EFTA00305980.pdf

Leon Black Meeting Sept. 2, 2015 9:00am 1.Have you been refused a visa for any country including the UK in the last 10 years? 2. Have you been deported, removed or otherwise required to leave any country including the UK in the last 10 years? 3. Have you ever voluntarily elected to depart the UK? 4. Are you, or have you been subject to, an exclusion order from the UK? 5. 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 6 Family Name/Surname (Ifyou only have one name, please enter it here and in the given name box) 7. Given Names(s)/Forename(s) (Ifyou only have one name, please enter it here and in the family name box) 8. Date of Birth 9. Place of Birth 10. Gender 11. Nationality 12. Do you currently hold, or have you ever held, any other nationality or nationalities? 13. Current passport or travel document number 14. Place of Issue 15. Issuing Authority 16 Date of Issue 17. Date of Expiry 18. Current Location 19. Are you a national of the country in which you are applying? 20. Please enter Details 21. Is this your First Passport? 22. Nationality Document Number Issuing Authority Date of Issue Date of Expiry Is this Document lost, stolen or in your possession? 23. Date of Travel -Country Visited -Reason for the Trip EFTA00305980 -Date of Travel -Country Visited -Reason for the trip -Date of Travel -Country Visited -Reason for the Trip -Date of Travel -Country Visited -Reason for the Trip -Date of Travel -Country Visited -Reason for the Trip -Date of Travel -Country Visited -Reason for the Trip -Date of Travel -Country Visited -Reason for the Trip -Date of Travel -Country Visited -Reason for the Trip 24. Are you travelling with Anyone? 25. Date of Planned Arrival in the UK 26. How long do you intend to stay in the UK? 27. What is the main address and contact details of where you will be staying whilst in the UK? Part 2 Personal Details and Treave► History Personal Details 28. What is your permanent residential address and contact details? 29.How long have you lived at this address? 30. Are you preferred contact details different form the contact details already provided above? Travel History 31. Have you been issued any visa for the UK, UK overseas territories or commonwealth country in the last 10 years? EFTA00305981 32. Type of Visa Issued Date of Issue Date of Expiry Issuing Authority Type of Visa Issued Date of Issue Date of Expiry Issuing Authority 33. Have you ever travelled to the UK in the last 10 years? 34. Date of Arrival Departure Date Purpose of the Trip EFTA00305982