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UK Visas & Immigration

PARTIALLY COMPLETED APPLICATION
APPLICANT NAME:

KARIYAKARANAGE CLEMENT PRASANTHA
PERERA

GWF NUMBER:

GWF041179329

PASSPORT NUMBER:

N2819781

NATIONALITY:

Sri Lanka

DATE OF BIRTH:

24 November 1973

GENDER:

Male

DATE OF APPLICATION:
TYPE OF VISA / APPLICATION:

Visit Visa

DURATION OF VISA:

6-month

TOTAL FEE:
SUBMISSION METHOD:

Online

ISSUING OFFICE:

Colombo

PAYMENT REFERENCE:
CONTACT EMAIL:

clement40@gmail.com

CONTACT LANGUAGE:

English

Personal information
Email address

clement40@gmail.com

Travel information
Date you will arrive in the UK

4 October 2016

Date you will leave the UK

9 October 2016

Calculated duration of visit

5 days

What is the main reason for your visit to the UK?

other

Will you be travelling to the UK as part of an
organised group?

Yes

Company or group name

KARIYAKARANAGE CLEMENT PRASANTHA
PERERA AND GROUP

Are you visiting the UK for any of the following

I am visiting for another reason

GWF041179329

KARIYAKARANAGE CLEMENT PRASANTHA PERERA

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HARROGATE. as shown in your passport or Male travel document? What is your relationship status? Married or a civil partner Country of nationality Sri Lanka Date of birth 24 November 1973 GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 2 of 10 .DAY-2 08-10-2016 ATTEND TO RCGP ANNUAL CONFERENCE. Give details of places you will go. months or years have you 15 Years lived at this address? What is the ownership status of your home? I live with my family What is your gender.DAY-3 09-10-2016 DEPARTURE FROM MANCHESTER AIR PORT UK Personal information Given names KARIYAKARANAGE CLEMENT PRASANTHA Family name PERERA Are you now or have you ever been known by another name? No Residential address NO: 695. KAPUWATTA.HARROGATE.ELA WESTERN PROVINCE 11350 Sri Lanka Telephone number +94 0773567424 +94 0112237621 How many days.HARROGATE.UK Visas & Immigration reasons? Explain in full what you will do in the UK. STATION ROAD. any people or organisations you will visit and any activities you plan to do during your trip.DAY-1 07-10-2016 ATTEND TO RCGP ANNUAL CONFERENCE. 04-10-2016 ARRIVE TO MANCHESTER AIRPORT-UK 05-10-2016 LONDON CITY TOUR 06-10-2016 ATTEND TO RCGP ANNUAL CONFERENCE. weeks. JA .

UK Visas & Immigration Place of birth MARADANA Country of birth Sri Lanka Do you have an national identity card? Yes National identity card number 733290200V Passport details Passport number or travel document reference number N2819781 Place of issue COLOMBO Issue date 8 February 2011 Expiry date 8 February 2021 Do you have another passport or travel document? No Spouse / partner details Given name KOLAMUNNA GALGANAGE RUHINI HESHANTHI Family name THELIS Date of birth 14 January 1977 Nationality Sri Lanka Do they currently live with you? Yes Will they be travelling with you to the UK? Yes Their passport number N5269765 Dependant details Do you have people who need you for financial support? Yes Given name KARIYAKARANAGE BERNADETH DEWMINI KAUSHALYA Family name PERERA Date of birth 4 April 2003 GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 3 of 10 .

UK Visas & Immigration Does this person currently live with you? Yes Is this person travelling with you to the UK? Yes Nationality Sri Lanka Passport number N5269781 Given name KARIYAKARANAGE CLEMENT DIMANTHA Family name PERERA Date of birth 27 August 2005 Does this person currently live with you? Yes Is this person travelling with you to the UK? Yes Nationality Sri Lanka Passport number N5269784 Given name KARIYAKARANAGE SENARA RANDINI Family name PERERA Date of birth 17 September 2007 Does this person currently live with you? Yes Is this person travelling with you to the UK? Yes Nationality Sri Lanka Passport number N5269764 Given name KIRIKANKANAMLAGE ROHINI Family name THELIS Date of birth 16 December 1945 Does this person currently live with you? Yes Is this person travelling with you to the UK? Yes Nationality Sri Lanka Passport number N6553792 GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 4 of 10 .

after tax? 500000.10 WESTERN PROVINCE 11350 Sri Lanka Employer's telephone number +94 0112694033 Your job title DOCTOR How much do you earn each month . BADDEGAMA WIMALAWASA THERO MAWATHA.UK Visas & Immigration Parent details What is this person's relationship to you? Father Given name KARIYAKARANAGE NICULUS GORDI Family name PERERA Date of birth 6 January 1938 Nationality Sri Lanka Have they always had the same nationality? Yes What is this person's relationship to you? Mother Given name PATHTHAGE JOSAPIN NANDA Family name WICKRAMASINGE Date of birth 3 March 1943 Nationality Sri Lanka Have they always had the same nationality? Yes Employment What is your employment status? Employed Date you started working for this employer July 2003 Employer's name MINISTRY OF HEALTH. COLOMBO . SRI LANKA Address line 1 NO: 385.10 COLOMBO .00 LKR Describe your job I AM FULLY OCCUPIED IN MINISTRY OF GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 5 of 10 .

