FO R O FFICIAL USE O NLY

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Application Form - NOT VALID FOR TRAVEL
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Application Reference / Transaction Number: 58674692
Type of Visa/Preclearance: Short St ay
Journey Type: Single Journey
Visa/Preclearance cat egory: Visit Tourist
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Surname: Ali
Forename: Yousuf
Ot her names:
Cont act Email: yousuf_ ali0786@out look.com
Dat e of Birt h: 29/06/1959
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Gender: Male
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Nat ionalit y: Pakist an

Passport / Travel Document Number: LS1800782
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Issue Dat e: 22/02/2017

Expiry Dat e: 22/02/2027
Dat es of Travel From: 21/06/2023
Dat es of Travel To: 30/06/2023

Please not e t he address/cont act det ails of t he Irish Embassy/Consulat e/Visa Office t o which
your applicat ion has been sent .
Visa Office
Embassy of Ireland
United Kingdom (Great Britain & Northern Ireland)
Email : londonvisaoffice@df a.ie
Website : http://www.embassyofireland.co.uk
Please check above websit e for det ails of where you should now submit t he following
document at ion, t oget her wit h t he relevant fee. Document s must be submit t ed wit hin 30 days of
complet ing your online applicat ion.

1. Printed and signed application summary sheet

2. Original passport
 3. Passport sized colour photographs
4. Evidence of payment of the visa f ee (unless you are f ee exempt)
5. Supporting documents f or the relevant visa category (See www.irishimmigration.ie f or more
inf ormation. If you are applying to the Visas Offices in Abuja, Abu Dhabi, Beijing, London, Moscow or
Turkey please check the relevant website f or any additional local requirements)
6. All supporting documentation must be in English or accompanied by a notarised translation

Please not e t hat your applicat ion will be held online for 30 days and it can be ret rieved and
print ed any t ime during t his period. However, it will not be possible for you t o make changes t o
any of t he det ails you have provided. If you need t o advise us of anyt hing you have omit t ed or
incorrect ly ent ered, you should submit t his informat ion in writ ing t o t he Embassy/Consulat e or
Visa Office shown above, wit h your support ing document at ion.

DECLARAT ION BY APPLICANT

You must now read t he declarat ion below and sign it . T his must be signed by t he applicant
personally.

An applicat ion for a person under t he age of 18 should be complet ed by t he parent or legal
guardian.

DECLARAT ION

I hereby apply for a visa/preclearance to t ravel to Ireland. T he informat ion I have given is complet e and is t rue
to t he best of my knowledge. I also declare t hat t he photograph submit t ed wit h t his form is a t rue likeness of
me, t he applicant . I confirm t hat if, before t he applicat ion is decided, t here is a mat erial change in my
circumst ances or new informat ion relevant to t his applicat ion becomes available, I will inform t he Embassy/
Consulat e/Visa Office handling my applicat ion.

I underst and t hat I may be required to provide my biomet ric informat ion (fingerprint s and facial image) before
my applicat ion will be processed and t hat any such informat ion, toget her wit h my biographical informat ion,
will be collect ed by t he Unit ed Kingdom Home Office or anot her aut horised agent on behalf of t he Immigrat ion
Service Delivery of t he Depart ment of Just ice and Equalit y.

I underst and t hat I may be recorded by elect ronic means (CCT V) when I at t end at a cent re for t he purpose of
providing my biomet rics and biographical det ails or lodging my document s and t hat any such recordings may
be ret ained for t he purpose of maint aining t he int egrit y of t he visa/preclearance applicat ion process.

I underst and t hat addit ional informat ion may be required before my applicat ion can be processed. I
underst and t hat failure to provide such dat a, if request ed to do so by t he Embassy/Consulat e/ Visa Office,
may result in t he refusal of my applicat ion.

I underst and t hat any false or misleading informat ion, or false support ing document at ion, may result in t he
refusal of my applicat ion and t hat t his may result in me being prevent ed from making furt her Irish
visa/preclearance applicat ions for a period of up to five years. An appeal, against t he decision to refuse to
grant t he visa/preclearance sought , may not be permit t ed.

I also underst and t hat if I have incorrect ly claimed to be exempt from t he requirement s to provide biomet rics
my applicat ion may be refused and I may be prevent ed from making furt her Irish visa/preclearance
applicat ions for a period of up to five years. An appeal, against t he decision to refuse to grant t he
visa/preclearance sought , may not be permit t ed.

I underst and t hat t he out come of t his visa/preclearance applicat ion may be made available to t he Unit ed
Kingdom Home Office for t he purpose of preserving t he int egrit y of t he Common Travel Area.
I underst and t hat t he applicat ion form and support ing document at ion or copies t hereof, may be conveyed to
t he Irish deciding aut horit y as considered appropriat e by t he receiving office, including commercial courier (in a
sealed package) or ot her post al or elect ronic means.

Signat ure of applicant / parent or legal guardian

(in case of an applicant under 18 years of age)
 

Dat e