SIGN ALL PAGES OF THE FORM Clear

Submit a colour
digital photo:

• with dimensions
of at least
1300 x 1600 pixels
An applicant aged 15 years and older shall write a specimen signature. An
applicant aged 7 to 14 years or an applicant with restricted active legal
• size capacity may write a specimen signature. In case of an applicant under 7
from 1 MB to 5 MB years of age or an applicant who lacks capacity to sign the field shall be left
blank. The specimen signature shall be written in dark ink and the signature
must not exceed the limits of the signature field.

PERSONAL DATA FORM IN TEMPORARY PROTECTION PROCEDURE

To be completed in capital letters. Please spell the names of a person according to the Latin name form on the
identity document. Corrections are not allowed. If there is no data, draw a line.

PERSONAL DATA
Given name or names Surname or names

Previous names Other names

Date of birth (dd.mm.yyyy) Gender Personal identification code

male female
Country of birth Place of birth

Nationality or ethnic group Religion

Citizenship(s) (including previous ones)

Country Date of acquisition of Basis or circumstance of acquisition of Is a previous
citizenship (dd.mm.yyyy) citizenship one

………………………………... ………………… ……………………………………………….… yes no

.……………………………...... ………………… ……………………………………………….… yes no

………………………………... ………………… ………………………………………………… yes no

Language skills
Language Mother tongue Can speak Can read Can write Can understand
……………………………

……………………………

……………………………

……………………………

Contact details in Estonia

Address in Estonia (street/farm, house number, flat number, village/borough/town; parish; county) Postal code

Phone number (in use since (dd.mm.yyyy) E-mail address (in use since (dd.mm.yyyy)

I confirm that all the information provided in the application and the attached documents are correct. I am
aware that the submission of false information is punishable.
Date (dd.mm.yyyy) Signature of the applicant or his/her legal
representative

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Other contact details (current and past)

Phone, e-mail or social media account In use since In use until Note
(dd.mm.yyyy) (dd.mm.yyyy)
………………………………………………… ………………… ……………… …………………………………………
…………………………………………………. ………………… ……………… …………………………………………
…………………………………………………. ………………… ……………… …………………………………………

Previous places of residence (all previous actual places of residence)

Country Residential address

Legal basis for stay Start (dd.mm.yyyy) End (dd.mm.yyyy)

Country Residential address

Legal basis for stay Start (dd.mm.yyyy) End (dd.mm.yyyy)

Country Residential address

Legal basis for stay Start (dd.mm.yyyy) End (dd.mm.yyyy)

INFORMATION ON STAYS

Country of origin

Country ………………………………………………………….. Date of exit from the country (dd.mm.yyyy)………...………

Place of stay at the beginning of the crisis (Ukraine crisis 24.02.2022)

Country ……………………………………………… Address of stay…………………………………………………………..

Transit countries
Country Date of entry Date of exit Border crossing point Document used for passing
(dd.mm.yyyy) (dd.mm.yyyy) the border crossing point
…………………………… ……………… ……………… ……………………………....... ………………………………
…………………………… ……………… ……………… ……………………………....... ………………………………
…………………………… ……………… ……………… ……………………………....... ………………………………
…………………………… ……………… ……………… ……………………………....... ………………………………

Time and legal basis for arrival in Estonia

Date of arrival in Estonia (dd.mm.yyyy) …………………

Border crossing point ………………………………………………………..……………………………………………….……
Document used for passing the border crossing point ………………………………………………………..……………
Reason for arriving in Estonia and/or requesting temporary protection
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………

I confirm that all the information provided in the application and the attached documents are correct. I am
aware that the submission of false information is punishable.
Date (dd.mm.yyyy) Signature of the applicant or his/her legal
representative

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Time and legal basis for arrival in Estonia

Purpose and actual destination of the journey

………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………….

Education
Country Name of the educational Level of education
establishment
Specialty Start (dd.mm.yyyy) End (dd.mm.yyyy)

Country Name of the educational Level of education

establishment
Specialty Start (dd.mm.yyyy) End (dd.mm.yyyy)

Country Name of the educational Level of education

establishment
Specialty Start (dd.mm.yyyy) End (dd.mm.yyyy)

Employment data
Name of the company/other important circumstance Start End
(dd.mm.yyyy) (dd.mm.yyyy)

……………………………………………………………………………………………… ………………… ………………

……………………………………………………………………………………………… ………………… ………………
……………………………………………………………………………………………… ………………… ………………
……………………………………………………………………………………………… ………………… ………………
……………………………………………………………………………………………… ………………… ………………

Security and service record If you answer “yes” to at least one of the following questions, please fill in the additional
form “Security assessment and service record additional form”
Have you been involved in activities that could threaten the territorial integrity and independence of Estonia or
your country of nationality?
yes no
During the period of validity of your residence permit granted on the basis of protection, have you visited a
country that is (was) at war with your country of nationality or occupying (has occupied) the territory of your
country of nationality?
yes no
During the period of validity of protection, have you visited the country/countries of nationality?
yes no
Have you been convicted of an offence?
yes no
Have you witnessed any war crimes or crimes against the person?
yes no
Have you had any contact with any country’s intelligence or security services?
yes no
Have you cooperated with any country’s intelligence or security services?
yes no

I confirm that all the information provided in the application and the attached documents are correct. I am
aware that the submission of false information is punishable.
Date (dd.mm.yyyy) Signature of the applicant or his/her legal
representative

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Security and service record If you answer “yes” to at least one of the following questions, please fill in the additional
form “Security assessment and service record additional form”
Are you serving or have you served in the armed forces of any other country (other than Estonia), including in
a career position, intelligence, or security services, or have you participated in military operations outside
Estonia?
yes no
Are you subject to mobilisation in the country of nationality?
yes no
Have you received a summons for mobilisation?
yes no

Applications lodged elsewhere

Have you applied for international protection in other countries?
Yes, currently Yes, previously No Not known

Current or previous applications

Country Date of application (dd.mm.yyyy)

Reason for application Decision on the application

Family members
Marital status
married divorced widow(er) in a registered partnership in a common-law marriage
single
Do you have any family members?
no yes (Please fill in the form “Information on close relatives and family members”)

LEGAL REPRESENTATIVE For a child under the age of 18 or other person with restricted active legal capacity, the form is
completed by a legal representative (parent or guardian of a minor child or a representative of guardianship authority)
Representative
parent guardian authorised person/representative
Estonian personal identification code or date of birth Given name and surname / name of the
(dd.mm.yyyy) / registry code of the guardianship authority guardianship authority

I confirm that all the information provided in the application and the attached documents are correct. I am
aware that the submission of false information is punishable.
Date (dd.mm.yyyy) Signature of the applicant or his/her legal
representative

SHALL BE COMPLETED BY AN OFFICIAL

Accepted for proceedings Name, signature

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