HARROGATE Address YORKSHIRE HOTEL.11 . HARROGATE HG1 1LA When will you arrive there? 4 October 2016 When will you leave there? 9 October 2016 Travel history (UK) Have you been issued with a UK visa in the past 10 years? No How many times have you been to the UK in the last 10 years? None Have you ever been: No GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 6 of 10 .2004 Income and expenditure Do you have another income or any savings? Savings How much money are you planning to spend on your visit to the UK? 5000. SRI LANKA SINCE 18-07-2003 .JA . IN ADDITION I AM WORKING AS A PART TIME GENERAL PRACTITIONER IN JUDE FAMILY CLINIC . PROSPECT PLACE. HARROGATE.ELA SINCE 01 .UK Visas & Immigration HEALTH.00 GBP How much money do you spend each month? 100000.00 LKR Will anyone be paying towards the cost of your visit? No Family in the UK Do you have any family in the UK? No Accommodation details Have you already made arrangements for where you are going to stay in the UK? Yes Where are you planning to stay in the UK? YORKSHIRE HOTEL.

weeks.UK Visas & Immigration refused a visa for the UK deported from the UK removed from the UK required to leave the UK refused entry at the UK border Travel history (other) How many times have you visited the following places in the past 10 years? Once Australia Canada New Zealand USA Schengen area Which country did you visit? Schengen Area Which country in the Schengen area? Netherlands What was the reason for your visit? Business Date of visit May 2016 Number of days. months or years 5 Days Have you visited any other countries in the past 10 Yes years? Which country did you visit? Pakistan What was the reason for your visit? To study Date of visit March 2011 Length of visit 3 days Which country did you visit? Singapore What was the reason for your visit? To study Date of visit October 2014 Length of visit 3 days Which country did you visit? Malaysia GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 7 of 10 .

KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 8 of 10 . or given support No to. expressed views that justify or glorify terrorist violence or that may encourage others to commit terrorist or other serious criminal acts? No Tell us about work for the following types of organisation Government (including Public or Civil Administration and compulsory national service) Armed Forces (including compulsory national or military service) Government (including Public or Civil Administration and compulsory national service) Media organisations Security organisations (including police and private security companies) GWF041179329 I AM WORKING IN MINISTRY OF HEALTH. WHICH IS A PERMANENT POST. crimes against humanity. supported or encouraged terrorist activities in any country? No Have you ever been a member of.UK Visas & Immigration What was the reason for your visit? Tourism Date of visit October 2014 Length of visit 4 days Have you ever been: No refused a visa for any country other than the UK deported from any country other than the UK removed from any country other than the UK required to leave any country other than the UK refused entry at the border of any country other than the UK Other history In either peace or war time have you ever been involved in. or genocide? No Have you ever been involved in. or suspected of involvement in. GOVERNMENT OF SRI LANKA AS A GRADE MEDICAL OFFICER SINCE 18-07-2003. by any means or medium. war crimes. an organisation which has been concerned in terrorism? Have you.

Documents Mandatory documents GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 9 of 10 . 2. at any time A driving offence.6 7 OCTOBER 2016. reprimand or fixed penalty notice A court judgment. in the UK or in a different country? No. I AM AN INTERNATIONAL MEMBER OF ROYAL COLLEGE OF GENERAL PRACTITIONERS (RCGP) MY MEMBERSHIP NUMBER : 94406.NOT ONLY TO UPDATE MYSELF BUT ALSO TO SHARE MY RESEARCH KNOWLEDGE WITH CONFERENCE DELEGATES BY PRESENTING TWO POSTERS ON FOLLOWING TOPICS: 1. I have never had any of these A criminal conviction. and currently on or awaiting trial A caution. IN ADDITION. at any time. " EVALUATION OF ASTHMA CONTROL IN PRIMARY CARE USING ASTHMA CONTROL TEST AND PEAK EXPIRATORY FLOW RATE. you can write it here MEDICINE AND I AM WOKING AS A PART-TIME GENERAL PRACTITIONER AT JUDE FAMILY CLINIC IN SRI LANKA." FREQUENCY AND NATURE OF HEADACHE IN CHILDREN ATTENDING IN PRIMARY CARE PHYSICIAN".UK Visas & Immigration Judiciary (including work as a judge or magistrate) Criminal or unspent convictions Do you have any of the following. I AM PLANNING TO ATTEND RCGP ANNUAL CONFERENCE 2016 AT HARROGATE INTERNATIONAL CENTER . eg for debt A fine for breaking UK immigration law (called a 'civil penalty') Additional information If you needed to add more information but were not I AM GOING TO SPECIALIZED IN FAMILY able to. eg for speeding or no insurance Arrested and charged. warning.

You must leave the UK when your visa ends. I confirm that I understand and agree with the above declarations. your application will be refused and you may be banned from the UK and prosecuted. you confirm that to the best of your knowledge and belief the following is correct: the information relating to your application your supporting documents Also. You cannot get free medical treatment from the NHS. GWF041179329 KARIYAKARANAGE CLEMENT PRASANTHA PERERA Page 10 of 10 . If false information is given.00 USD Declaration By sending this application. If you do not pay for any billed treatment this may affect future visa applications. the application will be processed according to the privacy policy and terms and conditions.00 USD Total 117. you may be removed and banned from the UK. unless you are exempt from charges. If not.UK Visas & Immigration The Sri Lanka passport or travel document for KARIYAKARANAGE CLEMENT PRASANTHA PERERA Payment Length of your visit visa 6-month Service Standard service KARIYAKARANAGE CLEMENT PRASANTHA PERERA's application for Visit Visa 117.