Placement Dates: From: To

For Office Use Only					YSP
Farm Name:		Placement Dates: From: To:
No.
Application Form 2023
1. Surname: Mukumova			2. First name(s): Gulorom
3. Nationality: Uzbekistan	4. Place of birth: Spitamen Region			5. Country of birth: Tajikistan
6. Date of birth: 21.12.1979	7 . Sex: Male Female			8. Country of residence: Uzbekistan
9.Passport No.: FA 4935192	10. Date of issue 04.02.2022			11. Date of expiry: 03.02.2032
12. Place of passport issue: MIA 24413			13. National ID No.: AB 0543540 29.07.2015 / 28.07.2025
14. Permanent address: Uzbekistan, Syrdarya, Yangiyer city, Binokor, Sportchilar 32/1.			15. Telephone + 998 94 166 68 44 Mobile: [phone] Email: [e-mail]
16. Name of University: Vocational college Year started: 1995 Year to graduate: 1996
17. Mother full name : Juraeva Galandon Abdusamatovna Place of birth: Syrdarya Date of birth: 03.09.1958			Father full name : Ruziboev Turakul Zokirovich Place of birth: Tajikstan Date of birth: 20.01.1958
1 8. Knowledge of the English language: Good Moderate Poor					None
1 9. Driving license Yes No			20. Tractor Driver		Y es No
21. Have you had Covid-19 Vaccination?.....ZF-UZ-VAC 2001................................. Date of first:………03.09.2021………………………. Date of 2^nd:…… …………29.12.2021…………………… Date of 3^nd:……02.02.2022
2 2. Have you worked in Great Britain before: Yes No National Insurance Number D o you have a bank account in the UK? Yes No
2 3. Previous experience in farm work (provide details below) : Yes No Employer: Dates: Duties:

24. What is your marital status? Married - if yes ( you partner name and DOB) Mukimov Umid Abdualievich 02.12.1975
25. Do you have children? If yes, what are their names and DOB 1.Abdaliev Shakhzod Umid o’g’li 15.03.1998 2.Abdualiev Muhibbullox Umid o’g’li 13.08.2001 3. Abduvalieva Zarina Umid qizi 07.03.2005
26. Do you have direct relatives in the UK? What is their address and phone number? Do you plan to visit them? No
27. Emergency Contact details; Name……………… Juraeva Galandon Abdusamatovna ………………………. Contact number:…… + 998 99 474 57 12 ……Relationship to you:………Mather………………………………..
28. Have you been granted a UK visa before? No	29. Have you ever travelled to the UK before? No
	30.Have you been or worked illegally in the UK? No
31.Have you ever been refused a visa for the UK? No	32.Have you ever been deported‚ removed or otherwise required to leave the UK? No
33. Have you ever travelled outside your country or residence‚ in the last 10 years? 2015 Russian Federation
34. Do you have any criminal convictions in any country? No	35. Are you able to commit to six months of work in the UK? Yes
36. Why would you return to your home after your UK visa expires? Because, I have a family in my country. 36 a:If you want to travel with someone else what is their Names No, I will travel on my own.
37. Do you understand that you do not need to pay any commission to get a work with PRO-FORCE? Yes
38. I confirm my consent that may store my data to contact me to further fill out the application and assist in the visa application process. Signature: Agreed
39. Do you have health problems that can affect your ability to do to job? No If Yes, please provide the details: