Tier 4 Applicationform 1

APPLICATION FOR A GRANT OF LEAVE AND BIOMETRIC IMMIGRATION DOCUMENT UNDER TIER 4 (GENERAL) STUDENT -

MAIN APPLICANTThis form is for students who are already in the United Kingdom to apply to study

under Tier 4 (General).

TIER 4 (G)

version 04/13

Postal address:

UK Border AgencyTier 4PO Box 500DurhamDH99 1WJ

Courier address:

UK Border AgencyTier 4 Millburngate HouseMillburngateDurhamDH97 1PA

In accordance with paragraph 34 of the Immigration Rules, this form is specified for applications made on or after 6 April 2013.

Please check on the website at www.ukba.homeoffice.gov.uk that this is the current form for use on the date that you apply.

You are advised to read the help text and separate guidance notes that are available to help with this form. Please read them before making your application. If you do not already have them, you can download them from our website.

Applications made on this form may be made by post, courier or in person. To apply in person you must make an appointment.

Details of where you can make an application in person can be found on our website:www.ukba.homeoffice.gov.uk/contact/applyinginperson/

This form is specified for applications made on or after 6 April 2013

Postal address (Student Batch):

UK Border AgencyPBS DependantsPO Box 505DurhamDH99 1WD

www.ukba.homeoffice.gov.uk

www.ukba.homeoffice.gov.uk/contact/applyinginperson/

TIeR 4 (GeneRAl) APPlICATIOn FORM

Tier 4 (G) Application Form (version 04/13) - page 2

Intentionally Blank



A. Payment DetailsThere is a separate help text leaflet available with this form. Where a question in this form has information available in the help text leaflet it will be marked with (ht). Please complete this form in block capitals and black ink.If you do not select a fee then we cannot take a payment and your application will be rejected as invalid.A1. Is your sponsor a Highly Trusted Sponsor? YeS nOA2. Tick the applicable fee (ht):The student is making a standard postal application as a Tier 4 (General) student - £406The student is making a Tier 4 (General) student application in person - £781For applications made in person at a public enquiry office, the total fee includes a £100 apopintment fee, which may be retained should the applicant fail to attend their appointment without good reason.A3. Address for correspondence in the UK (ht)

House number/name

Address line 1

Address line 2

Address line 3

Town/CityCounty/DistrictPostcodeA4. If you are using a solicitor or other authorised immigration advisor to help you with this application form, you should enter the name of that person here (ht)

A5. Your full Name (ht):

A6. Your date of birth: (ht)

D D M M Y Y Y YA7. Please select the method of payment from the list below (ht)United Kingdom postal order (payable to ‘Home Office’) - go to question A20

Cheque/bankers draft (payable to ‘Home Office’) - go to question A8

Visa/Mastercard/Amex - go to question A11 Delta / Maestro - go to question A11

A8. Account number A9. Sort code A10. Cheque number - go to question A20

A11. Name on card (ht)

A12. Card number (the long number across the centre of the card):

A13. Valid from: A14. Valid to: A15. Issue number A16. CVV security number

/ / (where available)

(3 digit number or 4 digit number for Amex)

A17. Amount - please tick appropriate box (ht) - £406 - £781A18. Cardholder’s signature: A19. Date

D D M M Y Y Y Y



If you are producing a double-sided copy of this application form, please include this page and make

sure it falls on the reverse of the payment details page in the two-sided copy.

For administrative reasons, it is important that the rest of the form begins with Section B -

Your Personal Details facing upwards



A20. Please provide details of any dependant applications that are being submitted with this form. Please photocopy this page if more space is needed.IMPORTANT – each dependant must also complete their own Tier 4 Dependant form (ht).

Dependant 1 - First name

Last name

Date of birth D D M M Y Y Y Y


Last name



Last name



Last name



Last name



Last name





Last name



Last name



Last name



Last name




You must complete all of the sections and questions in this form that apply to you. The form will not be valid if it is not fully completed and your application will be rejected and returned to you.

There is a separate help text leaflet available with this form. Where a question in this form has information available in the help text leaflet it will be marked with (ht)B. Your Personal DetailsIn this section you will be asked to provide information about your personal situation, for example your name, date of birth and nationality as well as information about any other names you have used, or other nationalities you have held.

