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COVID-19 AVRR Pre-Departure Information

 

VOLUNTARY ASSISTED RETURN AND REINTEGRATION
PROGRAMME
(IRELAND)

The International Organization for Migration DOES NOT CHARGE A FEE AT ANY STAGE of the Voluntary Assisted Return process. This is a free and confidential service.

TO APPLICANT OR APPLICANT’S REPRESENTATIVE:
Please complete this form in BLOCK CAPITALS.

1. Family Name/s:

First Name/s

Date of Birth:

Sex :

MaleFemale

Place of Birth:

Nationality:

Marital Status:

Citizenship:

Address in Ireland:

 

Telephone No:

Referral Agency:
(How did you hear about IOM?)

Immigration Status:

Asylum application pendingAsylum application refusedAsylum appeal pendingAsylum appeal dismissedLeave to Remain/Pending (HLR)

Other (please specify):

2. Date of exit from Country of Origin:

Date of last entry into Ireland:

Date applied for Asylum:

 

Passport/Travel Doc:

YesNo

Date of Expiry:

Location
(Is it with you?):

 

Documents held by Immigration:

(ID card, Driving License, etc)

3. Family Members returning with you:

First Name
Family Name
Date of Birth Sex
(M/F)
Relationship to Applicant Citizenship Passport Expiry Date Immigration/ Asylum Ref. No.

4. Reasons for Wishing to Return:

Would you like to apply for reintegration assistance from IOM:

YesNo

Special Needs (Wheelchair or other medical requirements):

(Please note that IOM may need to share information on medical issues with the third parties in order to provide medical assistance)

Final Destination in Country of Origin (please state full address):

Town of Destination:

Closest Airport:

  Project co-financed by the European Return Fund