Passenger Locator Form

STATUS: NON-RED LIST

VACCINE STATUS: DECLARED FULL/EXEMPT

The code contains personal

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

Summary
Name Mohammed Alshamsi
Passport number GY8266261
Which company are you travelling with? Emirates
What is the flight number, train number or ship EK001
name that you will arrive on?
Reference UKVI_5ZAA031655289
Status NON-RED LIST
Are you required to book a COVID-19 test Yes
package for when you arrive in the UK?
Your test package booking reference BRUHY0077547
Arrival location London Heathrow Airport (LHR)
Date of arrival 24 January 2022 11:40 Greenwich Mean Time
(GMT)
Date of submission 22 January 2022 14:40 Greenwich Mean Time
(GMT)

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 UK Visas & Immigration

Personal information

Email address Alshamsi.mrs@gmail.com

Travel information

Do you have an address for where you will stay Yes

during your first 10 days in the UK?

Who are you planning to stay with in the UK? The capital Hotel

What address will you stay at for your first 10 days CAPITAL HOTEL
in the UK? 22-24 BASIL STREET
LONDON
SW3 1AT

When will you arrive there? 24 January 2022

When will you leave there? 29 January 2022

Where will you arrive in the UK? London Heathrow Airport (LHR)

What country or territory are you travelling from? United Arab Emirates

Which company are you travelling with? Emirates

What is the flight number, train number or ship EK001

name that you will arrive on?

Your cabin type or your coach number Aircraft - Economy

Which countries or territories have you been in, or United Arab Emirates
will you be in, for the 10 days before coming to the
UK?

Did you transit through this country or territory via No

plane or train without passing Border Control?

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

country or territory during the 10 days before you
arrive in the UK?

Departure date 24 January 2022

Are you required to book a COVID-19 test package Yes

for when you arrive in the UK?

Your test package booking reference BRUHY0077547

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 UK Visas & Immigration

Your dates of travel

When do you plan to arrive in the UK? 24 January 2022 11:40 AM

When do you plan to leave the UK? (optional) 29 January 2022

Personal information

Given name(s) Mohammed

Family name / Surname Alshamsi

What is your sex? Male

Is your home address in the UK? No

Home address Dubai, al mizhar 1, st21b, villa38

Dubai
United Arab Emirates

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 8 February 1995

Your primary phone number +971 553838738

Your secondary phone number (optional) +971 502727575

Do you meet the COVID-19 vaccination eligibility Yes

criteria for reduced isolation and testing
requirements?

How do you meet the COVID-19 vaccination status I am fully vaccinated by a recognised programme
eligibility requirements?

Which country or territory did you receive your United Arab Emirates
COVID-19 vaccination(s) in?

Passport and travel document details

Passport number or travel document reference GY8266261

number

Country or territory of issue United Arab Emirates (ARE)

Expiry date 29 January 2024

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 UK Visas & Immigration
People you are travelling with

Are you travelling to the UK with anyone under 18 No

years old that you are including on this form?

Declaration
I declare that:

I understand I have to provide proof of my negative PCR or LFD coronavirus (COVID-19) test result, unless
I am exempt or meet vaccine eligibility criteria
I understand that I must bring proof of my COVID-19 vaccination status if I meet the eligibility criteria. My
proof of vaccination status (if declared) contains my full name, date of birth, vaccine brand and
manufacturer, the dates for all my vaccination doses and the country of vaccination and/or certificate
issuer
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

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

Mohammed Alshamsi Page 4 of 4