Refer to the guidance notes when you see this icon. The notes will give you extra information to help you complete the form correctly.

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1 PR1 Applicatio for studet fiace - cotiuig studets 2017/18 Foreame(s) Surame Refer to the guidace otes whe you see this ico. The otes will give you extra iformatio to help you complete the form correctly. You will have to sed evidece with your applicatio wheever you see this ico. e Details about the evidece required ca also be foud i the guidace otes. You should complete this form if you are cotiuig study o oe of the followig courses: A full-time or sadwich course of higher educatio. A diploma or degree course i a health related disciplie ad you are eligible to apply for a icome assessed bursary from the Natioal Health Service (NHS). A full-time distace learig course, for reasos ot related to a disability, that started o or after 1 September 2012 (You ca oly apply for a Tuitio Fee Loa) ad Disabled Studets Allowaces (if applicable). A full-time Iitial Teacher Traiig (ITT) course. Deadlie To make sure you receive your fi rst paymet at the start of term, you must retur this form ad all of the evidece we eed by 23 Jue We will do our best to process your applicatio as soo as possible, however if the deadlie date has passed, your fi rst paymet may ot be ready for the start of term. If your applicatio form is retured more tha 9 moths after the start of your academic year it wo t be processed, ad you may lose your full etitlemet to studet fi ace. /A /SF_Eglad 1

2 ! Sectio 1 Fiace available If you started your course o or after 1 August 2016 you could get: Tuitio Fee Loa Maiteace Loa * Special Support Loa (if you re aged 60 or over) If you started your course o or after 1 September 2012 ad before 1 August 2016 you could get: Tuitio Fee Loa Maiteace Loa Maiteace Grat Special Support Grat Extra help You ca also apply for additioal studet fiace: Childcare Grat Parets Learig Allowace Bursaries ad Scholarships Adult Depedats Grat Disabled Studets Allowaces Travel Grat Childcare Grat (CCG) If you wat to apply for CCG you ll eed to: complete ad retur this form ad complete a Childcare Grat Applicatio form (CCG1). You ca dowload the CCG1 form at: Tick the box below if you wat us to sed you a CCG1 form istead. Sed me a CCG1 form Tick Disabled Studets Allowaces (DSAs) If you applied for DSAs last year you oly eed to complete this form (PR1). If you wat to apply for DSAs for the first time you ll eed to: complete ad retur this form ad complete a Disabled Studets Allowaces Applicatio Form (DSA slim). You ca dowload the DSA slim form at: Tick the box below if you wat us to sed you a DSA slim form istead. Sed me a DSA slim form Tick Go to to fid out more about what studet fiace is available. You ca apply i 5 easy steps Depedig o your circumstaces you may ot eed to complete all of the steps. 1 For all studets Complete sectios 2-4. You do ot eed to complete sectio 4 if you are oly applyig for a Tuitio Fee Loa. If you are applyig for a Maiteace Loa, Special Support Loa ad/or a Tuitio Fee Loa you eed to tell us how much you wat by completig the loa request sectio o 10 ad 11. If you oly wat to apply for a Tuitio Fee Loa ad/or a Maiteace Loa that is ot based o household icome you ca go to Step For studets who wat studet fiace based o household icome Complete sectios 5 ad 6. If you wat to apply for Special Support complete sectio 7. If you re aged 60 or over ad are applyig for studet fiace based o your household icome, you ll receive a Special Support Loa istead of a Maiteace Loa. You do t eed to complete sectio 7. For studets who have depedats Complete sectio 8. You should complete this sectio if you have ay childre or adult depedats ad wat to apply for fiacial help i relatio to them.! If you are a sigle idepedet studet go directly to Step 5. 2

3 Sectio 1 Fiace available 4 For studets who wat studet fiace based o household icome Complete sectio 9. Depedig o your aswers i sectio 9 you may eed to ask your paret(s) or parter to provide details about their icome i sectio 10 so we ca work out what your full etitlemet to studet fiace will be. 5 For all studets Make sure that you have siged the Studet Declaratio o pages 18 ad 19. If you asked someoe to complete sectio 10, make sure that they have siged their declaratio(s) o page 28. What if I have further questios? If you have further questios you ca: visit call us o or by textphoe o Where do I sed my form? Retur this form to: Studet Fiace Eglad, PO Box 210, Darligto, DL1 9HJ. Please remember to pay the correct postage. 3

