Passenger Locator Form

STATUS: NON-RED LIST

VACCINE STATUS: VERIFIED FULL/EXEMPT

The code contains personal

information. By sharing the code,
you will be sharing your passenger
locator form data.

Summary
Name Luc Buset
Passport number 21dc35614
Which company are you travelling with? Ryanair UK Limited
What is the flight number, train number or ship TBF78T
name that you will arrive on?
Reference UKVI_5ZAA024169783
Status NON-RED LIST
What are your travel plans? Stay in the UK
Are you required to book a COVID-19 test Yes
package for when you arrive in the UK?
Your test package booking reference ADBLB2017361
Arrival location London Stansted Airport (STN)
Date of arrival 16 November 2021 09:45 Greenwich Mean Time
(GMT)
Date of submission 16 November 2021 07:56 Greenwich Mean Time
(GMT)

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 UK Visas & Immigration

Personal information

Email address lucbuset@gmail.com

Travel information

Do you have an address for where you will stay Yes

during your first 10 days in the UK?

What address will you stay at for your first 10 days 3 THE VILLAGE
in the UK? ORTON LONGUEVILLE
PETERBOROUGH
PE2 7DN

When will you arrive there? 16 November 2021

When will you leave there? 17 November 2021

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? Italy

Which company are you travelling with? Ryanair UK Limited

What is the flight number, train number or ship TBF78T

name that you will arrive on?

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

Did you transit through this country via plane or No

train without passing Border Control?

Have you visited, or will you visit, any islands in this No

country during the 10 days before you arrive in the
UK?

Arrival date 10 November 2021

Departure date 16 November 2021

Are you required to book a COVID-19 test package Yes

for when you arrive in the UK?

Your test package booking reference ADBLB2017361

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 UK Visas & Immigration
Your dates of travel

When do you plan to arrive in the UK? 16 November 2021 09:45 AM

When do you plan to leave the UK? (optional) 17 November 2021

Personal information

Given name(s) Luc

Family name / Surname Buset

What is your sex? Male

Is your home address in the UK? No

Home address 11 avenue de la gare

Poligny
39800
France

How can we contact you when you are in the UK? I can be contacted by phone call and text message
(SMS)

Date of birth 20 September 1973

Your primary phone number +33 628331560

Do you meet the COVID-19 vaccination eligibility Yes

criteria for reduced isolation and testing
requirements?

Do you have a QR code that you can use to verify Yes

your vaccination status?

How would you like to provide proof of your Scan a QR code

vaccination status?

Have you provided proof of your vaccination Yes

status?

How do you meet the COVID-19 vaccination status I am fully vaccinated by a recognised programme
eligibility requirements?

Which country or territory did you receive your France

COVID-19 vaccination(s) in?

Passport and travel document details

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 UK Visas & Immigration

Passport number or travel document reference 21dc35614

number

Country of Issue France (FRA)

Expiry date 1 September 2031

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 understand I have to provide proof of negative coronavirus (COVID-19) test result if I am travelling from a
red list country or island, or do not qualify as fully vaccinated, unless I am exempt
I understand that I must bring proof of my COVID-19 vaccination status if I meet the eligibility criteria. My
proof of vaccination status (if declared) contains my full name, date of birth, vaccine brand and
manufacturer, the dates for all my vaccination doses and the country of vaccination and/or certificate
issuer
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

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

Luc Buset Page 4 of 4