SAMPLE DECLARATION FORM FOR DNA TESTING IN
IMMIGRATION CASES / Order number
Date
Signature
1. TO BE FILLED OUT BY DONOR/GUARDIAN (with sampler’s assistance) :
Dynamic Code case no: / Donors DUF No:
Full name of Donor (last, first, middle):
Gender / Male Female / Please staple one passport sized photographs of donor here
Please enclose a copy of the passports biopage
(personaliasiden)
Date of Birth
Country of origin
Declaration:
I hereby give consent for a mouth swab sample to be taken for DNA analysis for the purpose of establishing family relationships as part of an application for residency in Norway. I consent for the result of this test to be used for the assessment of the application. I also consent to the results of the test to take part of anonymous statistics.
I understand the content of this declaration, and I sign this document of my own free will. I am aware that if I do not accept to undergo DNA analysis, my application will be based on the existing documentation in the case.
Signature: / Date:
2. TO ALSO BE FILLED OUT WHEN DONOR IS A CHILD UNDER 18 YEARS OLD :
Full name of guardian (last, first, middle):
Guardian’s relationship to donor:
Declaration:
I hereby give consent for a sample to be taken from the above mentioned child whom I have parental responsibility or for whom I am the guardian or caretaker. I understand that it is my responsibility to ensure I have the legal right to sign this form.
Signature of parent/guardian of the child: / Signature of child over the age of 12:
3. SAMPLER: to be filled out by embassy stuff or police officer in charge
(Please enclose copies of any ID documents provided by donor)
Declaration:
I have ensured that the donor understands the possible implication if the DNA test does not support their claim. I certify that I have checked and enclosed any ID documents and photographs provided, and that to the best of my knowledge the donor is the same as the applicant.
Tick here if no ID documents have been provided
Samplers name:
Place of sampling:
Sampler’s Signature: / Date:
How to fill out the sample declaration form for DNA testing
Please, fill one Sample Declaration Form per donor.
You may find the Dynamic Code reference number and DUF case number in the DNA request sent to you from UDI via DUF/NORVIS.
NB! The WB or Lot. No. on the sample card plastic envelope or sample pin should never be used.
donor = the person giving DNA, sample = the DNA sample, sampler = the embassy staff
caretaker = the person bringing the minor for DNA-test in the embassy
Part 1 - To be completed by the donor/guardian
Fill all the spaces in the form. First part of the form is to be filled out always by the donor or the caretaker if the donor is under 18 years. We prefer that the form is filled out in print.
- Shall always be filled out when donor is a minor under 18 years.
- Donor’s full name, in print. Please note that the spelling is correct.
- One passport photo should be attached to the form.
- Date and signature – the donor signs here, alternatively the caretaker when the donor is under 18.
Part 2 - To be completed by guardian when the donor is under 18
- Caretaker’s full name, in print
- Caretaker’s signature
- Donor’s signature, when he/she is between 12 and 18
- The relationship between the donor and the guardian should be listed.
Part 3 - To be completed the embassy staff administering the test
- Embassy staff’s name, in print
- Test location, in print
- Test date and embassy staff’s signature
Completion of the sample card
Signatures
Fill out the FTA-card with the following information: DUF number of the donor. The FTA-card must be duly filled out in order for the sample to be analysed. Please do not remove the FTA-card from the folder, and please do not seal the FTA-card.
Further information
For more information, please see An example of how a completed test should look is available on the FTA-card folder. Here you will also find the address of the laboratory in Sweden that the test should be sent to.
If you encounter any problems downloading the sample declaration form or the instructions, please contact us at and we will send you what you need via e-mail.
All other inquiries should be sent to the same address.
A donor attendance notice is submitted to UDI as a regular interagency statement via NORVIS.
Updated 26.03.2014.