PhotographsFor your application to be valid, you must provide two recent identical passport-size photographs of yourself with your full name written on the back of each one. The photographs must be in the format specified in the separate photograph guidance, including the mandatory requirements, which can be found on our website at http://www.ukba.homeoffice.gov.uk. Please ensure that you place the photographs in a small sealed envelope attached to this part of the form - and without allowing any staples, clips, pins or anything else to mark or damage the photographs. The photographs will be checked against the images taken when your biometric features are recorded.

I have enclosed the required photographs as outlined in the box above.

I am a low risk student and I am applying under the differentiation arrangements (please see paragraph 10 and 11 of the Tier 4 guidance for more information about this arrangement)B1. What is your name, as given in your passport or travel document? (ht)Title - please select from the following list:

Mr Mrs Miss Ms Dr

First name(s) or given name(s):

Last name(s) or family name(s):

B2. What is your gender? (ht):

Male Female

B3. What is your date of birth?D D M M Y Y Y Y

B4. What is your relationship status? (ht):Married Dissolved Civil Partnership

Civil Partner Surviving Civil Partner

Single Unmarried Partner

Divorced Separated

Widow/Widower Separation Order

http://www.ukba.homeoffice.gov.uk



B5. What village, town or city were you born in?

B6. What is your country of birth?

B7. What is your current nationality? (ht)

B8. If you currently hold or have ever held any other Nationality, please provide details in the box below: (ht)

What Nationality did you or do you hold? Date held from: Date held to:

Please tick to confirm that you are submitting the required evidence relating to this other Nationality with this application.

B9. If you are currently known by or have ever been known by any other name, please provided details in the box below: (ht)

What name are you or were you known by?

Date of Birth when using this name:

Dates that you used this name from:

Dates that you used this name to:

Please tick to confirm that you are submitting the required evidence relating to this other name with this application.

Now go to Section C



Section C - Your Contact details in the UKIn this section you will be asked to provide information about how we can contact you, including your correspondence address in the UK, contact telephone numbers, email address, etc.

C1. What is your current address? (ht)

House number/nameAddress line 1Address line 2Address line 3Town/CityCounty/DistrictPostcode:

C2. What date did you move to this address?:

D D M M Y Y Y YC3. Is your correspondence address the same as your current address (as given above)? (ht)

Yes - go to C5 No - go to C4

C4. What is your correspondence address? (ht)

House number/nameAddress line 1Address line 2Address line 3Town/CityCounty/DistrictCountryPostcode:

C5. Please provide the following contact details:

Work telephone numberHome telephone numberMobile telephone numberFax number

Email address line 1Email address line 2

C6. Please tick to indicate what your preferred contact telephone number is:

Work Home Mobile

now go to Section D



Section D - Details of your RepresentativeIn this section you will be asked to provide information about your representative such as their name, address and contact details. It also asks whether or not they are appropriately registered or regulated to provide immigration advice. If you have a representative, then they will also need to complete the representative’s declaration at section Q of this form.D1. Do you have a representative acting on your behalf on this application?

Yes - go to D2 No - go to Section E

D2. What is the name of your representative? (ht)

D3. What is the name of your representative’s organisation? (ht)

D4. Is your representative based in the UK?Yes - go to D5 No - go to D6

D5. What is their UK address?House number/nameAddress line 1Address line 2Address line 3Town/CityCounty/DistrictPostcode:

Now go to D7D6. What is their overseas address?House number/nameAddress line 1Address line 2Address line 3Town/CityCounty/DistrictCountryPostcode:D7. Please provide your representative’s contact details:Work telephone numberMobile telephone numberE-mail address line 1E-mail address line 2Fax number



D8. Is your representative regulated by the Office of the Immigration Services Commissioner? (ht)

Yes - go to D9 No - go to D10

D9. What is their OISC registration number?

Now go to D11

D10. What is the reason that they are not OISC registered?

They are authorised by designated professional body or regulator

They are registered or authorised in an EEA State

They are supervised

They are exempt or employed or supervised by exempt person

They are specified by an order

I don’t know

D11. Is your representative listed with one of the UK Border Agency’s Public Enquiry Office (PEO) services?

Yes No

Now go to Section E



Section e - Your reference numbers

In this section you will be asked to provide information about any UK Border Agency or Home Office reference numbers that you might have. These can be found on documents and correspondence that we have previously sent to you. You will also be asked to provide any current and previous National Insurance number.

