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1. Name in full.
2. Sex.
3. Matrimonial status (married or single).
4.—(a) Date of birth.
(b)Country of birth.
5.—(a) Present nationality.
(b)How and when acquired.
(c)Previous nationality (if any).
6. Particulars of passport or other document establishing nationality.
7. Business, profession or occupation.
8. Residence in the United Kingdom (or address if no residence).
9. Name and address of referee (if any) supplied under Regulation 7(b).
10. Last residence outside the United Kingdom.
11.—(a) Date of arrival in the United Kingdom.
(b)Place of arrival in the United Kingdom.
(c)Mode of arrival in the United Kingdom.
12. Duration of limited leave and conditions attached thereto.
13. Restrictions or conditions, if any, applicable by virtue of section 9(2) of the Act.
14.—(a) If employed in the United Kingdom—
(i)name and address of employer;
(ii)address at which employed, if different.
(b)If engaged in business or profession in the United Kingdom—
(i)name under which business or profession is carried on;
(ii)address at which business or profession is carried on.
15. Signature (or fingerprints if unable to write in the characters of the English language).
16. Photograph.
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