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 Samantha Charlotte Roberts
Passport number 556707769
Which company are you travelling with? Ryanair
What is the flight number, train number or ship FR2714
name that you will arrive on?
Reference UKVI_5ZAA030321696
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 or I
the UK? meet vaccine eligibility criteria
Are you required to book a COVID-19 test Yes
package for when you arrive in the UK?
Your test package booking reference RANDX5221045
Arrival location London Gatwick Airport (LGW)
Date of arrival 09 January 2022 10:30 Greenwich Mean Time
(GMT)
Date of submission 07 January 2022 19:30 Greenwich Mean Time
(GMT)

Samantha Charlotte Roberts Page 1 of 4

 UK Visas & Immigration

Personal information

Email address sammy.2000@live.co.uk

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?
61 GLOSTER ROAD
WOKING
GU22 9EU

What address will you stay at for your first 10 days 61 GLOSTER ROAD
in the UK? WOKING
GU22 9EU

When will you arrive there? 9 January 2022

Are you required to self-isolate when you arrive in I need to self-isolate when I arrive in the UK or I
the UK? meet vaccine eligibility criteria

What are your travel plans? Stay in the UK

Where will you arrive in the UK? London Gatwick Airport (LGW)

What country or territory are you travelling from? Spain

Which company are you travelling with? Ryanair

What is the flight number, train number or ship FR2714

name that you will arrive on?

Your cabin type or your coach number Aircraft - Economy

Which countries or territories have you been in, or Spain

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

Samantha Charlotte Roberts Page 2 of 4

 UK Visas & Immigration
arrive in the UK?

Arrival date (optional) 20 December 2021

Departure date 9 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 RANDX5221045

Your dates of travel

When do you plan to arrive in the UK? 9 January 2022 10:30 AM

Personal information

Given name(s) Samantha Charlotte

Family name / Surname Roberts

What is your sex? Female

Is your home address in the UK? Yes

Home address 61 GLOSTER ROAD

WOKING
GU22 9EU
(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 13 July 2000

Your primary phone number +44 7429349496

Your secondary phone number (optional) +44 7762225099

Do you meet the COVID-19 vaccination eligibility Yes

criteria for reduced isolation and testing
requirements?

Do you have a QR code that you can use to verify No

your vaccination status?

Have you provided proof of your vaccination No

status?

Samantha Charlotte Roberts Page 3 of 4

 UK Visas & Immigration
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 Spain

COVID-19 vaccination(s) in?

Passport and travel document details

Passport number or travel document reference 556707769

number

Country of Issue British Citizen (GBR)

Expiry date 14 September 2028

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 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.

Samantha Charlotte Roberts Page 4 of 4