EFTA02396873.pdf

Leon Black Meeting Sept 2, 2015 9:00am Part 1-Passport and Travel Information Passport/Travel Document I. Family Name/Surname (ifyou 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 the family name box) 3. Date ofBirth 4. Place ofBirth 5. Gender 6. Nationality 7. Doyou currently hold, or have you ever held, any other nationality or nationalities? 8. Current passport or travel document number 9. Place ofIssue 10. Issuing Authority 11. Date ofIssue 12. Date ofExpiry 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 ofIssue Date ofExpiry EFTA_R1_01429559 EFTA02396873 Is this Document lost, stolen or in your possession? 18. Are you travelling with Anyone? 19. Date ofPlanned 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 Personal Details 22. What is your permanent residential address and contact details? 23.1low long have you lived at this address? 24. Are you preferred contact details different form the contact details already provided above? TravelHistory 25. Have you been issued any visa for the UK, UK overseas territories or commonwealth country in the last 10years? 26. Type of Visa Issued Date ofIssue Date ofExpiry Issuing Authority 27. Have you ever travelled to the UK in the last 10years? 28. Date ofArrival Departure Date Purpose of the Trip 31. Have you been refused a visa for any country including the UK in the last 10years? 32. Have you been deported, removed or otherwise required to leave any country including the UK in the last 10years? 33. Haveyou ever voluntarily 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 outside your country ofresidence, excluding the UK, in the last 10years? 36. Date of Travel -Country Visited EFTA_R1_01429560 EFTA02396874 -Reason for the Trip EFTA_R1_01429561 EFTA02396875