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UK Visas & Immigration

PARTIALLY COMPLETED APPLICATION

APPLICANT NAME: Mohammad Rizki Agustandi


GWF NUMBER: GWF054377508
PASSPORT NUMBER: X701128
COUNTRY OF NATIONALITY: Indonesia
DATE OF BIRTH: 5 August 1988
GENDER: Male
DATE OF APPLICATION:
TYPE OF VISA / APPLICATION: Visitor visa
SERVICE OPTION: Standard
DURATION OF VISA: 6-month
TOTAL FEE:
SUBMISSION METHOD: Online
PAYMENT REFERENCE:
CONTACT EMAIL: rizkyagustandi@gmail.com
CONTACT LANGUAGE: English

Personal information

Email address rizkyagustandi@gmail.com

Travel information

What is the main reason for your visit to the UK? Tourism (including visiting family and friends)

Will you be travelling to the UK as part of an No


organised group?

Will you be travelling to the UK with someone who Yes


is not your partner, spouse, or dependant?

Given names mohammad iqbal

Family name alamsyah

Country of nationality Indonesia

Relationship to you Parent

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UK Visas & Immigration
Enter their relationship to you

What is the main reason for your holiday visit to the Visiting family
UK?

Give details of the main purpose of your visit and Me , my father and my mother want to visite my
anything else you plan to do on your trip. See brother ( family) in Liverpool. my brother stays at
tourist and short stays for more information. Livepool and we are going to have a trip around UK

Your planned travel information

Date you plan to arrive in the UK 30 November 2019

Date you plan to leave the UK 16 December 2019

Personal information

Given names Mohammad Rizki

Family name Agustandi

Are you now or have you ever been known by No


another name?

Who does this email address belong to? You


rizkyagustandi@gmail.com

Do you have another email address? No

What is your gender, as shown in your passport or Male


travel document?

What is your relationship status? Single

Country of nationality Indonesia

Country of birth Indonesia

Place of birth jakarta

Date of birth 5 August 1988

Do you have a valid national identity card? Yes

National identity card number 3174100508880002

Issuing authority jakarta selatan

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UK Visas & Immigration
Do you currently hold, or have you ever held, any No
other nationality or citizenship?

Address l. Merbabu No.8RT.8/RW.1,


Petukangan Sel., Kec. Pesanggrahan, Kota Jakarta
Selatan, Daerah Khusus Ibukota Jakarta 12270
jakarta selatan
DKI Jakarta
12270
Indonesia

Is this address also your correspondence address? Yes

How long have you lived at this address? 1995 years

What is the ownership status of your home? Other

Give more details about your living situation, such i live with my parents at their house
as who you live with and who owns the property

Provide your telephone number +62 82115222224

Where do you use this telephone number? For use whilst in the UK

Select whether this is your home, mobile or work Mobile telephone number
telephone number

Are you able to be contacted by telephone? I can only be contacted by text message (SMS)

Explain why you cannot be contacted by telephone local number


call

Passport details

Passport number or travel document reference X701128


number

Issuing authority jakarta selatan / Indonesia

Issue date 3 October 2018

Expiry date 3 October 2023

Dependant details

Does anyone rely on you for financial support? No


Include both those travelling with you and those
who are not.

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UK Visas & Immigration

Parent details

What is this person's relationship to you? Mother

Given names Erlina Marhimpun

Family name Alamsyah

Date of birth 16 September 1959

Country of nationality Indonesia

Have they always had the same nationality? Yes

What is this person's relationship to you? Father

Given names mohammad iqbal

Family name alamsyah

Date of birth 3 July 2019

Country of nationality Indonesia

Have they always had the same nationality? Yes

Employment

What is your employment status? Self-employed

What is your job? Enterpreneur

How much do you earn from this job in a year? 50000000.00 IDR

Previous employment organisation I have not worked in any of the jobs listed above

Income and expenditure

Do you have another income or any savings? Other regular income

What kind of regular income do you have? Allowance or regular money from your family

Total amount of money that you get in a year 60000000.00 IDR

How much money are you planning to spend on 20000000.00 IDR


your visit to the UK?

What is the total amount of money you spend each 500000.00 IDR

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UK Visas & Immigration
month?

Will anyone be paying towards the cost of your Yes


visit?

Who is paying towards the cost of your visit? Someone I know (for example, family or friend)

Name mohammad iqbal alamsyah

Address l. Merbabu No.8RT.8/RW.1,


Petukangan Sel., Kec. Pesanggrahan, Kota Jakarta
Selatan, Daerah Khusus Ibukota Jakarta 12270
jakarta selatan
DKI Jakarta
12270
Indonesia

How much money will they be paying towards your 25000000.00 IDR
visit?

Why are they helping to pay for your visit? because he is my father.

Who is paying towards the cost of your visit? Someone I know (for example, family or friend)

Name Erlina Marhimpun Alamsyah

Address l. Merbabu No.8RT.8/RW.1,


Petukangan Sel., Kec. Pesanggrahan, Kota Jakarta
Selatan, Daerah Khusus Ibukota Jakarta 12270
jakarta selatan
DKI Jakarta
12270
Indonesia

How much money will they be paying towards your 10000000.00 IDR
visit?

Why are they helping to pay for your visit? she is my mom

Family in the UK

Do you have any family in the UK? No

Accommodation details

Do you have an address for where you are going to Yes


stay in the UK?