E1. Have you ever had a Home Office or UK Border Agency reference number assigned to you? (ht)

Yes - go to E2 No - go to E3

E2. What is/are your Home Office or UK Border Agency reference number? You may enter up to 3 reference numbers below:

Reference number 1

Reference number 2

Reference number 3

E3. Do you currently have a National Insurance number? (ht)

Yes - go to E4 No - go to E5

E4. What is your National Insurance number?

E5. Have you previously had a National Insurance number? (ht)

Yes - go to E6 No - go to Section F

E6. What was your previous National Insurance number?

Now go to section F



Section F - About your Passport or Travel DocumentIn this section you will be asked to provide information about your current and previous passports or travel documents. If you have lost or had any passports or travel documents stolen then you should have reported this to the Police and you will be asked to provide information about this.

F1; Please provide the following details:

Current Passport or Travel Document

What is your current passport or travel document number?

What is the nationality on the passport?

What is the issue date?

What is the expiry date?

What is the place of issue?

Is the passport or travel document enclosed?

If the passport or travel document is not enclosed, please indicate why:

Yes - Lost - go to F2

go to F4

Stolen - go to F3No -

go to next column

Expired and returned to national authorities - go to F4

Already with UKBA - go to F4

F2; Please explain how you lost your passport: (ht)


What was the Police report number?

What was the crime reference number?

Which police station was this reported at?

What date was this reported to the Police on?



F4: Have you had a previous Passport or Travel Document? (ht)

Yes go to F5 No go to Section G


Previous Passport or Travel Document

What is the passport or travel document number?

What is the nationality on the passport?



What is the place of issue?

Is the passport or travel document enclosed?

If the passport or travel document is not enclosed, please indicate why:

Yes - Lost - go to F6

go to Section G Stolen - go to

F7

No - Expired and returned to national authorities go to Section G

go to next column

Already with UKBA

F6; Please explain how you lost your passport: (ht)






Now go section G



Section G - About your Biometric Residence PermitIn this section you will asked to provide information about any Biometric Residence Permit(s) that have previously been issued to you.

G1; Do you have a BRP?

Yes go to G2 No go to Section H

G2; Please provide the following details: (ht)

Biometric Residence Permit

What is your BRP number?

What is your nationality on the BRP?



Is your BRP enclosed with this application?

If your BRP is not enclosed please indicate why:

Yes - go to Section H

Lost - go to G2

Stolen - to go G3No - go

to next column Expired and

returned to national authorities - go to Section HAlready with UKBA - go to Section H

G3; Please explain how you lost your BRP: (ht)

G4; Please provide the following details:





G5; Have you reported this to the UKBA card management service?

Yes go to G6 No go to Section H

G6; What date did you report this?

D D M M Y Y Y Y

Now go to Section H



Section H - About your Previous AddressesIn this section you will be asked to provide information about any previous addresses in the UK, including Northern Ireland, where you have lived in the last five years.

H1; Have you previously lived in Northern Ireland?

Yes go to H2 No go to H5

H2; What was your address?

House number/name

Address line 1

Address line 2

Address line 3

Town/City

County/District

Country

Postcode

H3; What date did you move to this address?

D D M M Y Y Y Y

H4; What date did you move from this address?

D D M M Y Y Y Y

If you have lived at more than one address in Northern Ireland, please continue on a seperate sheet.

H5; Have you lived at any other addresses in the UK within the last 5 years? (ht)

Yes go to H6 No go to Section I

H6; What was your address?

House number/name

Address line 1

Address line 2

Address line 3

Town/City

County/District

Postcode



H7; What date did you move to this address?

D D M M Y Y Y Y

H8; What date did you move from this address?

D D M M Y Y Y Y

If you have lived at more than one address in the last five years, please continue on a seperate sheet.

Now go to Section I



Section I - About your Personal HistoryIn this section you will be asked to provide information about any criminal convictions you have, any civil judgements or immigration civil penalties against you and details of any involvement you may have had in war crimes, genocide, crimes against humanity or terrorism.

I1; Have you ever been convicted of a criminal offence either in the UK or in another country? (ht)Yes go to I2 No go to I7

I2; What was the offence?

I3; What was the sentence given?

I4; If you were sentenced to a period of imprisonment, what was the length of the prison sentence in months?

