Applicant Biographic Details and Travel Date: Official Use Only
Applicant Biographic Details and Travel Date: Official Use Only
Applicant Biographic Details and Travel Date: Official Use Only
SEX: MALE
NATIONALITY: NIGERIA
GWF030632366
DATE APPLICATION 22 FEB 2014
SUBMITTED ONLINE:
VISA APPLICATION FEE AND PAYMENT CONFIRMATION >> OFFICIAL USE ONLY
EC NUMBER:
DECLARATION
I declare that the information given on this form whether input by myself, input on my behalf by a third party or automatically pre-populated is complete
and correct to the best of my knowledge and belief. I also declare that the photograph submitted with this form is a true likeness of me. I confirm that if,
before this application is decided, there is a material change in my circumstances or new information relevant to this application becomes available, I
will inform the United Kingdom diplomatic mission handling my application.
I understand that all information provided by me will be processed by the Home Office in accordance with the Data Protection Act 1998. I am aware
that the Home Office is the data controller in relation to the information provided by me in this application form. I am aware that the information I
provide, including biometric data, will be treated in confidence, but it may be disclosed to other government departments, agencies, local authorities,
foreign governments, and other bodies, to enable the Home Office or those bodies to perform their functions. Any disclosures will be in accordance with
the Data Protection Act 1998. I also understand that the information provided by me may also be used for staff training purposes.
I declare that the documents that I have supplied with this application are genuine and the statements I have made with this application are truthful. I
understand that the Home Office (or a trusted third party) may make reasonable checks to confirm the accuracy and authenticity of evidence I have
provided and documents I have submitted with this application. I further understand that the Home Office (or a trusted third party) may also make
reasonable checks on any sponsors to my application to verify statements contained in the application and establish that I will comply or have complied
with the terms of any visa granted.
I understand that UK entry clearance applications may be handled by British Missions in other locations, including outside the country in which I have
applied for entry clearance and that this may involve the transferring of my application and supporting documents to and from another Mission. I
understand that the Home Office will be responsible for transferring my application and supporting documents safely. I understand in these
circumstances my application will still be handled in line with Home Office published customer service standards.
I understand that the fee payable is for an application processing and entry clearance decision-making service, not for the guaranteed delivery of a
visa, therefore I will not be entitled to a refund should my application for entry to the UK or Commonwealth and Overseas Territories be refused or
granted for a shorter time period than I applied for. I also understand that my visa application fee will be refunded only if the application is withdrawn in
writing within 3 months and 7 days of the original date of application and prior to the submission of biometric data or any processing taking place.
I also understand that the information provided by me, or information made available to the Home Office during the processing of my application, may
be shared with my sponsor(s) or any person(s) acting on their behalf or any applicant linked to my application (for example to my spouse / partner if we
apply for visas for a trip together) for the sole purpose of considering my application. I am aware that if there is any information I do not want you to
disclose to them I will tell you by enclosing a letter with my supporting documentation. If such requests prevent you from making legitimate inquiries, my
application may be refused.
I am also aware that my application will be automatically refused and I may be banned from going to the UK for 10 years if I use a false document, lie or
withhold relevant information. I may also be banned if I have breached immigration laws in the UK. I am further aware that should I use a false
document, lie or withhold relevant information my details may be passed to law enforcement agencies.
I understand that I may be required to provide a record of my fingerprints and a photograph of my face (“biometric data”) as part of my application. If I
refuse to do so, my application may be treated as invalid and, if so, will not be considered further. (See Statutory Instrument 2006 No 1743 - The
Immigration (Provision of Physical Data) Regulations 2006, Regulation 7(1)).
I am aware that I may be billed for any NHS medical treatment undertaken in the UK and that I do not have recourse to public funds during my stay in
the UK.
I understand that if I fail to pay NHS debts incurred by me this could adversely affect future entry clearance applications I make.
I understand that my details may, in certain circumstances, be passed to fraud prevention agencies to prevent and detect fraud and money laundering.
I also understand that such agencies may provide the Home Office with information about me. Further details explaining when information may be
passed to or from fraud prevention agencies and how that information may be used can be obtained from the Home Office website.
I am aware that it is an offence under the Immigration Act 1971 (as amended) to make a statement which I know to be false, or not believe to be true, in
order to obtain a visa/entry clearance to the UK.
