EFTA00340766.pdf

From: Lesley Groff <a To: Jeffrey Epstein <a Subject: Missing #29 and 30 on Leon Black Notes! Date: Tue, 01 Sep 2015 20:35:18 +0000 Leon Black Meeting Sept 2, 2015 9:00am Part I -Passport and Travel Information Passport/Travel Document I. Family Name/Surname (I[you only have one name, please enter it here and in the given name box) 2. Given Names(s)/Forename(s) (Ifyou only have one name, please enter it here and in thefamily name box) 3. Date ofBirth 4. Place ofBirth 5. Gender 6. Nationality 7. Do you currently hold, or have you ever held, any other nationality or nationalities? 8. Currentpassport or travel document number EFTA00340766 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? 18. Are you travelling with Anyone? 19. Date of Planned Arrival in the UK 20. How long do you intend to stay in the UK? 21. What is the main address and contact details of where you will be staying whilst in the UK? Part 2 Personal Details and Treavel History EFTA00340767 Personal Details 22. What is your permanent residential address and contact details? 23.How long have you lived at this address? 24. Are you preferred contact details differentform the contact details already provided above? Travel History 25. Have you been issued any visa for the UK, UK overseas territories or commonwealth country in the last 10 years? 26 Type of Visa Issued Date of Issue Date ofExpiry Issuing Authority 27. Have you ever travelled to the UK in the last I0 years? 28. Date ofArrival Departure Date Purpose of the Trip 31. Have you been refused a visafor any count?), including the UK in the last 10 years? 32. Have you been deported, removed or otherwise required to leave any count?), including the UK in the last 10 years? 33. Have you ever voluntarily elected to depart the UK? 34. Are you, or have you been subject to, an exclusion orderfivm the UK? EFTA00340768 35. Have you ever travelled outside your country of residence, excluding the UK, in the last 10 years? 36 Date of Travel -Country Visited -Reasonfor the nip EFTA00340769