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

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SECTION 12 ~ Supporting documents The documents and photographs needed in support of your application arelisted below. Please tick the boxes next to the relevant items to show what documents andphotographs you are sending. Please submit original documents, photocopies are not acceptable. You should retain photocopies of any original documents that you submitwith this applicationPlease see the box below for advice on what to do if you cannot provide any of therequired documentsTwo unseparated passport sized photographs of yourself, sized 45mm x 35mm(standard passport photograph size). On the reverse clearly print your name, date ofbirth and Home Office or Port reference number.Two unseparated passport sized photographs of each of your dependants who arerequesting settlement, sized 45mm x 35mm (standard passport photograph size). Onthe reverse of each, clearly print the name, date of birth and Home Office or Portreference number of the person who appears in the photograph (see section 4.1).Evidence of your identity or confirmation of your current immigration status. If you oryour dependants have any of the following, please provide:i. Current national passport(s)*ii. Travel document(s)*iii. Immigration Status Document(s) (ASL.2151, ASL.2152 or ASL.2150)iv. Relevant birth or marriage certificatesEvidence of the identity or confirmation of the current immigration status of each ofyour dependants requesting leave to remain or settlement. Evidence should be in theform of any and all of the above that they hold.If you cannot provide any photographs or all the documents that we have asked for,please still complete and submit this application form, but use this space to explain whysome of the items cannot be sent in. You should also tell us when you will provide them.We will not be able to complete your application until you have provided everythingthat we have asked for.STATELESS LEAVE APPLICATION FORM Version 03/2013 – page 22 of 33
SECTION 13 ~ DeclarationYou must now read the declaration below and sign it. It must be signed by you(the applicant) and not by a representative or other person acting on yourbehalf. If you are under the age of 18, your parent or legal guardian maycomplete the application form and sign the declaration on your behalf.I hereby apply for leave to remain in the United Kingdom as a stateless personfor myself and any dependants listed in this form. The information I have given iscomplete and is true to the best of my knowledge. I also declare that thephotograph(s) submitted with this form is/are a true likeness of me and of thedependants included in the application, as named on the back of eachphotograph.I confirm that if, before this application is decided, there is a material change inmy circumstances or new information relevant to this application becomesavailable I will inform the Home Office.I understand that all information given by me will be treated in confidence butmay be disclosed to other government departments, agencies, local authoritiesand other bodies to enable them to carry out their functions. I understand thatthe Home Office will normally seek my consent before making enquiries of thoseauthorities which may be necessary in order to reach a decision on myapplication.If my application is unsuccessful and I am to be removed from the UnitedKingdom, I understand that it may be necessary for the Home Office to provideinformation about my identity to the authorities in the country of re-admission,solely in order to obtain travel documentation.I understand that my details may in certain circumstances be passed to other people,including fraud prevention agencies, to prevent and detect fraud, money laundering andother crimes. I also understand that the Home Office may receive information about me.Further details explaining when information may be passed to or from other people,including fraud prevention agencies, and how that information may be used can beobtained from the UK Border Agency/Home Office website.I am aware that it is an offence under the Immigration Act 1971, as amendedby the Immigration and Asylum Act 1999 and the Nationality, Immigrationand Asylum Act 2002, to make to a person acting in execution of any ofthose Acts a statement or representation which I know to be false or do notbelieve to be true, or to obtain or seek to obtain leave to remain in theUnited Kingdom by means which include deception.Signed: ___________________________________________Date: __________________________________STATELESS LEAVE APPLICATION FORM Version 03/2013 – page 23 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 and 14: SECTION 10 ~ Personal historyYou mu
Page 15 and 16: 10.3. Do you or any dependants who
Page 17 and 18: * DefinitionsFor the purposes of an
Page 19 and 20: 5. If the BRP was stolen, please gi
Page 21: 16. Please explain why a person oth
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

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