Beruflich Dokumente
Kultur Dokumente
Isem
Name
Kunjom
Surname
Numru ta l-Identita
Identity Number
Tel / Mob
Data tat-Twelid
Date of Birth
e-mail *
Nazzjonalita`
Nationality
Indirizz
Postal Address
EHIC gal tfal tat is-sittax-il sena iddikjarati mill-enituri (jekk applikabbli)
EHIC requested for children (under 16) declared by parent (if applicable)
Numru ta l-Identita
ID Number
Kunjom
Surname
Isem
Name
Dikjarazzjoni / Declaration
Jien niddikkjara li l-persuni kollha imsemmija fdin l-applikazzjoni jgixu bmod permanenti fMalta jew Gawdex u
aettaw li jagtu d-dettalji personali taghom. Sa fejn naf jien l-informazzjoni kollha li niilt hija eatta.
I understand that all persons specified in this form live permanently in Malta or in Gozo and have consented to their personal
details being disclosed. All the information given on this form is correct and complete to the best of my knowledge.
___________________________________
Firma / Signature of Applicant
_____________________________
Data / Date
L-Entitlement Unit jibor l-informazzjoni sabiex ikun jista jagti servizzi mitluba skond ir-Regoli 1480/71 u 574/72 tal-Komunita Ewropeja. Kull informazzjoni
mibura u pproessata hija konformi ma l-Att dwar il-Protezzjoni tad-Data u l-Privatezza tad-Data, l-imsemmija Ordinanza u leislazzjoni sussidjarja ora.
The Entitlement Unit carries out its functions in accordance to EC Reg. 1480/71 and EC Reg. 574/72. All data is collected and processed in Accordance with the
Data Protection Act, 2001, the said Ordinance, other subsidiary legislation and the Privacy Policy of the Department.
Xitwa
Winter
Mondays and Fridays between 9:00 12:00
Wednesdays between
9:00 12:00 and 14:00 16:00