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Section 1 - Applicant Details
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Title (Please place an X inMrMrs
Miss
Ms
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ONE box)OtherPlease State:
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First Name/s
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Family Name
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Previous Family Name
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Other Name/s Known By
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Date of Birth (dd/mm/yyyy)Sex (Place X in ONE box)MF
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Nationality
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Place of Birth
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Section 2 - Applicant Contact Details
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Current AddressLine 1
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Line 2
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Line 3
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TownPostcode
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Daytime Tel. No.
Email
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Previous AddressLine 1
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Line 2
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Line 3
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TownPostcode
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Proof of the Applicants Identity
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In order to prove the Applicants Identity, we need to see copies of two pieces of identification. One from list A
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and one from list B below. Please indicate with an X in the appropriate box which ones you are supplying.
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Do NOT send originals
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List AList B
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Passport/Travel DocumentA Letter Sent to you by the Home Office
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Photo Driving LicenceUtility Bill Showing Current Home Address
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National Identity CardBank Statement or Building Society Book
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ARC Card
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Please supply copies of all records and information (including electronic)
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held by UK Border Force in my name, particularly but not exclusively, in
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relation to any stops, searches or seizures of excise goods
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Please use the space below for any further information you require.
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Declaration
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The information I have supplied in this application is correct and I am the person to who it relates.
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I enclose a cheque/PO (delete as applicable) to the value of £10 made payable to:-
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The Accounting Officer - Home Office
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Signature
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Date
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THIS FORM CAN BE PRINTED BLANK OR FILLED-IN FIRST AND PRINTED OFF.
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**IMPORTANT** IF YOU ENTER ANY DETAILS, REMEMBER TO CLEAR THE BOXES ONCE YOU HAVE
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FINISHED OR THEY WILL BE VISIBLE TO OTHER PEOPLE WHO USE THIS FORM !!
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Use the following Print Settings in the Print Dialogue Box:-
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Options – “Current Sheet” Radio Button + “No Gridlines” Check Box
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Paper Size – A4 210mm x 297mm
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Layout – “Actual Size” & “Portrait”
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Please send your completed form, identification and fee to:-
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Data Protection Unit UK Border Force,
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Lunar House, 40 Wellesley Road,
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Croydon
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CR9 2BY
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Fax: 02081 960748 Email: dataprotectionunit@UKBA.gsi.gov.uk
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