Form 1/89

LOST PASSPORT QUESTIONNAIRE FORM

Uganda High Commission, Uganda House

58-59 Trafalgar Square

London WC2N 5DX, Tel: 0207 839 5783 Fax: 0207 839 8925, Email:

This form must be fully completed in English using blue or black ink. Complete all sections of this form in detail giving as much information as possible.

Personal Details

1.1 Surname (as shown in your passport) 1.2 Other Names (as shown in your passport)

1.3 Lost Passport Number 1.4 Place and Date of Issue

1.5 Date of Birth 1.6 Place of Birth and Nationality

D / D / M / M / Y / Y / Y / Y

1.7 Current Occupation 1.8 Full Address of Employer / School

Particulars of Applicants Parents

2.1 Full Names of Father 2.2 Date of Birth and District

2.3 Full Names of Mother 2.4 Date of Birth and District

Particulars of Lost Passport

3.1 How & when was loss of passport discovered? 3.2 When & where was passport last used?

Continuation of Particulars of Lost Passport

3.3 Was there any other property lost with your Passport? Yes No If Yes, give details

3.4 What steps did you take to ensure that your Passport was being kept in safe custody?

3.5 Did you report the loss of your Passport? Yes No If Yes give Date and Place.

3.6 Have you ever lost a Passport before? Yes No If yes, When and Where?

3.7 Have you ever applied for a Travel Document? Yes No If Yes give Date and Place of issue

3.8 When did you arrive in the United Kingdom? Give Date, Month & Year

3.9 Which Port or Airport did you use to enter the United Kingdom?

4.0 Which mode of transport did you use to enter the UK? Give Carrier name or Flight details

4.1 Give details of Country or Airport used before arriving in the UK

4.2 When do you intend to travel back to Uganda?

Declaration

The information I have given in this form is complete and true to the best of my knowledge and belief

Signature Date

D / D / M / M / 2 / 0 / 1 / 1

NOTE:

A Sworn Affidavit / Statutory Declaration relating to the lost Passport MUST accompany

this questionnaire stating whether the Passport was mislaid, burnt or stolen and how, when

and where it happened.