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

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Current nationality:Country of origin:Current place ofresidence:Ethnicity:<strong>Home</strong> <strong>Office</strong> referencenumber (if applicable):8.5 Your children Child 1 Child 2Full name:Date and place of birth:Sex: Male Female Male FemaleWas <strong>the</strong> birth recorded? Ifso, at which registry?Current nationality:Country of origin:Current place ofresidence:Ethnicity:<strong>Home</strong> <strong>Office</strong> referencenumber (if applicable):Full name:Child 3 Child 4Date and place of birth:STATELESS LEAVE APPLICATION FORM Version 03/2013 – page 9 of 33

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