Passenger Locator Form

STATUS: NON-RED LIST

VACCINE STATUS: DECLARED FULL/EXEMPT

The code contains personal

information. By sharing the code,
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locator form data.

Summary
Name Michael Anthony Pengilley
Passport number 563096097
Which company are you travelling with? EasyJet
What is the flight number, train number or ship EZY6294
name that you will arrive on?
Reference UKVI_5ZAA034652181
Status NON-RED LIST
Arrival location Bristol Airport (BRS)
Date of arrival 20 February 2022 01:45 Greenwich Mean Time
(GMT)
Date of submission 18 February 2022 12:35 Greenwich Mean Time
(GMT)

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 UK Visas & Immigration

Personal information

Email address tinaruth2012@me.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?
98 COOMBE PARK LANE
PLYMOUTH
Pl5 2LT

What address will you stay at for your first 10 days 98 COOMBE PARK LANE
in the UK? PLYMOUTH
Pl5 2LT

When will you arrive there? 20 February 2022

Where will you arrive in the UK? Bristol Airport (BRS)

What country or territory are you travelling from? Egypt

Which company are you travelling with? EasyJet

What is the flight number, train number or ship EZY6294

name that you will arrive on?

Your cabin type or your coach number Aircraft - Economy

Which countries or territories have you been in, or Egypt

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
arrive in the UK?

Departure date 20 February 2022

Your dates of travel

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 UK Visas & Immigration

Which date do you plan to arrive in the UK? 20 February 2022 01:45 AM

Personal information

Given name(s) Michael Anthony

Family name / Surname Pengilley

Date of birth 30 September 1954

Document type Passport

Nationality British Subject

Country or territory of issue British Citizen (GBR)

Passport number or travel document reference 563096097

number

Expiry date 10 September 2029

Is your home address in the UK? Yes

Home address 98 COOMBE PARK LANE

PLYMOUTH
Pl5 2LT
(address verified)

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

Your primary phone number +44 7427141732

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?

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 England (United Kingdom of Great Britain and
COVID-19 vaccination(s) in? Northern Ireland)

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 UK Visas & Immigration
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.

Michael Anthony Pengilley Page 4 of 4