UK Visas & Immigration

NAME: IRINA MOVILEANU

PASSPORT NUMBER: 057256078
DATE OF SUBMISSION: 10 May 2021 18:56 British Summer Time (BST)
FORM: Public Health Passenger Locator Form
REFERENCE: UKVI_5ZAA004852550
REGISTRATION EMAIL: m4iupa@gmail.com
Are you required to complete Covid tests? Yes
What is your booking reference for your Covid PRENE0562182
tests?
What is the name of your test provider if you PRENETICS
have opted into Test to Release?
Arrival location London Luton Airport (LTN)

Personal information

Email address m4iupa@gmail.com

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?
1 TOLPITS CLOSE
WATFORD
WD18 7SX

What address will you stay at for your first 10 days 1 TOLPITS CLOSE
in the UK? WATFORD

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 UK Visas & Immigration
WD18 7SX

When will you arrive there? 11 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 Luton Airport (LTN)

What country are you travelling from? Moldova

Which company are you travelling with? Wizz Air UK Limited

What is the flight number, train service or ship W93797

name that you will arrive on?

What is your seat number? (you must provide your 7C

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, Moldova
for the 10 days before coming to the UK?

Departure date 11 May 2021

Your dates of travel

When do you plan to arrive in the UK? 11 May 2021 20:45 PM

Personal information

Given name(s) IRINA

Family name MOVILEANU

What is your sex? Female

Is your home address in the UK? Yes

Home address 1 TOLPITS CLOSE

WATFORD
WD18 7SX
(address verified)

Are you able to be contacted by telephone? I can be contacted by telephone call and text
message (SMS)

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 UK Visas & Immigration
Date of birth 17 May 1983

Provide your primary telephone number +44 7448976416

Passport and travel document details

Passport number or travel document reference 057256078

number

Country of Issue Romania (ROU)

Expiry date 9 April 2029

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.

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