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UK Visas & Immigration
Where are you planning to stay in the UK? Randi Adhianta

Enter the address for where you are staying 65 Crown Station Place
Liverpool
L73LB

When will you arrive there? 30 November 2019

When will you leave there? 16 December 2019

Travel history (UK)

Have you been to the UK in the past 10 years? No

Have you ever: No

entered the UK illegally


remained in the UK beyond the validity of your
visa or permission to stay
breached the conditions of your leave, for
example, worked without permission or
received public funds when you did not have
permission
given false information when applying for a
visa, leave to enter, or leave to remain
breached UK immigration law in any other way

For either the UK or any other country, have you No


ever been:

Refused a visa
Refused entry at the border
Refused permission to stay or remain
Refused asylum
Deported
Removed
Required to leave
Excluded or banned from entry

Travel history (other)

How many times have you visited the following Once


places in the past 10 years?

Australia
Canada

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UK Visas & Immigration
New Zealand
USA
Switzerland
European Economic Area (do not include travel
to the UK)
Which countries are part of the European Economic
Area (EEA)?

Austria Greece Norway


Belgium Hungary Poland
Bulgaria Iceland Portugal
Croatia Ireland Romania
Republic Italy Slovakia
of Latvia Slovenia
Cyprus Liechtenstein Spain
Czech Lithuania Sweden
Republic Luxembourg UK
Denmark Malta
Estonia Netherlands
Finland
France
Germany

Which country did you visit? Australia


Which countries are part of the European Economic
Area (EEA)?

Austria Greece Norway


Belgium Hungary Poland
Bulgaria Iceland Portugal
Croatia Ireland Romania
Republic Italy Slovakia
of Latvia Slovenia
Cyprus Liechtenstein Spain
Czech Lithuania Sweden
Republic Luxembourg UK
Denmark Malta
Estonia Netherlands
Finland
France
Germany

What was the reason for your visit? Tourism (including visiting family and friends)

Date of visit August 2014

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UK Visas & Immigration
Number of days, weeks, months or years 5 Days

Have you been to any other countries in the past Yes


10 years?

Which country did you visit? Korea, South (Republic of Korea)

What was the reason for your visit? Tourism (including visiting family and friends)

When did you enter this country? 10 May 2014

When did you leave this country? 15 May 2014

Other history

In either peace or war time have you ever been No


involved in, or suspected of involvement in, war
crimes, crimes against humanity, or genocide?

I have read all of the information about war crimes,


including the guidance

Have you ever been involved in, supported or No


encouraged terrorist activities in any country?

Have you ever been a member of, or given support No


to, an organisation which has been concerned in
terrorism?

Have you, by any means or medium, expressed No


views that justify or glorify terrorist violence or that
may encourage others to commit terrorist or other
serious criminal acts?

I have read all of the information about terrorist


activities, organisations and views, including the
guidance

Have you ever been a member of, or given support No


to, an organisation which is or has been concerned
with extremism?

Have you, by any means or medium, expressed any No


extremist views?

I have read all of the information about extremist


organisations and views, including the guidance

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UK Visas & Immigration
Have you, as a part of your employment or No
otherwise, undertaken paid or unpaid activity on
behalf of a non-UK government which you know to
be dangerous to the interests or national security
of the UK or its allies?

Have you ever engaged in any other activities which No


might indicate that you may not be considered to
be a person of good character?

Is there any other information about your character No


or behaviour which you would like to make us
aware of?

Convictions and other penalties

At any time have you ever had any of the following, No, I have never had any of these
in the UK or in another country?

A criminal conviction
A penalty for a driving offence, for example
disqualification for speeding or no motor
insurance
An arrest or charge for which you are currently
on, or awaiting trial
A caution, warning, reprimand or other penalty
A civil court judgment against you, for example
for non payment of debt, bankruptcy
proceedings or anti-social behaviour
A civil penalty issued under UK immigration
law

Extra information

If you needed to add more information about your me and my family want to visite my little brother
application but were not able to, you can write it whos studying in Liverpool University and having a
here. trip around UK
If there is no further information you want to add,
click the 'Save and continue' button.
Add further details:

English language

We may have to talk to you about your application. English


Which language would you prefer to use?

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UK Visas & Immigration

Documents

Mandatory documents The passport or travel document for Mohammad


Rizki Agustandi from Indonesia

Payment

Length of your visit visa 6-month

Service Standard service

Mohammad Rizki Agustandi's application for Visitor 122.00 USD


visa

Total 122.00 USD

Consent

If your application is successful, there will be I confirm that I understand and accept these
conditions on your visa or leave to remain. This will conditions
include, for example, whether you are able to work
in the UK.
If you stay in the UK without permission:

You can be detained


You can be prosecuted, fined and imprisoned
You can be removed and banned from
returning to the UK
You will not be allowed to work
You will not be able to rent a home
You will not be able to claim any benefits and
can be prosecuted if you try to
You can be charged by the NHS for medical
treatment
You can be denied access to a bank account
DVLA can prevent you from driving by taking
away your driving licence
You cannot get free medical treatment from the
NHS, unless you are exempt from charges. If you
do not pay for any billed treatment this may affect
future visa applications.

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UK Visas & Immigration
You or your family members are not entitled to
receive state-funded education whilst in the UK
(except for children of academics visiting the UK
for 12 months).
You should leave the UK when your visa ends. If
not, you may be removed and banned from the UK.

Declaration
By sending this application, you confirm that to the best of your knowledge and belief the following is correct:

the information relating to the application


the supporting evidence

I understand that the data I have given can be used as set out in the privacy policy
I consent to organisations, including financial institutions, providing information to the Home Office when
requested in relation to this application.
I have discussed with any other applicants that I am acting on behalf of, and confirmed that the contents of the
application are correct and complete.
I agree to the terms and conditions.
I understand that if false information is given, the application can be refused and I may be prosecuted, and, if I am
the applicant, I may be banned from the UK.

I am the applicant aged 18 or over

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