UK Visas & Immigration

NAME: Nicolae Stan

PASSPORT NUMBER: 054505566
DATE OF SUBMISSION: 18 June 2020 12:23 British Summer Time (BST)
FORM: Public Health Passenger Locator Form
REFERENCE: 5ZAA014481179
REGISTRATION EMAIL: nicolas.eran@yahoo.com

Personal information

Email address nicolas.eran@yahoo.com

Travel information

Do you know where you will stay for your first 14 Yes
days in the UK?

Who are you planning to stay with in the UK? Haygrove Ltd

What address will you stay at for your first 14 days Redbank Ledbury
in the UK? Ledbury
HR8 2JL

When will you arrive there? 20 June 2020

When will you leave there? 12 November 2020

Are you exempt from self-isolating for the first 14 No

days you are in the UK?

Will you be travelling to the UK as part of an No

organised group?

What are your travel plans? Stay in the UK

Where will you arrive in the UK? dover ( ferry ) ship

What country are you travelling from? Romania

Which operator will you be travelling with? transmarian

What are the booking reference(s) for your travel? JM5TA5

What is the flight number, train service or ship ZG83K5E

name that you will arrive on?

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What is your seat number? (if relevant) 6

Your planned travel information

When do you plan to arrive in the UK? 19 June 2020 18:45 PM

When do you plan to leave the UK? (optional) 12 November 2020

Personal information

Are you completing this form for someone else? No

Given name(s) Nicolae

Family name Stan

Are you now or have you ever been known by No

another name?

What is your sex? Male

Residential address street , baraganului ,BL ,L30, sc 2 et2, ap 31

calarasi
Calarasi
Calarasi
9500
Romania

Provide your telephone number 447438869632

Where do you use this telephone number? For use whilst in the UK

Select whether this is your home, mobile or work Mobile telephone number
telephone number

Provide your telephone number 40727155808

Where do you use this telephone number? For use whilst in the UK

Select whether this is your home, mobile or work Mobile telephone number
telephone number

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

What is your preferred contact number? 40727155808

Date of birth 26 August 1978

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Passport details

Passport number or travel document reference 054505566

number

Issuing authority Calarasi,Romania

Issue date 8 March 2017

Expiry date 8 March 2022

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?

Emergency contact

Their name stan vasilica daniela

Their telephone number +40737617660

Their email address nicolas.eran@yahoo.com

Declaration
I declare that:

I will arrive in the UK within the next 48 hours

the information I have entered in this form is correct

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

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