Is this your first passport?YesNoIf no, provide details of previous passport(s)Number Place of issue Number Place of issue
Have you ever applied for UK entry clearance?YesNoIf
, please give dates and places of application
Have you visited the UK before?YesNoIf
, please give dates and length of each stay
Have you ever been refused UK entry clearance, refusedleave to enter the UK or had your leave to enter or remaincancelled?YesNoIf
, complete IM2E
Have you ever been deported, removed or otherwiserequired to leave the UK?YesNo
Have you ever been refused an Entry Clearance or beendeported from another country?YesNoIf yes, please give country and date
Do you have any criminal convictions?YesNo
Have you ever been a charge on public funds in the UK?YesNo
Type of visit:(1) Private(2) Business(3) Family(4) OtherIf (3): family member’s name and relationship to youIf (4): specify reason
Have you any other reason for travelling to the UK?YesNoPlease specify
How long do you intend to stay in the UK?
Date of arrival
How much money is available to you for your stay?
Who is paying for your ticket?
Intended address in the UK Postcode Telephone number
Do you have any friends or relatives in the UK?YesNoIf
, please give details to include acontact number
What is your present job?
What date did you start this job?
What is your annual income?
Where do you work (name, address and telephone number)?
Declaration – to be completed by all applicants
Please tick to confirm that you have read and understood the information on page 3I declare that the information given on pages 1 and 2 of this application is correct to the best of my knowledge and belief.Information given will be treated in confidence. I understand that the information on this form may be disclosed to theDepartment of Work and Pensions in the UK for the purpose of determining benefit claims and to the Department of Healthin the UK for the purpose of investigating payment for any NHS treatment. I agree to the information on this form beingused for these purposes.Applicant’s SignatureDate