Personal information which is provided about a person acting in support of an application, including any documentary evidence provided by or about
them, will be processed in accordance with the Data Protection Act 1998 by the Home Office, which is the data controller in relation to the information
provided.
The Home Office will use this information to make decisions about the application and to prevent and detect fraud. We may share this information with
other government departments or agencies, local and public authorities, foreign governments, companies (including financial and utility companies),
employers or other bodies in order to make reasonable checks to verify the information provided in the application and confirm that sponsors have or
will comply with the terms of any visa which may be or have been granted. Any information received by the Home Office about a sponsor may be used
in reaching a decision on the application. Full details of the way in which the data may be processed can be found on the Home Office website at
http://www.ukba.homeoffice.gov.uk/
I confirm that, where I have a sponsor, I have informed my sponsor of the information set out above and my sponsor has confirmed that they consent to
me providing the information about them which is set out in this application.
APPLICANT'S SIGNATURE:
DATE SIGNED:
GWF030632366
TRAVEL INFORMATION
17 ARE YOU TRAVELLING WITH ANYONE? YES
TRAVEL HISTORY
25 HAVE YOU BEEN ISSUED ANY VISA FOR THE UK, UK YES
OVERSEAS TERRITORIES OR COMMONWEALTH
COUNTRY IN THE LAST 10 YEARS?
26 TYPE OF VISA ISSUED DATE OF ISSUE DATE OF EXPIRY ISSUING AUTHORITY
FATHER
53 NATIONALITY NIGERIA
54 FAMILY NAME / SURNAME NJIDDA
(IF THEY ONLY HAVE ONE NAME, PLEASE ENTER IT
HERE AND IN THE GIVEN NAME BOX)
55 GIVEN NAME(S) / FORENAME(S) BUBA
(IF THEY ONLY HAVE ONE NAME, PLEASE ENTER IT
HERE AND IN THE FAMILY NAME BOX)
56 DATE OF BIRTH 15 FEB 1935
57 PLACE OF BIRTH GWOZA
MOTHER
58 NATIONALITY NIGERIA
59 FAMILY NAME / SURNAME MUSTAPHA
(IF THEY ONLY HAVE ONE NAME, PLEASE ENTER IT
HERE AND IN THE GIVEN NAME BOX)
60 GIVEN NAME(S) / FORENAME(S) FADIMATU
(IF THEY ONLY HAVE ONE NAME, PLEASE ENTER IT
HERE AND IN THE FAMILY NAME BOX)
61 DATE OF BIRTH 19 JUN 1940
62 PLACE OF BIRTH GWOZA
DEPENDENT CHILDREN
63 DO YOU HAVE ANY DEPENDENT CHILDREN? YES
64 PASSP NATIO FAMILY GIVEN DATE PLACE TRAVE LIVE ADDRE ADDRE ADDRE ADDRE POSTA COUNT CONTA
ORT NALITY NAME NAMES OF OF LLING WITH SS 1 SS 2 SS 3 SS 4 L RY CT
NUMBE BIRTH BIRTH WITH YOU CODE NUMBE
R YOU R
A02228 NIGERI ABUBA FATIMA 18 NOV MAIDU YES YES FHA NIGERI
090 A KAR BUBA 2001 GURI ESTAT A
E,
TRANS
AMADI,
PORTH
ARCOU
A02228 NIGERI ABUBA ABUBA 26 SEP MAIDU YES YES FHA NIGERI
089 A KAR KAR 2004 GURI ESTAT A
BUBA E
T/AMA
DI,
PORTH
ARCOU
RT
A02228 NIGERI BUBA HAFSA 22 JUL PORTH YES YES FHA NIGERI 080331
080 A T 2009 ARCOU ESTAT A 27824
ABUBA RT E,
KAR T/AMA
DI,
PORTH
ARCOU
RT
A02228 NIGERI ABUBA MOHA 19 FEB PORTH YES YES FHA NIGERI
081 A KAR MMED 2010 ARCOU ESTAT A
BUBA RT E,
T/AMA
DI
PORTH
ARCOU
RT
DECLARATION
I declare that the information given on this form whether input by myself, input on my behalf by a third party or automatically pre-populated is complete
and correct to the best of my knowledge and belief. I also declare that the photograph submitted with this form is a true likeness of me. I confirm that if,
before this application is decided, there is a material change in my circumstances or new information relevant to this application becomes available, I
will inform the United Kingdom diplomatic mission handling my application.