I5; What date were you sentenced on?

D D M M Y Y Y Y

I6; Which country were you convicted in?

I7; Have you ever had any civil judgements issued against you or received a civil penalty under the UK Immigration Acts? (ht)

Yes go to I8 No go to I11

I8; Please provide details of the judgement or civil penalty:



I9; Date of the judgement or civil penaltyD D M M Y Y Y Y

I10; Which country was the judgement issued in?

I11; Have you ever been charged or indicted in any country with a criminal offence for which you have not yet been tried in court? (ht)


I12; Please provide details of the offence:

I13; In either peace or war time, have you ever been involved in, or suspected of involvement in, war crimes, crimes against humanity or genocide? (ht)


I14; Please provide details:

I15; Have you ever been involved in, supported or encouraged terrorist activities in any country? (ht)





I17; Have you ever been a member of, or given support to an organisation which has been concerned with or involved in terrorism? (ht)



I19; Have you, by any means or medium, expressed views that justify or glorify terrorist violence or that may encourage othes to commit terrorists acts or activities or other serious criminal activites? (ht)

Yes go to I20 No to to Section J


Now go to Section J



Section J - About your Immigration HistoryIn this section you will be asked to provide information about your current and previous immigration status in the UK, including previous applications that you have made.

J1; What is your current immigration status?

I have leave to enter/remain for a limited period - Go to J4

I am an EU national / family member of an EU national - Go to J4

I am exempt from immigration control - Go to J4

I have leave to enter/remain for a limited period, but leave has now expired - Go to J2

None of the above - Go to J4

J2; Did this leave expire more than 28 days before this application was made?:

Yes - Go to J3No - Go to J4

J3; I am submitting evidence of exceptional circumstances which prevented me from submitting my application within 28 days of overstaying.

Tick to confirm

J4; Were you required to register with the Police as a condition of your previous leave?

Yes No

J5; Did you have a visa or entry clearance when you came to the UK? (ht)

Yes go to J6 No go to J10

J6; In which country did you obtain your visa or entry clearance?

J7; What is the reference number of the visa or entry clearance?

J8; What date was your visa or entry clearance valid from?

D D M M Y Y Y Y

J9; What date was your visa or entry clearance valid to?

D D M M Y Y Y Y



J10. How did you enter the UK?

By air

By sea

By the Channel Tunnel

Travelling overland via the Republic of Ireland

J11. At which Port did you enter the UK?

J12. What was your ticket booking reference number?

J13. What was the name of your transport operator?

J14. Have you ever stayed in the United Kingdom beyond your period of leave? (ht)

Yes - go to J15 No - go to J16

J15. Please provide details:

J16. Have you ever knowingly used deception when seeking leave to enter or remain, entered the United Kingdom illegally or worked in the united Kingdom without immigration permission to do so (contrary to your conditions of stay)? (ht)



J18. Have you ever been refused entry clearance, leave to enter or leave to remain in the UK?


J19. Please give details:



J20. Have you ever been removed, required to leave or deported from the UK? (ht)



J22. Do you currently have any other applications with the UK Border Agency on which you are awaiting a decision? (ht)


J23. Please provide details :

J24. Do you currently have an immigration appeal before the Tribunal which has not yet been finally determined? (ht)

Yes - go to J25 No - go to Section K

J25. Please provide details :

Now go to Section K.



Section K - Public FundsIn this section you will be asked to provide information about whether or not you have claimed public funds (benefits and housing) in the UK and details about any claims you have made.

K1; Have you ever claimed any public funds? (ht)

Yes go to K2 No go to Section L

K2; Have you claimed Attendance Allowance?

Yes No

K3; Have you claimed Carer’s Allowance?

Yes No

K4; Have you claimed Child Benefit?

Yes No

K5; Have you claimed Child Tax Credit?

Yes No

K6; Have you claimed Council Tax Benefit?

Yes No

K7; Have you claimed Disability Living Allowance?

Yes No

K8; Have you claimed Housing or Homelessness Assistance?

Yes go to K9 No go to K10

K9. What is the name of the local housing authority or housing association that provided this?



K10. Have you claimed Housing Benefit?

Yes No

K11. Have you claimed Income-based Jobseekers Allowance?

Yes No

K12. Have you claimed Income Support?

Yes No

K13. Have you claimed Severe Disablement Allowance?

