EFTA00305983.pdf

Leon Black Meeting Sept. 2, 2015 9:00am Part 1-Passport and Travel Information Passport/TravelDocument 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 the family name box) 3. Date ofBirth 4. Place ofBirth 5. Gender 6. Nationality 7. Doyou currently hold, or haveyou 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. Areyou a national of the country in which you are applying? 15. Please enter Details 16. Is thisyour First Passport? 17. Nationality Document Number Issuing Authority Date ofIssue Date ofExpiry EFTA00305983 Is this Document lost, stolen or inyour possession? 18. Areyou travelling with Anyone? 19. Date ofPlanned Arrival in the UK 20. How long doyou 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 PersonalDetails 22. What isyour permanent residential address and contact details? 23.How long haveyou lived at this address? 24. Areyou 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 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. Have you ever voluntarily elected to depart the UK? 34. Areyou, or haveyou been subject to, an exclusion order from the UK? 35. Have you ever travelled outsideyour country ofresidence, excluding the UK, in the last 10years? 36. Date of Travel -Country Visited EFTA00305984 -Reason for the Trip EFTA00305985