UK Visas & Immigration

NAME: Marta Trifan

PASSPORT NUMBER: 057886478
DATE OF SUBMISSION: 06 February 2021 07:25 Greenwich Mean Time
(GMT)
FORM: Public Health Passenger Locator Form
REFERENCE: UKVI_5ZAA002593093
REGISTRATION EMAIL: applications+38665@passengerlocator.co.uk

Personal information

Email address applications+38665@passengerlocator.co.uk

Travel information

Do you know where you will stay for your first 10 Yes
days in the UK?

You provided the following address as your No

residential address. Do you plan on staying at this
address?
Flat 11Beech House, Stone Well Road
Stains
TW19 7FF

Who are you planning to stay with in the UK? With My boyfriend

What address will you stay at for your first 10 days Flat 11 Beech House, Stone Well Road
in the UK? Stains
TW19 7FF

When will you arrive there? 8 February 2021

Do you need to self-isolate when you arrive in the Yes, I need to self-isolate

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 UK Visas & Immigration
UK?

What are your travel plans? Stay in the UK

Which countries have you been in, or will you be in, Romania
for the 10 days before coming to the UK?

Departure date 6 February 2021

Have you opted-in to Test to Release? No

Where will you arrive in the UK? London

What country are you travelling from? Romania

Which operator will you be travelling with? Le shuttle

What is the flight number, train service or ship 27831130

name that you will arrive on?

Your planned travel information

When do you plan to arrive in the UK? 8 February 2021 05:00 AM

Personal information

Given name(s) Marta

Family name Trifan

What is your sex? Female

Is your home address in the UK? Yes

Home address Flat 11Beech House, Stone Well Road

Stains
TW19 7FF
(manually entered)

Are you able to be contacted by telephone? I can be contacted by telephone call and text
message (SMS)

Date of birth 4 July 1991

Provide your primary telephone number +44 07548068067

Passport details

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 UK Visas & Immigration
Passport number or travel document reference 057886478
number

Issuing authority Romania

Issue date 5 August 2019

Expiry date 5 August 2029

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 will arrive in the UK within the next 48 hours

I understand I have to provide proof of a negative COVID 19 test prior to departure to the UK (unless
exempt)
I have provided my seat number, if relevant
The information I have entered in this form is correct

If any of your information changes once you have submitted your details, such as travel details, seat number, or
contact information, you must complete a new form.

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

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