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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UK Visas & Immigration

reasons?
Explain in full what you will do in the UK. Give
details of places you will go, any people or
organisations you will visit and any activities you
plan to do during your trip.

04-10-2016 ARRIVE TO MANCHESTER

AIRPORT-UK 05-10-2016 LONDON CITY TOUR
06-10-2016 ATTEND TO RCGP ANNUAL
CONFERENCE,HARROGATE- DAY-1 07-10-2016
ATTEND TO RCGP ANNUAL
CONFERENCE,HARROGATE- DAY-2 08-10-2016
ATTEND TO RCGP ANNUAL
CONFERENCE,HARROGATE- 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,
STATION ROAD,
KAPUWATTA,
JA - ELA
WESTERN PROVINCE
11350
Sri Lanka

Telephone number

+94 0773567424
+94 0112237621

How many days, weeks, 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, 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

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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

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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

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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, SRI LANKA

Address line 1

NO: 385, BADDEGAMA WIMALAWASA THERO

MAWATHA,
COLOMBO - 10
COLOMBO - 10
WESTERN PROVINCE
11350
Sri Lanka

Employer's telephone number

+94 0112694033

Your job title

DOCTOR

How much do you earn each month - after tax?

500000.00 LKR

Describe your job

I AM FULLY OCCUPIED IN MINISTRY OF

GWF041179329

KARIYAKARANAGE CLEMENT PRASANTHA PERERA

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UK Visas & Immigration

HEALTH, SRI LANKA SINCE 18-07-2003 . IN
ADDITION I AM WORKING AS A PART TIME
GENERAL PRACTITIONER IN JUDE FAMILY
CLINIC - JA - ELA SINCE 01 - 11 - 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?

5000.00 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, HARROGATE

Address

YORKSHIRE HOTEL,
PROSPECT PLACE,
HARROGATE.
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

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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, weeks, 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

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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 suspected of involvement in, war
crimes, crimes against humanity, or genocide?

No

Have you ever been involved in, supported or

encouraged terrorist activities in any country?

No

Have you ever been a member of, or given support No

to, an organisation which has been concerned in
terrorism?
Have you, by any means or medium, 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,

GOVERNMENT OF SRI LANKA AS A GRADE
MEDICAL OFFICER SINCE 18-07-2003, WHICH IS
A PERMANENT POST.

KARIYAKARANAGE CLEMENT PRASANTHA PERERA

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UK Visas & Immigration

Judiciary (including work as a judge or
magistrate)

Criminal or unspent convictions

Do you have any of the following, in the UK or in a
different country?

No, I have never had any of these

A criminal conviction, at any time

A driving offence, at any time, eg for speeding
or no insurance
Arrested and charged, and currently on or
awaiting trial
A caution, warning, reprimand or fixed penalty
notice
A court judgment, 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, you can write it here
MEDICINE AND I AM WOKING AS A PART-TIME
GENERAL PRACTITIONER AT JUDE FAMILY
CLINIC IN SRI LANKA. IN ADDITION, I AM AN
INTERNATIONAL MEMBER OF ROYAL COLLEGE
OF GENERAL PRACTITIONERS (RCGP) MY
MEMBERSHIP NUMBER : 94406. I AM PLANNING
TO ATTEND RCGP ANNUAL CONFERENCE 2016
AT HARROGATE INTERNATIONAL CENTER - 6 7 OCTOBER 2016,NOT ONLY TO UPDATE
MYSELF BUT ALSO TO SHARE MY RESEARCH
KNOWLEDGE WITH CONFERENCE DELEGATES
BY PRESENTING TWO POSTERS ON
FOLLOWING TOPICS: 1." FREQUENCY AND
NATURE OF HEADACHE IN CHILDREN
ATTENDING IN PRIMARY CARE PHYSICIAN". 2. "
EVALUATION OF ASTHMA CONTROL IN
PRIMARY CARE USING ASTHMA CONTROL
TEST AND PEAK EXPIRATORY FLOW RATE.

Documents
Mandatory documents

GWF041179329

KARIYAKARANAGE CLEMENT PRASANTHA PERERA

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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

117.00 USD

Total

117.00 USD

Declaration
By sending this application, 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, the application will be processed according to the privacy policy and terms and conditions.
If false information is given, your application will be refused and you may be banned from the UK and
prosecuted.
You cannot get free medical treatment from the NHS, unless you are exempt from charges. If you do not pay for
any billed treatment this may affect future visa applications.
You must leave the UK when your visa ends. If not, you may be removed and banned from the UK.
I confirm that I understand and agree with the above declarations.

GWF041179329

KARIYAKARANAGE CLEMENT PRASANTHA PERERA

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