Passenger Locator Form

STATUS: NON-RED LIST

VACCINE STATUS: NO/NOT DECLARED

The code contains personal

information. By sharing the code,
you will be sharing your passenger
locator form data.

Summary
Name Klara Helena Blomfjord
Passport number 35196022
Which company are you travelling with? British Airways plc
What is the flight number, train number or ship BA0661
name that you will arrive on?
Reference UKVI_5ZAA036747317
Status NON-RED LIST
Are you required to book a COVID-19 test Yes
package for when you arrive in the UK?
Your test package booking reference COVTS6120572
Arrival location London Heathrow Airport (LHR)
Date of arrival 04 March 2022 11:20 Greenwich Mean Time
(GMT)
Date of submission 02 March 2022 16:17 Greenwich Mean Time
(GMT)

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 UK Visas & Immigration

Personal information

Email address klaralps@hotmail.com

Travel information

Do you have an address for where you will stay Yes

during your first 10 days in the UK?

Who are you planning to stay with in the UK? James Biglin

What address will you stay at for your first 10 days 23 CRICKETFIELD ROAD
in the UK? HORSHAM
RH12 1TE

When will you arrive there? 4 March 2022

When will you leave there? 9 March 2022

Where will you arrive in the UK? London Heathrow Airport (LHR)

What country or territory are you travelling from? Cyprus

Which company are you travelling with? British Airways plc

What is the flight number, train number or ship BA0661

name that you will arrive on?

Which countries or territories have you been in, or Cyprus

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 4 March 2022

Are you required to book a COVID-19 test package Yes

for when you arrive in the UK?

Your test package booking reference COVTS6120572

Your dates of travel

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 UK Visas & Immigration
Which date do you plan to arrive in the UK? 4 March 2022 11:20 AM

When do you plan to leave the UK? (optional) 9 March 2022

Personal information

Given name(s) Klara Helena

Family name / Surname Blomfjord

Date of birth 8 April 2007

Document type Passport

Nationality Sweden

Country or territory of issue Sweden (SWE)

Passport number or travel document reference 35196022

number

Expiry date 7 September 2025

Is your home address in the UK? No

Home address Melinas Merkouri

Limnaria Gardens M1
Paphos
8042
Cyprus

Your phone number +357 97662842

Do you meet the COVID-19 vaccination eligibility No/Prefer not to say

criteria for reduced isolation and testing
requirements?

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

Klara Helena Blomfjord Page 3 of 4

 UK Visas & Immigration
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.

Klara Helena Blomfjord Page 4 of 4