Yes No

K14. Have you claimed Social Fund Payments?

Yes No

K15. Have you claimed State Pension Credit?

Yes No

K16. Have you claimed Working Tax Credit?

Yes No

K17. Have you claimed Income-related Employment and Support Allowance?

Yes No

K18. Is your housing provided by a local authority or housing authority as part of an agreement between your employer and a housing authority? (ht)Yes No

K19. Have you claimed Council Tax Reduction?

Yes No

K20. Have you claimed Personal Independence Payment?

Yes No

K21. Have you claimed Universal Credit?

Yes No

Now go to Section L



Section l - About your course In this section you will be asked to provide information about the course you are studying (if you are applying to continue on your current course) or intending to study. In some cases you will need approval from someone else for your studies and we will also ask for information about that.

L1. What is the licence number of your Tier 4 sponsor? (ht)

L2. What is the name of your Tier 4 sponsor?

L3. Please provide your Tier 4 sponsor’s address: (ht)

House number/name

Address line 1

Address line 2

Address line 3

Town/City

County/District

Country

Postcode:

L4. Do you have a CAS? (ht)

Yes - go to L5 no - go to L6

L5. What is your CAS number?

L6. What type of qualification are you studying for? (ht)

L7. What is the title of your course?

L8. What date does your course start? (ht)

D D M M Y Y Y Y



L9. What date does your course end? (ht)

D D M M Y Y Y YL10. Is the address of your primary site of study the same as your Tier 4 sponsor’s address (as given above)? (ht)

Yes - go to L12 no - go to L11

L11. Please provide the address of your main site of study:House number/name

Address line 1

Address line 2

Address line 3

Town/City

County/District

Country

Postcode:

L12. What is the study level of your course? Below NQF Level 6 - go to L14

At NQF Level 6 or NQF Level 7 - go to L15

At NQF Level 8 - go to L13

L13. Are you applying for the Doctorate Extension Scheme? (ht)

Yes No

now go to l15

L14. How can you demonstrate your English Language ability? I am a national of a listed country.

I am providing a degree-level qualification from a listed country. I have previously studied in the UK as a Tier 4 (Child) Student.

I am providing an English Language test certificate at level B1 of the CEFR which is from an approved and registered provider.

Now go to L16L15. How can you demonstrate your English Language ability?

I am a national of a listed country.

I am providing a degree-level qualification from a listed country.I have previously studied in the UK as a Tier 4 (Child) Student.

I am providing an English Language test certificate at level B2 of the CEFR which is from an approved and registered provider.

I am studying at a Sponsor who is an HEI or Recognised Body and who have tested my ability and has confirmed on my CAS that I can speak English to the required standard. I am studying at a Sponsor who is an HEI or Recognised Body and who has confirmed on my CAS that I am a gifted student.



L16. Can you speak English to the required standard?Yes No

Now go to Section M

Section M - About your maintenanceIn this section you will be asked to provide information about maintenance, which is the money you will need for your course fees / boarding fees and living costs in the UK.

It is essential that you ensure that the information you provide in this section is accurate, and that where appropriate, that it is the same as that given on your CAS. We use this information to advise you of the amount of money you will need for maintenance. If you do not provide accurate information, the figure you are given will not reflect the amount of money you need, and may result in you being advised that you will need less money than is actually required.

Where there is an inconsistency between the information you provide and that given on the CAS by your Tier 4 sponsor, we will assess the money you require using the information we hold, including the CAS.

M1. How much are your course fees, as stated on your CAS? (ht)

Course Fees £ .

M2. If you have paid anything towards your course fees, please provide this amount below:

Amount paid £ .

M3. If you have paid something towards your course fees, what are you submitting as evidence of this? (ht)

Receipts for payments

It is stated on my CAS

I am a low risk National

M4. Do you have an established presence in the UK? (ht)

Yes No

M5. Where are you intending to study? (ht)

Inside the Inner London area

Outside the Inner London area

M6. If you have paid anything to your sponsor for your accommodation, please provide the amount below: (ht)Accommodation £ .

M7. If you have paid something to your sponsor towards your accommodation, what are you submitting as evidence of this? (ht)

Receipts for payments

It is stated on my CAS




M8. Are you receiving money from an Official Financial Sponsor? (ht)

Yes go to M9 No go to M11

M9. If they are not covering the full amounts, please state how much your Official Financial Sponsor is paying towards:Maintenance £ .

