Passenger Locator Form

STATUS: GREEN
VACCINE STATUS: NO/NOT DECLARED

The code contains personal

information. By sharing the code,
you will be sharing your passenger
locator form data.

Summary
Name Ciprian Rafael GROZA
Passport number 125721029
Which company are you travelling with? Ryanair UK Limited
What is the flight number, train service or ship FR2699
name that you will arrive on?
Reference UKVI_5ZAA010439770
Status GRN
What are your travel plans? Stay in the UK
Are you required to self-isolate when you arrive in I need to self-isolate when I arrive in the UK,
the UK? unless I was fully vaccinated in the UK or under a
vaccine programme approved by the UK or I have
only been in green list countries or islands
Are you required to book a COVID-19 test Yes
package for when you arrive in the UK?
Covid test booking reference EXMED0370941
Test to release provider EXMED0370941
Arrival location London Stansted Airport (STN)
Date of arrival 19 August 2021 12:50 British Summer Time (BST)
Date of submission 18 August 2021 19:59 British Summer Time (BST)

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 UK Visas & Immigration

Personal information

Email address ciprelo@yahoo.it

Travel information

Do you have an address for where you will stay Yes

during your first 10 days in the UK?

You provided the following address as your Yes

residential address. Do you plan on staying at this
address?
37 NORCOTT CLOSE
DUNSTABLE
Lu5 4ah

What address will you stay at for your first 10 days 37 NORCOTT CLOSE
in the UK? DUNSTABLE
Lu5 4ah

When will you arrive there? 19 August 2021

Are you required to self-isolate when you arrive in I need to self-isolate when I arrive in the UK, unless I
the UK? was fully vaccinated in the UK or under a vaccine
programme approved by the UK or I have only been
in green list countries or islands

What are your travel plans? Stay in the UK

Where will you arrive in the UK? London Stansted Airport (STN)

What country are you travelling from? Romania

Which company are you travelling with? Ryanair UK Limited

What is the flight number, train service or ship FR2699

name that you will arrive on?

What is your seat number? (you must provide your 05D

seat number if relevant. Include coach number if
travelling by train, for example coach 5 seat 2)

Which countries have you been in, or will you be in, Romania
for the 10 days before coming to the UK?

Have you visited, or will you visit, any islands in this No

country during the 10 days before you arrive in the

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 UK Visas & Immigration
UK?

Arrival date 30 July 2021

Departure date 19 August 2021

Your dates of travel

When do you plan to arrive in the UK? 19 August 2021 12:50 PM

Personal information

Given name(s) Ciprian Rafael

Family name GROZA

What is your sex? Male

Is your home address in the UK? Yes

Home address 37 NORCOTT CLOSE

DUNSTABLE
Lu5 4ah
(address verified)

How can we contact you when you are in the UK? I can be contacted by phone call and text message
(SMS)

Date of birth 31 March 1978

Your primary phone number +44 07812464611

Do you meet the COVID-19 vaccination eligibility No/Prefer not to say

criteria for reduced isolation and testing
requirements?

Passport and travel document details

Passport number or travel document reference 125721029

number

Country of Issue British Citizen (GBR)

Expiry date 20 April 2031

People you are travelling with

Are you travelling to the UK with anyone under 18 Yes

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 UK Visas & Immigration
years old that you are including on this form?

Given name(s) Sophie Alyssa

Family name Groza

Relationship to you Daughter

Date of birth 28 June 2013

Is the person you are including 12 to 17 years old, No

or 12 to 15 years old if you are entering Scotland?

Given name(s) Marcus Oliver

Family name Groza

Relationship to you Son

Date of birth 21 August 2013

Is the person you are including 12 to 17 years old, No

or 12 to 15 years old if you are entering Scotland?

Declaration
I declare that:

I will arrive in the UK within the next 48 hours

I understand I have to provide proof of a negative COVID-19 test prior to departure to the UK (unless I am
exempt)
I understand that I must bring proof of my COVID-19 vaccination status if I meet the eligibility criteria
I have provided my seat number, if relevant
The information I have entered in this form is correct
I understand it could be a criminal offence to provide false details and I may be prosecuted

If any of your information changes once you have submitted your form, such as travel details, seat number, or
contact information, you must complete a new form.

I confirm that I understand and agree with the above declarations.

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