Application Form

Applicant Details
Given Name(s)/Forename(s) :

Family Name/Surname :

Email :

Primary Contact Number :

Secondary Contact Number :

Passport Number :

Date of Birth :

Gender :

Date of Intended Travel :

Location :

Passport / Travel Document

Family/Last Name as stated in the passport or travel

document. If you only have one name, please enter it
here and then re-enter it in the Given Name box
Given Names as stated in the passport or travel
document. If you only have a Family Name re-enter the
Family Name in this field
Yes*
Have you ever used, or been known by, any other
names?
No
Date of Birth as stated in the passport or travel document
Place of Birth as stated the passport or travel document

Gender as stated in the passport or travel document

Nationality as stated in the passport or travel document

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Do you have any other passports or travel documents
Yes*
which show you have held a different nationality or
No nationalities?
Number of the passport or travel document that you will
use to travel to the UK
Place of Issue as stated in the passport or travel
* document
Issuing Authority as stated in the passport or travel
* document
Date of Issue as stated in the passport or travel
* document
Date of Expiry as stated in the passport or travel
* document. If the passport or travel document has no
date of expiry please enter 01 JAN 2050.
Your permanent Country of residence

Yes*
Are you a national of the country in which you are
making your visa application?
No
Yes*
Is this your first Passport?
No

Travel Information

Yes*
Are you travelling with anyone?
No
On which date do you intend to arrive in the UK?

* How long do you intend to stay in the UK?

Name of Person / Hotel

Line 1: *
Line 2:
Line 3:
Line 4:
Postcode:
Primary contact no: *
Secondary contact no:
Email:
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Personal Details

What is your permanent

residential address and contact
details? You must enter at least
one contact phone number
How long have you lived at this address? Number of months and or years
you have lived at this address
* e.g. 4 years 3 months
Are your preferred contact details different from Are your preferred contact
the contact details already provided above? details different from the
contact details already
Yes*
provided above?
No

Travel and Criminal History

Have you been issued any visa

Yes*
for the UK, UK Overseas
No Territories or Commonwealth in
the last 10 years?
Yes*
Have you ever travelled to the
UK in the last 10 years?
No
Have you made an application
Yes*
to the Home Office to remain in
No the UK in the last 10 years?
Have you been refused entry to
Yes*
the UK in the last 10 years (for
No example at a UK airport or
seaport)?
Have you been refused a visa
Yes*
for any country, including the
No UK, in the last 10 years?
Have you been deported,
Yes*
removed or otherwise required
No to leave any country, including
the UK in the last 10 years?
Yes*
Have you ever voluntarily
elected to depart the UK?
No
Are you, or have you been
Yes*
subject to, an exclusion order
No from the UK?
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Have you travelled outside your
Yes*
country of residence, excluding
No to the UK or a Commonwealth
Country, in the last 10 years?
Have you ever been issued with
Yes*
a UK National Insurance
No Number? E.g. QQ 123456A
Have you ever been convicted
Yes*
of any criminal offence in the
No UK or any country?
Have you been arrested and
Yes*
charged with any offence in any
No country and are awaiting, or are
currently on trial?
Have you ever been involved in,
supported or encouraged
terrorist activities in any country
Yes*
or ever been a member of, or
No given support to, an
organisation that has been
connected with terrorism?
Have you, by any means or
medium, expressed views that
Yes*
justify or glorify terrorist
No violence or that may encourage
others to terrorist acts or other
serious criminal acts?
In times of either peace or war
have you ever been involved in,
Yes*
or suspected of involvement in
No war crimes, crimes against
humanity or genocide?
Have you engaged in any other
Yes*
activities that might indicate
No that you may not be considered
a person of good character?
If we need to interview you,
* what language would you like
to use in the interview?
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Have you received any other
penalty in relation to a criminal
Yes*
offence; for example a caution,
No reprimand, warning, or similar
penalties in the UK or any other
country?
Have you had any UK court
judgement against you for non-
Yes*
payment of a debt, or received
No a civil penalty under UK
Immigration Acts?
Spouse / Partner

What is your marital status? Select your current marital

status
-- Select --

Single

Married / Civil Partner

Unmarried Partner

Fiancée / Proposed Civil Partner

Divorced / Dissolved Partnership

Separated

Widowed / Surviving Civil Partner

Father

Nationality as stated in the

Nationality passport or travel document
Family/Last Name as stated in
the passport or travel
Family Name / Surname

document. If you only have one

(If they only have one name, please enter it name, please enter it here and
here and in the Given Name box) then re-enter it in the Given
Name box
Given Names as stated in the
passport or travel document. If
* you only have a Family Name
re-enter the Family Name in this
field
Date of Birth as stated in the
* passport or travel document
Place of Birth as stated the
* passport or travel document
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Mother

Nationality as stated in the

Nationality passport or travel document
Family/Last Name as stated in
the passport or travel
document. If you only have one
* name, please enter it here and
then re-enter it in the Given
Name box
Given Names as stated in the
passport or travel document. If
* you only have a Family Name
re-enter the Family Name in this
field
Date of Birth as stated in the
* passport or travel document
Place of Birth as stated the
* passport or travel document

Dependent Children

Yes*
Do you have any dependent
children?
No

Non Dependent Children

Are any other children travelling

Yes*

with you?
No

Employment

What is your current working

What is your current working status?
status?