ANNEX 7Supplementary provisions
ANNEX 7 Text of image (Emblem of Sri Lanka) .............................................................…..... ...................................................................... ..................................................................... ........................................................…….... (Place and date) (Designation of issuing authority) Reference ................................................. COMMON PROVISIONAL TRAVEL DOCUMENT pursuant to Articles 2 to 5 of the Agreement of 4 June 2004 between the European Community and the Democratic Socialist Republic of Sri Lanka on the readmission of persons residing without authorisation Valid for a single return journey from ………………….…………….....………… (issuing State) to ........................................................................…………… (point of entry/country of destination) via ………..…….........................................................................………………. (transit countries) by …………………………..............................................………………. (mode of transportation) leaving on ..........................................…..……………............……………….. (date of departure) This travel document expires on ……....…... and must be produced to the Immigration Officer on arrival in ...................................……………………………… (point of entry/country of destination) Name ………………………………………………………….... Forename ……………………………………………………….. Date of birth ………..………………………………………….......……….. Place of birth ………..………………………………………..........……….. Sex ……../..........................................................................................………. Height ……...…………………………………………………….....……….. Distinguishing marks (if any) …….……………………….…........……….. Holder’s photograph Personal Identity card No …………………………………… Nationality ………………………..…………….…………….... Signature Address in Sri Lanka (if known) …………………….……….…………………………………………… ……………………………………………………………………………………………….………………………….………………… …………………………… (Signature) (Seal/stamp)