KONINKLIJKE NEDERLANDSE POLITIEHOND VERENIGING
Opgericht 1907
Beschermheer: Mr Pieter van Vollenhoven

APPLICATION FORM FOR KNPV MEMBERSHIP

Last Name:                                   
First name and middle name(s) in full:
Date (M, D, Y )and Place of Birth:
Occupation:                         
Home address:             
City:   State:

  Zip:               
Phone number, area code first:             

The undersigned declares that he/she is:

A.  A person of good moral character.
B.  Has never been arrested, charged, indicted, entered into a pre-trial diversion agreement, placed on deferred adjudication, placed on probation or convicted as the result of any felony, Class A, or Class B misdemeanor in any state or federal court (including military court martial) of the United States of America or in any other country?
(if answering yes, please attach documentation from the Court in which action was taken against you)
C.  Does not object to a thorough background investigation to verify the above two statements
D. Truthfully plans to adhere to the goals set forth by the KNPV and will in no way intentionally harm or blemish the reputation and/or holdings of the KNPV.

Applicant’s signature: ______________________________________Date:_________________                                                                         

 

Membership fee, fl 82,00 (eighty two Dutch guilders) Contact us for current US Dollar rates. Please send money order or cashiers check to:
Bureau KNPV
Liendertseweg 108
3815 BJ Amersfoort
The Netherlands
Please note: Send membership fee WITH application form to address above.

 

For KNPV office use only, applicant do NOT fill out
In the Governing rules of the KNPV, Article 1 sub c, state that foreign applicants for KNPV membership must be approved by the Secretary of the KNPV. This requirement has been met and the Secretary of the KNPV: .................................................has forwarded this form to the KNPV office on ................................................................................................................
so that the publication of the applicant’s name in the magazine ‘De Politiehond’ can take place.

Signature of the Secretary of the KNPV:...............................................................................