UK VISA APPLICATION FORM
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What is the main purpose of your visit to flre UK? .'' ;:.r' How long do you inbnd to stay in the UK?
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Travel Dates On which date will you leave the UK?
On which date do you wish to trarcl to the UK? :'i :,),. i:''r :::'::r,
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ffi Name b6o6lw
Surname
P<vneb First Name
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Middle Name
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Placeof Birth>'. ' : :. r ::. :
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Maritat Status? X t'nn," Married/Civil Partner Unmarried Partner
Divorced/Dissolved Partnership Separated Widqred/Surviving Civil Servant
Current passport ortravel document number Place of lssue
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Date of lssue
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Datg of E)<piry >'",'":'1-.': )r'rr:':' :r: : :r rr' :'r'' "'": ; ;i :.. : . ".';' ?1 is this your first passport? Put a cross (x) in the Gle\rant box
Yes *o X
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2.7 Please give details of any previous passports, covering the last 10 years, including where these passports are now
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Your full residential address and postal code How long have you lived at this address?
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Home (landline) telephone number
Your mobile telephone number
Email addresstr;."ir:r::r,:i.,:;::.r.).ii:)1.:!;,':r,:rr':r:))]r]).r:r..r,r.t))):- l-raa+16s0/5sB 3b
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Whatisyourpresentworkorjoboroccupation? : . ,: .I": r.:'. .: Jeu be_d<<-f
What is the name of the company or organisation you
work for
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Whatisyourworkaddress?:],,,]]]:-.,..:.,::::,:...':, What Position or designation did they offer you?
Please, give details of any additional job(s) or occupations(s) you have previously
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Have you traveled to the UK in the last l0years? lf 'Yes' Please provide details of
any
Put a cross (x) in the relevant box Yes No
X trips to the UK
Date Destination Purpose Destination
Have you traveled outside your aountry of residence, lf 'Yes' Please provide details of
Excluding to the UK in the last past l0years?
Put a cross (x) in the relevant box
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fi uo these trips
Date Destination Pumose Destination
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Have you ever been refused a visa for any country,
lncluding the UK? Put a cross (x) in the relevant box
Date Country Reason
Yes No
X lf 'Yes' Please provide full details
Refere nce number (for UK)
Have you been granted any UK visas in the last 10 years?
Put a cross (x) in the relevant box Yes
X lf 'Yes' Please provide details
Date Purpose Duration Reference number
Have you been refused entry on anival to the UK in the
Last 10 years? Put a cross (x) in the relevant box Ves No
X lf 'Yes' Please provide details
Dat+ Reason Reference number
Have you ever been deported, removed or otherwise,
Required to leave any country, including the UK in the last Yes No lf 'Yes' Please provide details
10 years? Put a cross (x) in the relevant box X
Date Reason Reference number (for UK)
Do you have a UK National lnsurance
Put a cross (x) in the relevant box
Number? Yes No
x lf 'Yes' Please Provide details
National lnsulance Number Reason for getting a national insurance number
Do vou have any criminal conditions in any country
Yes N.x lf 'Yes' please Provide details
(tnciuding trafiicoffence)? Put a cross (x) in the relevanl box
offence sentence
Date Country
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Organisation/ Employers Name 'I '
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Email Address
Postal Code ' ' Job Reference Number(s)
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Street Address
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Tell us brief details about yourselfl.2
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820304082017004
VISA APPLICATION NUMBER
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