Fillable DECLARATION: APPOINTMENT OF A TRUSTED PERSON

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DECLARATION: APPOINTMENT OF A TRUSTED PERSON

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C
OMMISSIONER
G
ENERAL FOR
R
EFUGEES AND
S
TATELESS
P
ERSONS
Page 1 of 2
Rue Ernest Blerot 39, 1070 BRUSSELS T 02 205 51 11 F 02 205 50 01 cgvs.info@ibz.fgov.be
www.cgrs.be
DECLARATION: APPOINTMENT OF A TRUSTED PERSON
Case number CGRS:
P.S. number:
The applicant for international protection:
Name, first name:
Nationality:
Place and date of birth:
Chosen residence:
Telephone number:
Fax number:
E-mail address:
………………………………………………………………………………………………………………
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………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
Appoints as a confidant:
Mr or Ms:
Name, first name:
Nationality:
Place and date of birth:
Occupation + employer:
Professional link with asylum seeker:
Working address:
Phone number and/or e-mail address:
……………………………………………………………………………………………
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……………………………………………………………………………………………
……………………………………………………………………………………………
……………………………………………………………………………………………
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who accepts this appointment.
Hereby the applicant for international protection authorizes the confidant to assist him/her during the
processing of his/her application by the CGRS.
A copy of a Belgian identity document or of a residence document (Belgian or issued by a European
Member State) has been attached to this document.
C
OMMISSIONER
G
ENERAL FOR
R
EFUGEES AND
S
TATELESS
P
ERSONS
Page 2 of 2
Rue Ernest Blerot 39, 1070 BRUSSELS T 02 205 51 11 F 02 205 50 01 cgvs.info@ibz.fgov.be
www.cgrs.be
According to article 1/1, 6° of the coordination officieuse de l’Arrêté royal du 11 juillet 2003 fixant la
procédure devant le Commissariat général aux Réfugiés et aux Apatrides ainsi que son function-
nement, a confidant is a person who is specially authorized by applicant for international protection to
assist him during the processing of his application and who acts professionally.
Done in …………………………………………………… on ………………………………………………………………
Signature asylum seeker Signature confidant
…………………………………………………………………… ……………………………………………………………………
Please send this form completed, dated and signed to the CGRS:
By post Office of the Commissioner General for Refugees and Stateless Persons
Helpdesk lawyers, trusted persons and UNHCR
Rue Ernest Blerot, n° 39
1070 Brussels
By fax 02 205 50 07
By e-mail CGRA-CGVS.Advocate@ibz.fgov.be
Or hand in this form completed, dated and signed at the Helpdesk lawyers, trusted persons and
UNHCR.
This Helpdesk is open every working day from 9 a.m. to 12.30 a.m. and from 2 p.m. to 4 p.m.
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DECLARATION: APPOINTMENT OF A TRUSTED PERSON

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Completed 15 March 2022

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