50

Premium Visa Application

N/A

EUR 300Changes to Application for Nomad Residence
Permit. Lost/Stolen/Damaged Card

N/AEUR 27.50

Form N3

Form N3 – Changes to Application for Nomad Residence Permit. Lost/Stolen/Damaged Card

Page 4 of 4