EFTA00305980.pdf

Leon Black Meeting Sept. 2, 2015 9:00am 1.Haveyou been refused a visa for any country including the UK in the last 10years? 2. Haveyou been deported, removed or otherwise required to leave any country including the UK in the last 10years? 3. Haveyou ever voluntarily elected to depart the UK? 4. Are you, or have you been subject to, an exclusion orderfrom the UK? 5. Haveyou ever travelled outside your country ofresidence, excluding the UK, in the last 10years? Part 1-Passport and Travel Information passport/TravelDocument 6 Family Name/Surname (Ifyou only have one name, please enter it here and in the given name box) 7. Given Names(s)/Forename(s) (Ifyou only have one name, please enter it here and in the family name box) 8. Date ofBirth 9. Place ofBirth 10. Gender 11. Nationality 12. Doyou currently hold, or haveyou ever held, any other nationality or nationalities? 13. Current passport or travel document number 14. Place ofIssue 15. Issuing Authority 16 Date ofIssue 17. Date ofExpiry 18. Current Location 19. Areyou a national of the country in which you are applying? 20. Please enter Details 21. Is thisyour First Passport? 22. Nationality Document Number Issuing Authority Date ofIssue Date ofExpiry Is this Document lost, stolen or inyour possession? 23. Date of Travel -Country Visited -Reason for the Trip EFTA00305980 -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 24. Are you travelling with Anyone? 25. Date of Planned Arrival in the UK 26. How long do you intend to stay in the UK? 27. What is the main address and contact details of where you will be staying whilst in the UK? Part 2 Personal Details and Treave► History Personal Details 28. What isyour permanent residential address and contact details? 29.How long haveyou lived at this address? 30. Areyou preferred contact details differentform the contact details already provided above? Travel History 31. Have you been issued any visa for the UK, UK overseas territories or commonwealth country in the last 10years? EFTA00305981 32. Type of Visa Issued Date of Issue Date of Expiry Issuing Authority Type of Visa Issued Date of Issue Date of Expiry Issuing Authority 33. Have you ever travelled to the UK in the last 10years? 34. Date of Arrival Departure Date Purpose of the Trip EFTA00305982