I understand that all information provided by me will be processed by the Home Office in accordance with the Data Protection Act 1998. I am aware
that the Home Office is the data controller in relation to the information provided by me in this application form. I am aware that the information I
provide, including biometric data, will be treated in confidence, but it may be disclosed to other government departments, agencies, local authorities,
foreign governments, and other bodies, to enable the Home Office or those bodies to perform their functions. Any disclosures will be in accordance with
the Data Protection Act 1998. I also understand that the information provided by me may also be used for staff training purposes.
I declare that the documents that I have supplied with this application are genuine and the statements I have made with this application are truthful. I
understand that the Home Office (or a trusted third party) may make reasonable checks to confirm the accuracy and authenticity of evidence I have
provided and documents I have submitted with this application. I further understand that the Home Office (or a trusted third party) may also make
reasonable checks on any sponsors to my application to verify statements contained in the application and establish that I will comply or have complied
with the terms of any visa granted.
I understand that UK entry clearance applications may be handled by British Missions in other locations, including outside the country in which I have
applied for entry clearance and that this may involve the transferring of my application and supporting documents to and from another Mission. I
understand that the Home Office will be responsible for transferring my application and supporting documents safely. I understand in these
circumstances my application will still be handled in line with Home Office published customer service standards.
I understand that the fee payable is for an application processing and entry clearance decision-making service, not for the guaranteed delivery of a
visa, therefore I will not be entitled to a refund should my application for entry to the UK or Commonwealth and Overseas Territories be refused or
granted for a shorter time period than I applied for. I also understand that my visa application fee will be refunded only if the application is withdrawn in
writing within 3 months and 7 days of the original date of application and prior to the submission of biometric data or any processing taking place.
I also understand that the information provided by me, or information made available to the Home Office during the processing of my application, may
be shared with my sponsor(s) or any person(s) acting on their behalf or any applicant linked to my application (for example to my spouse / partner if we
apply for visas for a trip together) for the sole purpose of considering my application. I am aware that if there is any information I do not want you to
disclose to them I will tell you by enclosing a letter with my supporting documentation. If such requests prevent you from making legitimate inquiries, my
application may be refused.
I am also aware that my application will be automatically refused and I may be banned from going to the UK for 10 years if I use a false document, lie or
withhold relevant information. I may also be banned if I have breached immigration laws in the UK. I am further aware that should I use a false
document, lie or withhold relevant information my details may be passed to law enforcement agencies.
I understand that I may be required to provide a record of my fingerprints and a photograph of my face (“biometric data”) as part of my application. If I
refuse to do so, my application may be treated as invalid and, if so, will not be considered further. (See Statutory Instrument 2006 No 1743 - The
Immigration (Provision of Physical Data) Regulations 2006, Regulation 7(1)).
I am aware that I may be billed for any NHS medical treatment undertaken in the UK and that I do not have recourse to public funds during my stay in
the UK.
I understand that if I fail to pay NHS debts incurred by me this could adversely affect future entry clearance applications I make.
I understand that my details may, in certain circumstances, be passed to fraud prevention agencies to prevent and detect fraud and money laundering.
I also understand that such agencies may provide the Home Office with information about me. Further details explaining when information may be
passed to or from fraud prevention agencies and how that information may be used can be obtained from the Home Office website.
I am aware that it is an offence under the Immigration Act 1971 (as amended) to make a statement which I know to be false, or not believe to be true, in
order to obtain a visa/entry clearance to the UK.
Personal information which is provided about a person acting in support of an application, including any documentary evidence provided by or about
them, will be processed in accordance with the Data Protection Act 1998 by the Home Office, which is the data controller in relation to the information
provided.
The Home Office will use this information to make decisions about the application and to prevent and detect fraud. We may share this information with
other government departments or agencies, local and public authorities, foreign governments, companies (including financial and utility companies),
employers or other bodies in order to make reasonable checks to verify the information provided in the application and confirm that sponsors have or
will comply with the terms of any visa which may be or have been granted. Any information received by the Home Office about a sponsor may be used
in reaching a decision on the application. Full details of the way in which the data may be processed can be found on the Home Office website at
http://www.ukba.homeoffice.gov.uk/
I confirm that, where I have a sponsor, I have informed my sponsor of the information set out above and my sponsor has confirmed that they consent to
me providing the information about them which is set out in this application.
APPLICANT'S SIGNATURE:
DATE SIGNED:
GWF030632366