EFTA02396873.pdf

Leon Black Meeting Sept 2, 2015 9:00am Part 1-Passport and Travel Information Passport/Travel Document I. Family Name/Surname (if you only have one name, please enter it here and in 2. Given Names(s)/Forename(s) (If you only have one name, please enter it here and in 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 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? the given name box) 17. Nationality Document Number Issuing Authority Date of Issue Date of Expiry the family name box) EFTA_R1_01429559 EFTA02396873 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 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? 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 of Expiry Issuing Authority 27. Have you ever travelled to the UK in the last 10 years? 28. Date of Arrival Departure Date Purpose of the Trip 31. Have you been refused a visa for 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 order from the UK? 35. Have you ever travelled outside your country of residence, excluding the UK, in the last 10 years? 36. Date of Travel -Country Visited EFTA_R1_01429560 EFTA02396874 -Reason for the Trip EFTA_R1_01429561 EFTA02396875