This form contains 45 fields organized into 15 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Applicant's Address in Spain
House Number Text
Provide the house or building number for the applicant's address.
Floor/Apartment Number Text
Enter the floor or apartment number of the applicant's address.
Street Address Text
Enter the street name of the applicant's address in Spain.
City Text
Enter the city or locality of the applicant's address in Spain.
Postal Code Number
Provide the postal code for the applicant's address.
Province Text
Enter the province of the applicant's address in Spain.
Applicant's Birth Place
Birth Locality Text
Please enter the locality or city where the applicant was born.
Birth Country Text
Please enter the country where the applicant was born.
Applicant's Contact Information
Email Text
Please provide the applicant's email address.
Telephone Number
Please provide the applicant's telephone number.
Applicant's Date of Birth
Birth Day Text
Please enter the day of the applicant's birth.
Birth Month Text
Please enter the month of the applicant's birth.
Birth Year Number
Please enter the year of the applicant's birth.
Applicant's Full Name
First Name Text
Please provide the applicant's first name.
First Surname Text
Please provide the applicant's first surname.
Second Surname Text
Please provide the applicant's second surname, if applicable.
Applicant's Identity Details
Nationality Text
Please provide the applicant's nationality.
NIE Text
Please provide the applicant's Foreigner Identification Number (NIE).
Passport Number Text
Please provide the applicant's passport number.
General
Soltero/a Checkbox
Check this box if the person's civil status is single.
Casado/a Checkbox
Check this box if the person's civil status is married.
Viudo/a Checkbox
Check this box if the person's civil status is widowed.
Divorciado/a Checkbox
Check this box if the person's civil status is divorced.
Separado/a Checkbox
Check this box if the person's civil status is separated.
Parents' Names
Text
Father's Name Text
Please provide the full name of the father.
Representative's Address
Floor Number Text
Please enter the floor number of the representative's address.
Locality Text
Please enter the locality or city of the representative's address.
Postal Code Number
Please enter the postal code of the representative's address.
Province Text
Please enter the province of the representative's address.
Street Address Text
Please enter the full street address of the representative.
Address Number Text
Please enter the building or street number for the representative's address.
Representative's Contact Information
Representative's Email Text
Provide the email address for the representative.
Representative's Phone Number Text
Enter the phone number for the representative.
Representative's Full Name
Representative's Name Text
Please provide the full name of the representative.
Representative's First Surname Text
Please provide the first surname of the representative.
Representative's Second Surname Text
Please provide the second surname of the representative.
Representative's Identification
Representative's DNI/NIF/NIE Text
Please provide the DNI, NIF, or NIE of the representative.
Representative's Company Name Text
Please enter the company name (Razón Social) of the representative.
Signature
Signature Text
Please enter your full name in this field to serve as your signature.
Signature Location and Date
Signature Location Text
Enter the city or town where the document is being signed.
Signature Day Text
Enter the day of the month the document is being signed.
Signature Month Text
Enter the month the document is being signed (e.g., January, February, or a numeric value like 01, 02).
Signature Year Number
Enter the full four-digit year the document is being signed.
Subject of Request
Subject of Request Text
Please enter the specific request or procedure that the designated representative is authorized to handle on your behalf.