UK Visas & Immigration

NAME: Marian Surdu

PASSPORT NUMBER: 059132666
DATE OF SUBMISSION: 01 May 2021 06:23 British Summer Time (BST)
FORM: Public Health Passenger Locator Form
REFERENCE: UKVI_5ZAA004622856
REGISTRATION EMAIL: surdumarian69@gmail.com
Are you required to complete Covid tests? Yes
What is your booking reference for your Covid CONFI0011153
tests?
What is the name of your test provider if you N/A
have opted into Test to Release?
Arrival location London Stansted Airport (STN)

Personal information

Email address surdumarian69@gmail.com

Your Profile

Given name(s) Marian

Family name Surdu

What is your sex? Male

Date of birth 18 October 1996

Provide your primary telephone number +39 3272642892

Provide your secondary telephone number +44 7405951886

Are you able to be contacted by telephone? I can be contacted by telephone call and text

Marian Surdu Page 1 of 3

 UK Visas & Immigration
message (SMS)

Is your home address in the UK? Yes

Home address 267 branston road

Burton on trent
DE14 3BS
(manually entered)

Passport number or travel document reference 059132666

number

Country of Issue Romania (ROU)

Expiry date 20 October 2030

Travel information

Do you know where you will stay for your first 10 Yes
days in the UK?

You provided the following address as your Yes

residential address. Do you plan on staying at this
address?
267 branston road
Burton on trent
DE14 3BS

What address will you stay at for your first 10 days 267 branston road
in the UK? Burton on trent
DE14 3BS

When will you arrive there? 1 May 2021

Do you need to self-isolate when you arrive in the Yes, I need to self-isolate
UK?

What are your travel plans? Stay in the UK

Where will you arrive in the UK? London Stansted Airport (STN)

What country are you travelling from? Romania

Which company are you travelling with? RYANAIR DAC

What is the flight number, train service or ship Q8DPYZ

name that you will arrive on?

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 UK Visas & Immigration
What is your seat number? (you must provide your 10a
seat number if relevant. Include coach number if
travelling by train, for example coach 5 seat 2)

Which countries have you been in, or will you be in, Romania
for the 10 days before coming to the UK?

Departure date 1 May 2021

Your dates of travel

When do you plan to arrive in the UK? 1 May 2021 13:30 PM

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 will arrive in the UK within the next 48 hours

I understand I have to provide proof of a negative COVID 19 test prior to departure to the UK (unless
exempt)
I have provided my seat number, if relevant
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

If any of your information changes once you have submitted your details, such as travel details, seat number, or
contact information, you must complete a new form.

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

Marian Surdu Page 3 of 3