от 23.10.2023 г. №
Agreement between the Government of the Republic of Uzbekistan and the Government of the Republic of Estonia
Date of entry into force
01.03.2024

______________

(place and date)

[State emblem]

________________________________________

(name of the Central Competent Authority of the Requesting State)

Number _________

○ Request for an interview

To: _______________________________

(name of the Central Competent Authority of the Requested State)

A. PERSONAL DATA

1. Full name (underline surname):

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

2. Maiden name (if applicable):

Photograph

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

3. Date and place of birth:

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

4. Sex and physical description (height, color of eyes, distinguishing marks etc.):

……………………………………………………………………

5. Also known as (earlier names, other names used/by which known or aliases):

........................................................................................................

6. Citizenship and language:

........................................................................................................

7. Civil status (where possible)

 married  single  divorced  widowed

If married, name of spouse

........................................................................................................

Names and age of children (if any)

........................................................................................................

8. Last address in the Requesting State:

........................................................................................................

9. Last place of residence in the Requested State

........................................................................................................

10. Names of parents (where possible)

........................................................................................................

B. SPECIAL CIRCUMSTANCES RELATING TO THE TRANSFEREE

1. State of health

(E.g. possible reference to special medical care; Latin name of contagious diseases):

........................................................................................................

2. Indication of a particularly dangerous person

(E.g. suspected of serious offence; aggressive behaviour):

........................................................................................................

C. MEANS OF EVIDENCE ATTACHED

1................................................

..................................................

(Passport No.)

(date and place of issue)

..................................................

..................................................

(issuing authority)

(expiry date)

2................................................

..................................................

(Identity card No.)

(date and place of issue)

..................................................

..................................................

(issuing authority)

(expiry date)

3................................................

..................................................

(Driving license No.)

(date and place of issue)

..................................................

..................................................

(issuing authority)

(expiry date)

4................................................

..................................................

(Other official document No.)

(date and place of issue)

..................................................

..................................................

(issuing authority)

(expiry date)

D. OBSERVATIONS

...............................................................................................................

...............................................................................................................

...............................................................................................................

Reasons for readmission (reference to the Article of this Agreement)

...............................................................................................................

(Signature of the representative of the competent authority of the Requesting State) (Seal/stamp)

______________

(place and date)

[State emblem]

________________________________________

(name of the Competent Authority of the Requesting State)

Number __________

To: _______________________________

(name of the Competent Authority of the Requested State)

A. Personal data

1. Names and surname (surname in block letters, including in the native language):

____________________________________________________

2. Maiden name:

____________________________________________________

3. Date and place of birth:

____________________________________________________

Photograph

4. Citizenship and language:

____________________________________________________

5. Sex and physical description (height, color of eyes, distinguishing marks etc.):

……………………………………………………………………….

6. Also known as (earlier names, other names used/by which known or aliases):

……………………………………………………………………….

7. Type and number of travel document:

……………………………………………………………………….

B. SPECIAL CIRCUMSTANCES RELATING TO THE TRANSFEREE

1. State of health

(E.g. possible reference to special medical care; Latin name of contagious disease):

……………………………………………………………………….

2. Indication of particularly dangerous person

(E.g. suspected of serious offence; aggressive behaviour):

……………………………………………………………………….

C. TRANSFER/TRANSIT OPERATION DETAILS

1. Type

□ by air

□ by land

2. State of final destination

……………………………………………………………………….

3. Possible other States of transit

……………………………………………………………………….

4. Proposed border crossing point, date, time of transfer and possible escorts.

……………………………………………………………………….

5. Admission assured in any other transit State and in the State of final destination

□ yes

□ no

6. Knowledge of any reason for a refusal of transit (If so, specify)

□ yes

□ no

……………………………………………………………………….

D. OBSERVATIONS

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

……………………………………………………………………….

(Signature of the representative of the Competent Authority of the Requesting State) (Seal/stamp)