IOM Assisted Voluntary Return from Finland - Application for Voluntary Return

Transkriptio

1 For IOM Use only AVR No: PF: IOM Assisted Voluntary Return from Finland English /Finnish IOM HELSINKI IOM Assisted Voluntary Return from Finland - Application for Voluntary Return Finnish Case Number / Ulkomaalaisrekisterin asiakasnumero: 1. Personal Details / Henkilötiedot Last Name / Sukunimi: First Name / Etunimi: Gender / Sukupuoli: Date of Birth / Syntymäaika (pp/kk/vvvv): Place of Birth / Syntymäpaikka: Marital Status / Siviilisääty: Nationality / Kansalaisuus: Contact details in Finland / Yhteystiedot Suomessa: Return Address in Country of Return / Paluuosoite: Telephone Number in Country of Return / Puhelinnumero paluumaassa: Return Country / Paluumaa: Date of Entry in Finland / Suomeen saapumispäivä: 2. Legal Status in Finland / Laillinen status Suomessa Withdrawing Asylum Process / Turvapaikkahakemuksen peruuttanut turvapaikanhakija Refugee Status, Protection / Pakolainen tai kansainvälinen suojelu Rejected Asylum Seeker / Kielteisen turvapaikkapäätöksen saanut turvapaikanhakija Other / Muu: 3. Documentation & visas / Matkustusasiakirjat ja viisumit Document type / Asiakirjatyyppi Passport / Passi Other travel document / Muu matkustusasiakirja Date & place issued / Myöntämispäivämäärä & -paikka Number / Numero Other documents and clarifications / Muut asiakirjat ja muita selvityksiä: Valid until / Voimassaoloaika Current location / Passin sijainti DAVRIF AVR Application Form 1/4

2 4. Dependants returning with applicant / Hakijan kanssa matkustavat perheenjäsenet Last Name / Sukunimi: First Name / Etunimi: Relationship / Perhesuhde Gender / Sukupuoli Date of Birth / Syntymäaika Nationality / Kansalaisuus Passport No / Passin numero 5. Relatives in home country / Sukulaiset kotimaassa Name / Nimi: Relationship / Perhesuhde: Contact Address / Osoite: Telephone / Puhelin: 6. Travel information / Matkustustiedot What is your final destination city in the return country? / Mikä kaupunki on määränpää kotimaassasi? Do you need transportation until your final destination? / Tarvitsetko kuljetuksen määränpäähän saakka? Yes / Kyllä No / Ei Do you need medical assistance during travel? / Tarvitsetko terveyteen liittyvää apua matkan aikana? No / En Yes / Kyllä If yes explain / Jos kyllä, miksi: 7. Language skills / Kielitaito Command / Taso Mother Tongue / Äidinkieli Finnish / Suomi Fluent / Sujuva Regular / Keskitaso Poor / Heikko English / Englanti Other Language / Muu kieli Fluent / Sujuva Regular / Keskitaso Poor / Heikko Fluent / Sujuva Regular / Keskitaso Poor / Heikko DAVRIF AVR Application Form 2/4