Course fees £ .

M10. Please tick one of the following:

I am enclosing a letter from my Official Financial Sponsor with this application

My Official Financial Sponsorship is shown on my CAS.


M11. Will you receive any other financial sponsorship, such as a scholarship or bursary, from your Tier 4 educational sponsor?

Yes go to M12 No go to M14

M12. If they are not covering the full amounts, please state how much your Tier 4 educational sponsor is paying towards:Maintenance £ .

Course fees £ .

M13. Your Tier 4 educational sponsor must show this on your CAS record:

My Tier 4 sponsor has agreed to show this on my CAS record.

M14. Please provide a summary of how much money you are still required to show for your outstanding fees and maintenance:Maintenance £ .

Course fees £ .

Total £ .

M15. Are all of the funds you are using to demonstrate your ability to maintain yourself and any dependants in your own name or in the name of your parent(s) or legal guardian(s)?

The funds are in my own name - go to M18

The funds are in the name of my parent(s) or legal guardian(s) - go to M16

M16. Please tick to confirm the following:

I am providing a letter from my parent(s) or legal guardian(s)

I am a low risk national and am not required to provide this evidence.

M17. I am also providing one of the following:

My full Birth Certificate naming both me and my parents.

A Certificate of Adoption naming me and my adoptive parent(s).



A formal Court document naming me and my legal guardian(s).


M18. Please tick to confirm that you are providing one of the following documents:

Personal bank or building society statements.

A building Society pass-book.

A letter from a bank or building society confirming funds

A letter from a regulated financial institution confirming the agreement of a loan.

No evidence is required as I do not owe any money for fees or maintenance.


Now go to Section N



Section n - Attributes and Financial SponsorshipIn this section you will be asked to provide information about the course you are studying or intending to study. In some cases you will need approval from someone else for your studies and we will also ask for information about that.

N1. What is the course level you are applying for?

Below NQF/QCF level 6 - go to N6

At or above NQF/QCF level 6 - go to N2

I am a Postgraduate Doctor or Dentist undertaking training - go to N3

N2. If you need an ATAS certificate for your course, please enter the reference number below:

Please also tick to confirm that you are enclosing your ATAS certificate with your application:

N3. Have you previously been given leave for a course as a Postgraduate Doctor or Dentist?

Yes No

N4. Have you previously had leave as a Tier 4 (General) student or Student?

Yes go to N5 No go to N6

N5. When were you last granted this leave?

D D M M Y Y Y Y

N6. Are you currently being sponsored by or have you ever been sponsored by a Government or an International Scholarship Agency? (ht)


N7. Are there any restriction imposed on the length of stay in the United Kingdom as a result of this sponsorship?


N8. Please provide details of the restrictions:

Please tick to confirm that you are enclosing written confirmation from your sponsor stating that they consent to your application.



N9. I am:

Studying English as a Foreign Language course only - go to N10

Studying any other type of course - go to N11

A Student Union Sabbatical Officer - we will use the information provided on your CAS as evidence.

Undertaking a Foundation course as a Post-graduate Doctor or Dentist - go to N12

N10. If you have been assessed by means of an academic or professional reference, you must send us each original reference used by your sponsor as the basis for their offer to you. Please tick one of the following boxes:

I am enclosing the original reference(s) with my application.

I am enclosing copies of my reference(s) along with a letter from my sponsor confirming the content of the reference copies.

n/a

I am a low risk national and am not required to include this document with my application.

Now go to Section O

N11. You must send us the evidence that your Tier 4 sponsor used as the basis for assigning a CAS to you, unless you are exempt from doing so.Please tick one of the following boxes:

I am enclosing all of the qualification certificates and transcripts of results used as the basis of my course offer.

I was assessed by my sponsor by other means.

I am a low risk national and am not required to include this document with my application.

Now go to Section O

N12. You must send us your original certificate of qualification and/or your original transcript of results of your UK qualification in Medicine or Dentistry, as listed by your Tier 4 sponsor on your CAS:

I am enclosing the required evidence.

I am a low risk national an am not required to include this document with my application.

Now go to Section O



Section O - About your Parent or legal GuardianYou should only complete this section if you are a TIer 4 (General) student aged 16 or 17 years old. In this section you will be asked to provide information about your care and living arrangements in the UK and about your parents or legal guardians.

