Passenger Locator Form

STATUS: NON-RED LIST

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 Mohammed Mustafah Khan
Passport number 564542460
Which company are you travelling with? RYANAIR DAC
What is the flight number, train number or ship FR2157
name that you will arrive on?
Reference UKVI_5ZAA021471278
Status NON-RED LIST
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?
Are you required to book a COVID-19 test Yes
package for when you arrive in the UK?
Your test package booking reference RANDX3947213
Arrival location Birmingham Airport (BHX)
Date of arrival 29 October 2021 11:30 British Summer Time
(BST)
Date of submission 28 October 2021 18:36 British Summer Time
(BST)

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 UK Visas & Immigration

Personal information

Email address m.khan10@hotmail.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?
9 GREEN AVENUE
BIRMINGHAM
B28 8DE

What address will you stay at for your first 10 days 9 GREEN AVENUE
in the UK? BIRMINGHAM
B28 8DE

When will you arrive there? 29 October 2021

Are you required to self-isolate when you arrive in I need to self-isolate when I arrive in the UK
the UK?

What are your travel plans? Stay in the UK

Where will you arrive in the UK? Birmingham Airport (BHX)

What country are you travelling from? Spain

Which company are you travelling with? RYANAIR DAC

What is the flight number, train number or ship FR2157

name that you will arrive on?

Which countries have you been in, or will you be in, Spain
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
UK?

Arrival date 25 October 2021

Departure date 29 October 2021

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 UK Visas & Immigration
Are you required to book a COVID-19 test package Yes
for when you arrive in the UK?

Your test package booking reference RANDX3947213

Are you using Test to Release? No

Your dates of travel

When do you plan to arrive in the UK? 29 October 2021 11:30 AM

Personal information

Given name(s) Mohammed Mustafah

Family name / Surname Khan

What is your sex? Male

Is your home address in the UK? Yes

Home address 9 GREEN AVENUE

BIRMINGHAM
B28 8DE
(address verified)

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

Date of birth 15 October 2001

Your primary phone number +44 7519291469

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 564542460

number

Country of Issue British Citizen (GBR)

Expiry date 14 March 2030

People you are travelling with

Are you travelling to the UK with anyone under 18 No

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

Declaration
I declare that:

I understand I have to provide proof of negative coronavirus (COVID-19) test result if I am travelling from a
red list country or island, or do not qualify as fully vaccinated, unless I am exempt
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.

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