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Registration Information Form

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STUDENT/EMPLOYMENT INFORMATION

International Visitors Registration Office

Full Name

Place of Birth Date of Birth

Police Registration Certificate Number

Name of Educational Institution/Employer in the UK

Name of Educational Institution/Employer in Home Country

Sponsor/Government Service

Address in Home Country Address in UK

Email:
Tel:
Mobile:

Please tick one of the following:


Married/Civil Partnership Single

Next of Kin Details: FATHER Next of Kin Details: MOTHER


Full Name: Full Name:
Date of Birth: Date of Birth:
Home Address: Home Address:

Occupation: Occupation:
Email: Email:
Tel: Tel:

If married or in a civil partnership, please complete the following details:

Date of Marriage or Civil Partnership

Place of Marriage or Civil Partnership

Name of Husband/Wife/Civil Partner

Date of Birth of Husband/Wife/Civil Partner

I can confirm that all of the above information is true to the best of my knowledge. Any person who
knowingly makes a false declaration may be committing a criminal offence and could be prosecuted under the
Immigration Act 1971.

Signature

Print Name Date

Form 357H (12/2013)

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