O1. Are you in Local Authority care in the UK? (ht)

Yes go to the next section No go to O2

O2. What is the name of your Parent or Legal Guardian?

Title - please select from the following list:

Mr Mrs Miss Ms Dr

First name(s) or given name(s)

Last name(s) or family name(s)

O3. What is their date of birth?

D D M M Y Y Y Y

O4. What country are they currently living in?

O5. Please provide their address:

House number/name

Address line 1

Address line 2

Address line 3

Town/City

County/District

Country

Postcode:

O6. How are you related to your Parent or Legal Guardian?

O7. What is the name of your Parent or Legal Guardian?

Title - please select from the following list:

Mr Mrs Miss Ms Dr



First name(s) or given name(s)

Last name(s) or family name(s)

O8. What is their date of birth?

D D M M Y Y Y Y

O9. What country are they currently living in?

10. Please provide their address:

House number/name

Address line 1

Address line 2

Address line 3

Town/City

County/District

Country

Postcode:

11. How are you related to your Parent or Legal Guardian?

12. Please tick the following box:

I am enclosing a letter from my Parent(s) or legal guardian(s) confirming they consent to this application.



Section P - Your DeclarationYou must complete part P. If it is not complete, then your application will be invalid and will be returned to you.

You must sign below to show that you have read and understood the following declaration. It must be authorised by you and not by a representative or other person acting on your behalf. If you are under 18, your parent or legal guardian may sign.

The information given in my application is complete and is true to the best of my knowledge and belief.

The photographs I have submitted with my application are a true likeness of me.

The documents I have submitted in support of my application are complete and correct to the best of my knowledge and belief.

I agree to co-operate with UK Border Agency officials, or any other person charged by the

Secretary of State for the Home Office with conducting pre-issue and post-issue checks in relation to this application.

If there is a material change in my circumstances or any new information relevant to this application becomes available before it is decided, I will inform the UK Border Agency.

I am aware that the rules and requirements for applications may change in the future and that I should not assume the current rules and requirements will continue to apply.

I agree to the UK Border Agency using the data provided in this application in accordance with its Information Charter. I understand that my details may in certain circumstances be passed to other people, including fraud prevention agencies, to prevent and detect fraud, money laundering and other crimes. I also understand that the UK Border Agency may receive information about me.

Name

Signature Date

D D M M Y Y Y Y



Section Q - Representative’s Declaration

If you are a representative acting in relation to this application you must complete the declaration below to show you have read and understood the representative’s declaration and to confirm that you are authorised to act on behalf of the applicant(s).

I have been appointed by the applicant(s) to act on their behalf in relation to this application which has been submitted online to the UK Border Agency.

I confirm that I am aware of the contents of this application, including its supporting documents, and that the application is, to the best of my knowledge and belief, true and correct.

I confirm that I will promptly give the applicant all correspondence I receive from the UK Border Agency about this application.

I am permitted to give immigration advice and immigration services by virtue of section 84 of the Immigration and Asylum Act 1999.

I am aware that it is an offence to do an act which facilitates a person who is not a citizen of the European Union to commit a breach of immigration law, knowing or having reasonable cause to believe that the act has this effect.

Name

Signature Date

D D M M Y Y Y Y

Name of your organisation:

Your position within the organisation:



SUMMARY SHeeT

Fill in this part of the form to help us to make sure that we have received the student’s documents and to keep a record of them while they are with us.

At “A”, tell us how many of each of the listed documents the student has sent with this application. This is a standard list, students should only send in the documents from this list that are required for their application.

At “B”, list any other documents and state how many in each case. Continue on a separate sheet if necessary.

Part A - Type of document How many? Part B - listed Items How many?Passports

2 photographsBiometric Residence Permits and/or travel documents

Police registration certificatesLetter of consent from parent/guardianMarriage or civil partnership

certificates

Birth certificates

Driving Licences

Fill in the summary sheet below listing the supporting evidence (documents) sent. You must send the required evidence as specified in this application form and the Tier 4 of the points based system Policy Guidance. Failure to submit required evidence is likely to lead to refusal of your application.

Area Documents provided (please list)

Possession of a Confirmation of Acceptance for Studies (CAS)

Maintenance (Funds)

Finally please ensure that your application is addressed correctly, as given on the front of this form.