Leon Black Meeting Sept. 2, 2015 9:00am 1.Have you been refused a visa for any country including the UK in the last 10 years? 2. Have you been deported, removed or otherwise required to leave any country including the UK in the last 10 years? 3. Have you ever voluntarily elected to depart the UK? 4. Are you, or have you been subject to, an exclusion order from the UK? 5. Have you ever travelled outside your country of residence, excluding the UK, in the last 10 years? Part 1-Passport and Travel Information passport/Travel Document 6 Family Name/Surname (Ifyou only have one name, please enter it here and in the given name box) 7. Given Names(s)/Forename(s) (Ifyou only have one name, please enter it here and in the family name box) 8. Date of Birth 9. Place of Birth 10. Gender 11. Nationality 12. Do you currently hold, or have you ever held, any other nationality or nationalities? 13. Current passport or travel document number 14. Place of Issue 15. Issuing Authority 16 Date of Issue 17. Date of Expiry 18. Current Location 19. Are you a national of the country in which you are applying? 20. Please enter Details 21. Is this your First Passport? 22. Nationality Document Number Issuing Authority Date of Issue Date of Expiry Is this Document lost, stolen or in your possession? 23. Date of Travel -Country Visited -Reason for the Trip EFTA00305980