CONFIDENTIAL
PART B
I.
(Mr/Mrs/Ms/Miss and full name in block letters)
No
holder of
issued at
on
passport/identity document
hereby undertake to
repay on demand to the *Foreign and Commonwealth Office/Government of myself and the members
of my family accompanying me, including costs incurred in respect of transport, maintenance,
medical attention and any other items. *Furthermore, unless I have repaid the full amount
within nine months of the date of the letter notifying me of the amount of such costs, L
undertake to pay on demand to the Foreign and Commonwealth Office an additional amount
equivalent to seven and one half per cent (7%%) of the amount then outstanding. (This is to
be regarded as being in lieu of interest upon my debt).
I clearly understand:
1.
that I am accepting evacuation of my own free will.
2. that the journey is at my own risk and that transport used may cost more than in normal
circumstances and (except in the case of air transport) may not comply with normal safety and
sanitary regulations:
3.
that in the case of civil air travel Her Majesty's Government act only as an agent and
are not a contracting carrier.
4.
that passport facilities will not normally be available to me until my debt has been paid
in full.
Date
Signed Place
Mr/Mrs/Ms/Miss with wife and
the journey from expenses en route.
Date
*Delete as necessary if applicant is other than a British national
•
British Embassy/Consulate at
children has signed an Undertaking to repay all costs of
including any incidental
....
to
Embassy/Consular stamp and initial of Consular Officer
D-2
CONFIDENTIAL