EFTA01191036.pdf

From: "Jeffrey E." <[email protected]> To: Jeffrey Epstein <[email protected]> Subject: Date: Tue, 25 Aug 2015 18:31:34 +0000 Inline-Images: Screen_Shot_2015-08-25_at_2.29.16_PM.png; Screen_Shot_2015-08- 25_at_2.30.10_PM.png; Screen_Shot_2015-08-25_at_2.30.37_PM.png; Screen_Shot_2015- 08-25_at_2.30.25_PM.png litnline image 2 PART 1 > PASSPORT AND TRAVEL INFORMATION PASSPORT / TRAVEL DOCUMENT 1 FAMILY NAME/SURNAME OF YOU ONLY HAVE ONE NAME. PLEASE ENTER IT HERE AND IN THE GIVEN NAME BOX) 2 GIVEN NAME(S) FORENAME(S) (IF YOU ONLY HAVE ONE NAME. PLEASE ENTER IT HERE AND IN THE FAMILY NAME BOX) 3 DATE OF BIRTH 4 PLACE OF BIRTH 5 GENDER 6 NATIONALITY 7 DO YOU CURRENTLY HOLD, OR HAVE YOU EVER HELD. ANY OTHER NATIONALITY OR NATIONALITIES? 8 CURRENT PASSPORT OR TRAVEL DOCUMENT NUMBER 9 PLACE OF ISSUE 10 ISSUING AUTHORITY 11 DATE OF ISSUE 12 DATE OF EXPIRY 13 CURRENT LOCATION 14 ARE YOU A NATIONAL OF THE COUNTRY IN WHICH YOU ARE APPLYING? 15 PLEASE ENTER DETAILS 16 IS THIS YOUR FIRST PASSPORT? 17 NATIONALITY DOCUMENT NUMBER ISSUING AUTHORITY DATE OF ISSUE DATE OF EXPIRY IS THIS DOCUMENT LOST. STOLEN OR IN YOUR POSSESSION EFTA01191036 36 DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP DATE OF TRAVEL COUNTRY VISITED REASON FOR THE TRIP 31 HAVE YOU BEEN REFU SED A VISA FOR ANY COUNTRY INCLUDING THE UK IN THE LAST 10 YEARS, 32 HAVE YOU BEEN DEPORT ED. REMOVED OR OTHERWISE REQUIRED TO LEAVE ANY COUNTRY INCLUDING THE UK IN THE LAST 10 YEARS, 33 HAVE YOU EVER VOLUNTAR ILY ELECTED TO DEPART THE UK? 34 ARE YOU, OR HAVE YOU BEEN SUBJECT TO, AN EXCLUSION ORDER FROM THE UK , 35 HAVE YOU EVER TRAVELLED OUTSI DE YOUR COUNTRY ' OF RESIDENCE, EXCLUDING THE UK . IN THE LAST 10 YEARS? EFTA01191037