3 8. Certification by Applicant / Hakijan vakuutus I, the undersigned,, express my informed decision to return voluntarily to my home country, which is, through the assistance of IOM. I understand that IOM will assist me to return home, and I will not be allowed to stop over in any transit country. I agree for myself, as well as for my dependants, heirs and estate that, in the event of personal injury or death during and/or after my participation in this IOM programme, neither IOM, nor any other participating agencies or government, can in any way be held liable or responsible. I authorize the International Organization for Migration and any authorized person or entity acting on behalf of IOM to collect, use, disclose and dispose of my personal data and, if mentioned in this form, the personal data of my dependants for making the Assisted Voluntary Return arrangements I understand that if I make a false statement in signing this form, the assistance provided by IOM can be terminated at any time. This declaration is signed in English and Finnish languages. In case of discrepancy between the English and the Finnish versions, the English version shall prevail. Minä, allekirjoittanut,, täten vakuutan että olen tehnyt tietoisen päätöksen palata vapaaehtoisesti kotimaahani, joka on, IOM:n avustamana. Olen ymmärtänyt, että IOM avustaa minua palaamaan kotiini, enkä ole oikeutettu jäämään mihinkään kauttakulkumaahan. Annan suostumukseni, joka koskee myös sukulaisiani, perillisiäni ja omaisuuttani, että henkilövahingon tai kulemantapauksen sattuessa tämän IOM:n ohjelman toimintojen aikana, IOM:ia eikä mitään toiminnassa osallisena olevaa tahoa tai valtiota voida pitää tästä vastuuvelvollisina. Valtuutan IOM:n sekä järjestön valtuuttaman, IOM:n puolesta toimivan henkilön tai tahon keräämään, käyttämään ja luovuttamaan henkilötietojani, tai mikäli lomakkeessa mainittu, omaisteni henkilötietoja vapaaehtoisen paluun järjestelyjä varten. Ymmärrän, että mikäli annan vääriä tietoja allekirjoitettuani lomakkeen, IOM:n myöntämä avustus voidaan million tahansa lopettaa. Tämä vakuutus allekirjoitetaan englannin ja suomenkielisenä. Mikäli englannin- ja suomenkieliset versiot eroavat toisistaan, pätee englanninkielinen versio. Applicant s Signature / Hakijan allekirjoitus Place and Date / Paikka ja päivämäärä IOM Representative / IOM:n edustaja Place and Date / Paikka ja päivämäärä DAVRIF AVR Application Form 3/4

4 9. Counsellor / Neuvova viranomainen Comments or concerns to be considered prior to the return arrangements / Kommentteja koskien paluujärjestelyitä: RECEPTION CENTER / VASTAANOTTOKESKUS - MUNICIPALITY / KUNTA - POLICE / POLIISI - OTHER / MUU (Circle / Ympyröi) (Signature of Counselor / Neuvovan viranomaisen allekirjoitus) (Name of Counselor / Neuvovan viranomaisen nimi) STAMP LEIMA (Telephone number / Puhelinnumero) (Fax Number / Faksinumero ( / Sähköposti) Place and Date / Paikka ja päivämäärä 10. Attachments to this application / HAKEMUKSEN LIITTEET Photocopy of the travel documents / Kopio matkustusasiakirjoista Application for Re-integration Support / Uudelleenkotoutumistuen hakulomake Other documents of relevance for travel arrangements (copies of personal IDs, medical statements)/ Muita paluun kannalta tärkeitä dokumentteja (kopioita henkilökorteista, lääkärinlausuntoja 11. For use of IOM Helsinki Only Received on (date): DAVRiF Number: Related PAX / Muut hakijat: IOM Helsinki / Applicant considered eligible for voluntary return: Yes No Estimated Date of Departure: Special Considerations for Return: Please forward the completed form to IOM Helsinki : Mailing address: P.O. Box 851 FI Helsinki, Finland - Visiting address: Unioninkatu 13, 6th floor, FI Helsinki Fax: / 10 iomhelsinkiavr@iom.int, Enquiries: Tel: DAVRIF AVR Application Form 4/4

5 IOM Assisted Voluntary Return from Finland Re-integration support IOM HELSINKI IOM Assisted Voluntary Return from Finland - Application for Re-integration support From 2010 to 2012, IOM Helsinki in cooperation with the Finnish Immigration Service and the European Return Fund can provide reintegration support to voluntary returnees from Finland. The support is provided against an application as cash grants in amounts varying generally between 200 and 1,500 for adults and between 100 and 1,000 for minors (less than 18 years). In exceptional cases, less than 200 may be granted. If you wish to apply for reintegration support from IOM for your voluntary return, please complete this form AND an IOM Voluntary Return Form and return both forms to IOM Helsinki or to your social worker at the reception centre. IOM Helsinki will process your application and inform you on your eligibility to receive the reintegration support. Please note that if you are returning in a family and want to apply for the support for each family member (spouse, children), each person over 18 must fill in his/her own form. Support for children under 18 can be applied for in the application form of one of the parents. The level of support granted to an applicant is decided individually and depends on the person s status in Finland. 1. Personal Details Last Name: First Name: Nationality: Gender: Date of Birth: Finnish case number (Ulkomaalaisrekisterin asiakasnumero): Contact details in Finland: 2. Background for application (check the boxes appropriate) a. I want to know if I am eligible to receive reintegration support before I make my final decision on voluntary return b. I will return voluntarily only if I can receive the reintegration support c. I want to return voluntarily also if I am not eligible for reintegration support 3. Return and reintegration plan 3.1 Where will you live after return? Will you a. rent/buy new accommodation c. return to your previous home b. stay with your relatives d. other, please give more details: 3.2. What do you plan to do after returning to your home country? (you can choose several alternatives) a. Start my own business e. Support my family / Finance education of own children b. Study / undergo training o. Other, please indicate: c. Find a job/work Please provide details on your answer to question 3.2. (what kind of studies/training/work/business etc., what are your goals for the chosen re-integration form) 3.3 Do you already have any a) WORKING EXPERIENCE and/or b) EDUCATION that you might use for achieving your reintegration plans? Please circle the relevant alternative and explain as necessary:

