## Leon Black Meeting
Sept 2, 2015
9:00am

## <u>Part 1-Passport and Travel Information Passport/Travel Document</u>

<u>I.</u> Family Name/Surname (if you only have one name, please enter it here and in thegiven name box)

2. Given Names(s)/Forename(s) (If you only have one name, please enter it here and in thefamily name box)

3. Date of Birth

4. Place ofBirth

5. Gender

6. Nationality

7. Do you 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 whichyou are applying?

15. Please enter Details

16. is this your First Passport?

17. Nationality
Document Number
Issuing Authority
Date ofIssue
Date ofExpiry

## <u>Part 1-Passport and Travel Information Passport/Travel Document</u> (cont.)

Is this Document lost, stolen or inyour possession?

18. Areyou 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?

## <u>Part 2 Personal Details and Treavel History Personal Details</u>

22. What isyourpermanent residential address and contact details?

- 23.1low long haveyou lived at this address?

24. Areyou preferred contact details different form the contact details already provided above?

## Travel History

25. Haveyou been issued any visa for the UK, UK overseas territories or commonwealth country in the last 10 years?

26. Type of Visa Issued
Date ofIssue
Date ofExpiry
Issuing Authority

27. Haveyou ever travelled to the UK in the last 10 years?

28. Date ofArrival
Departure Date
Purpose ofthe Trip

31. Haveyou 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. Areyou, or haveyou been subject to, an exclusion orderfrom the UK?

35. Haveyou ever travelled outside your country ofresidence, excluding the UK, in the last 10years?

36. Date of Travel
-Country Visited

## Travel History (cont.)

-Reason for the Trip