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 Anca-Elena Spiridon
Passport number 060643709
Which company are you travelling with? S.C. BLUE AIR AVIATION S.A.
What is the flight number, train number or ship 0B2931
name that you will arrive on?
Reference UKVI_5ZAA024697139
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 EXPDR1018341
Arrival location London Luton Airport (LTN)
Date of arrival 21 November 2021 09:55 Greenwich Mean Time
(GMT)
Date of submission 19 November 2021 20:58 Greenwich Mean Time
(GMT)

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 UK Visas & Immigration

Personal information

Email address spiridonciprian907@gmail.com

Travel information

Do you have an address for where you will stay Yes

during your first 10 days in the UK?

Who are you planning to stay with in the UK? Ciprian-Florin Spiridon, Georgiana-Madalina
Spiridon, Georgia Olivia Spiridon

What address will you stay at for your first 10 days 14 WOODLANDS DRIVE
in the UK? MORLEY
LEEDS
LS27 9QZ

When will you arrive there? 21 November 2021

When will you leave there? 12 December 2021

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? Romania

Which company are you travelling with? S.C. BLUE AIR AVIATION S.A.

What is the flight number, train number or ship 0B2931

name that you will arrive on?

Which countries have you been in, or will you be in, Romania
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?

Departure date 21 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 EXPDR1018341

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 UK Visas & Immigration

Your dates of travel

When do you plan to arrive in the UK? 21 November 2021 09:55 AM

When do you plan to leave the UK? (optional) 12 December 2021

Personal information

Given name(s) Anca-Elena

Family name / Surname Spiridon

What is your sex? Female

Is your home address in the UK? No

Home address str. Moldovei, nr 12, bloc M2, Sc. A

etaj 9, ap 33
Pascani
Iasi
705200
Romania

How can we contact you when you are in the UK? I can only be contacted by phone call

Date of birth 18 November 1987

Your primary phone number +40 754824351

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 Attach a file or screenshot containing 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 Romania

COVID-19 vaccination(s) in?

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 UK Visas & Immigration

Passport and travel document details

Passport number or travel document reference 060643709

number

Country of Issue Romania (ROU)

Expiry date 2 November 2031

People you are travelling with

Are you travelling to the UK with anyone under 18 Yes

years old that you are including on this form?

Given name(s) Medeea-Maria

Family name / Surname Spiridon

Relationship to you daughter

Date of birth 27 July 2018

Is the person you are including 12 to 17 years old? No

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.

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