EFTA00340755.pdf

From: Lesley Groff <a To: Jeffrey Epstein CC Subject: Leon Black Meeting Notes Date: Tue, 01 Sep 2015 19:12:17 +0000 Leon Black Meeting Sept 2, 2015 9:00am 3I.Have you been refused a visafor any country including the UK in the last 10 years? 32. Have you been deported, removed or otherwise required to leave any country 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 orderfirm the UK? 35. Have you ever travelled outside your country of residence, excluding the UK, in the last 10 years? Part 1-Passport and Travel Information Passport/Travel Document 1. 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 thefamily 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 EFTA00340755 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? 36 Date of Travel -Country Visited -Reasonfor the Trip -Date of Travel -Country Visited -Reason for the trip -Date of Travel -Country Visited -Reason for the Trip -Date of Travel EFTA00340756 -Country Visited -Reasonfor the Trip -Date of Travel -Country Visited -Reasonfor the Trip -Date of Travel -Country Visited -Reason for the Trip -Date of Travel -Country Visited -Reasonfor the Trip -Date of Travel -Country Visited -Reasonfor the Trip 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 Personal Details 22. What is your peimanent residential address and contact details? 23.How long have you lived at this address? EFTA00340757 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 Type of Visa Issued Date of Issue Date ofExpiry Issuing Authority 27. Have you ever travelled to the UK in the last 10 years? 28. Date ofArrival Departure Date Purpose of the Trip EFTA00340758