6 3.4 If you receive financial support from IOM, how do you intend to use it towards your reintegration? Why would support be important for you? 3.5 If you are returning with children, describe how they will benefit from the support received from IOM? 3.6 Any other remarks concerning the re-integration support? Anything you want IOM to know? Total amount you apply for (MAX. 1,500 EUR/adult, MAX EUR 1,000/child): 4. Follow-up. Note! optional For the purpose of developing our activities, IOM might contact you after your return has taken place. Please confirm if IOM can contact you after the return? Yes IOM may contact me after I have returned No I do not want IOM to contact me after I have returned 5. Signature By signing this application form, I certify that the information provided is correct to the best of my knowledge, and confirm that I am interested in returning voluntarily to (include also filled-in AVR form). Name Place and date Signature 6. Special Considerations (To be filled by the counsellor only) Please mention any special considerations that, in your opinion, need to be taken into account when deciding the returnee s eligibility for reintegration support. 7. For use of IOM Helsinki Only Received on (date): From (sender): Signature IOM Helsinki / Applicant considered eligible for reintegration support: Yes No (date, signature) Total amount granted for application: (date, signature) Please forward the completed form to IOM Helsinki : Mailing address: P.O. Box 851 FI Helsinki, Finland. Visiting address: Unioninkatu 13, 6th floor,. FI Helsinki Fax: / 10 or iomhelsinkiavr@iom.int, Enquiries: Tel:

7 IOM Assisted Voluntary Return Questionnaire IOM HELSINKI Date: RET / RC / POL / Other: IOM Assisted Voluntary Return from Finland Questionnaire on information sources and feedback - Note! Optional Through this questionnaire, IOM collects information on how applicants for Assisted Voluntary Return got to know of the possibility to return voluntarily from Finland. The information is used only to improve IOM s return programmes. We appreciate if you take two minutes of your time to fill the questionnaire. However, you are also free not to answer if you do not want to. Whether you answer the questions below or not does not affect your application for voluntary return in any way. You can reply anonymously. Information sources and feedback (optional) 1. Gender: Male Female 2. Age: Under Region/town of residence in Finland: 4. Country/area of return: 5. Are you planning to return together with your family? Yes, how many persons are there in your family? No, I am returning alone 6. From where did you hear about Assisted Voluntary Return support in Finland the first time? a. from the Reception Center b. from the Police c. from IOM d. from an association e. from a friend/family f. other (for example: media, Border Guards, Finnish Immigration Service etc. ): 7. Have you received/seen any of these IOM materials? a. IOM brochure b. IOM poster c. visiting card d. visited the IOM website e. received information in other ways? How? 8. Have you in your own opinion received enough information about voluntary return? Yes No I do not know/cannot answer 9. What is your most important reason to return voluntarily with the assistance of IOM? 10. Do you have any other comments for IOM? Thank you for taking time and answering the questions above. This will be helpful when making improvements for the project. Please forward the completed form to IOM Helsinki : Mailing address: P.O. Box 851 FI Helsinki, Finland. Visiting address: Unioninkatu 13, 6th floor FI Helsinki Fax: / 10 iomhelsinkiavr@iom.int, Enquiries: Tel: