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 Mahejabeen Mahejabeen
Passport number V5177197
Which company are you travelling with? Emirates
What is the flight number, train number or ship EK005
name that you will arrive on?
Reference UKVI_5ZAA036640228
Status NON-RED LIST
Arrival location London Heathrow Airport (LHR)
Date of arrival 04 March 2022 20:00 Greenwich Mean Time
(GMT)
Date of submission 01 March 2022 22:15 Greenwich Mean Time
(GMT)

Mahejabeen Mahejabeen Page 1 of 4

 UK Visas & Immigration

Personal information

Email address syedqutuub@gmail.com

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?
2a SAXON ROAD
Middlesex
United Kingdom
SOUTHALL
UB1 1QL

What address will you stay at for your first 10 days 2a SAXON ROAD
in the UK? Middlesex
United Kingdom
SOUTHALL
UB1 1QL

When will you arrive there? 4 March 2022

When will you leave there? 14 March 2022

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

What country or territory are you travelling from? India

Which company are you travelling with? Emirates

What is the flight number, train number or ship EK005

name that you will arrive on?

Your cabin type or your coach number Aircraft - Economy

Which countries or territories have you been in, or India

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

Mahejabeen Mahejabeen Page 2 of 4

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

Arrival date (optional) 4 March 2022

Departure date 4 March 2022

Your dates of travel

Which date do you plan to arrive in the UK? 4 March 2022 20:00 PM

Personal information

Given name(s) Mahejabeen

Family name / Surname Mahejabeen

Date of birth 22 July 2002

Document type Passport

Nationality India

Country or territory of issue India (IND)

Passport number or travel document reference V5177197

number

Expiry date 30 November 2031

Is your home address in the UK? Yes

Home address 2a SAXON ROAD

Middlesex
United Kingdom
SOUTHALL
UB1 1QL
(manually entered)

Your phone number +44 07448348495

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?

Mahejabeen Mahejabeen Page 3 of 4

 UK Visas & Immigration
Which country or territory did you receive your India
COVID-19 vaccination(s) in?

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.

Mahejabeen Mahejabeen Page 4 of 4