Form FLR(S) - UK Border Agency - the Home Office

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Sentence given by the CourtDate sentencedD D M M Y Y Y YIf you or any dependants who are applying with you were sentenced to a period ofimprisonment, what was the length of the prison sentence imposed (in months)?MonthsCriminal conviction 2Country where convictedNature of the offenceSentence given by the CourtDate sentencedD D M M Y Y Y YIf you or any dependants who are applying with you were sentenced to a period ofimprisonment, what was the length of the prison sentence imposed (in months)?MonthsSTATELESS LEAVE APPLICATION FORM Version 03/2013 – page 14 of 33
10.3. Do you or any dependants who are applying with you have any civil judgmentsagainst you or any civil penalty under the UK Immigration Acts?Yes go to 10.4 No go to 10.510.4. Give details for each civil judgment or any civil penalty under UK Immigration Acts,starting with the most recent one.If you or any dependants who are applying with you have received more than two civiljudgments and/or civil penalties under the UK Immigration Acts, please photocopy this pageand enclose it with this form.Details of judgment or civil penalty 1Date of judgment or civil penaltyD D M M Y Y Y YCountry where judgment madeDetails of judgment or civil penalty 2Date of judgment or civil penalty 2D D M M Y Y Y YCountry where judgment madeYou must answer questions 10.5 to 10.10 below even if you have answered no toquestion 10.1For help in answering these questions, please see the definitions at the end of thissection.*10.5 Have you or any dependants who are applying with you ever been chargedin any country with a criminal offence for which you have not yet been tried in acourt of law?10.6 In times of either peace or war, have you or any dependants who areapplying with you ever been involved, or suspected of involvement, in warcrimes, crimes against humanity or genocide?YesYesNoNoSTATELESS LEAVE APPLICATION FORM Version 03/2013 – page 15 of 33
Page 4 and 5: SECTION 4 ~ Travel history4.1 Date
Page 6: SECTION 7 ~ DocumentationPlease pro
Page 9 and 10: Current nationality:Country of orig
Page 11 and 12: Applicant’s maternalgrandfatherAp
Page 13: SECTION 10 ~ Personal historyYou mu
Page 17 and 18: * DefinitionsFor the purposes of an
Page 19 and 20: 5. If the BRP was stolen, please gi
Page 21 and 22: 16. Please explain why a person oth
Page 23 and 24: SECTION 13 ~ DeclarationYou must no
Page 25 and 26: FORM FLR(S) APPLICATION FOR LEAVE A
Page 27 and 28: enquiries the telephone number is 0
Page 29 and 30: 7. The Post Office offers a walk-in
Page 31 and 32: 29. If the application is successfu
Page 33: What should I do if the information

Form FLR(S) - UK Border Agency - the Home Office

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