4 Sectio 2 Persoal details Customer Referece Number Persoal details a Title Mr Mrs Miss Ms Foreame(s) Surame Sex Male Female Date of birth Natioal Isurace umber - - DAY MONTH YEAR b Cotact details Please give your curret home address. If you kow it, please also give your term-time correspodece address. Home address Term-time address Postcode Home phoe umber Postcode Date o which you will move to this address DAY MONTH YEAR c Mobile phoe umber address Curret relatioship status Tick oe box. You oly have to sed evidece if your circumstaces have chaged sice your last applicatio. Sigle Livig with a parter Married/civil partership Separated e Divorced/dissolved civil partership Widowed/survivig civil parter Armed Forces e Please give the date of marriage/civil partership e DAY MONTH YEAR e d1 Are you a member of the Armed Forces? d2 Are you a family member of someoe i the Armed Forces? (for example: spouse or child) 4

5 Sectio 3 About your course ad uiversity or college a Full tuitio fee amout for this academic year Your tuitio fee amout ca chage each year. If you are usure about the tuitio fee amout you will be charged, cotact your uiversity or college. b Is this the fial year of your course? c Will you be studyig at exactly the same uiversity or college ad o exactly the same course that you were i the academic year 2016/17? if go to f You must complete all of the questios i this sectio if ay of your course, uiversity or college details have chaged sice your last applicatio. d Uiversity or college details Uiversity or college ame ad address Postcode UCAS persoal idetificatio umber UCAS uiversity/college code UCAS campus code (if applicable) e Course details Course ame If you are followig a combied studies or modular course, please list all subjects beig studied UCAS course code Qualificatio you expect to gai (e.g. BSc Physics) Course start date Course ed date Course legth (years) MONTH MONTH YEAR YEAR 5

6 Sectio 3 About your course ad uiversity or college Year of course Foudatio First year Secod year Third year Fourth year Other (give details) If the course is frachised to aother uiversity/college, give the address of the other uiversity/college Postcode f Which of the followig is your course? Tick oe box oly. Full-time udergraduate Full-time Iitial Teacher Traiig (ITT) courses of up to 2 years i legth Full-time distace learig Full-time foudatio degree Full-time ivolvig a placemet (sadwich course) Do you have a disability which prevets you from attedig your uiversity or college i perso? e 6

7 Sectio 3 About your course ad uiversity or college g1 I this academic year, are you eligible to apply for a bursary, excludig social work bursary from ay of the followig? Natioal Health Service (NHS) Departmet of Health (DoH) Studet Awards Agecy Scotlad (SAAS) g2 If, is this bursary or award icome assessed or o-icome assessed? Icome assessed -icome assessed h i Term details Where will you live durig the academic year? Term 1 Livig with paret(s) Elsewhere or ow home Term 2 Livig with paret(s) Elsewhere or ow home Term 3 Livig with paret(s) Elsewhere or ow home Where will you sped most of your time this academic year? Term 1 Uiversity or college Study abroad Work placemet Term 2 Uiversity or college Study abroad Work placemet Term 3 Uiversity or college Study abroad Work placemet if you have ticked Uiversity or college for all 3 terms go to sectio 4 j Have you bee accepted oto the Erasmus exchage scheme? if or you ll be studyig abroad go to sectio 4 k Where will your placemet be? Abroad UK Do t kow Placemet ame ad address, if kow Postcode 7

8 Sectio 3 About your course ad uiversity or college l Is the placemet: paid upaid If upaid, please tick which type: a hospital, Public Health Service Laboratory or with Cliical Commissioig group i the UK; a Special Health Authority, the Natioal Health Service Commissioig Board, the Natioal Istitute for Health ad Care Excellece, the Health ad Social Care Iformatio Cetre, Local Health Board, Health Board, Special Health Board or Health ad Social Services Board i the UK; a Local Authority carryig out its duties relatig to health, welfare or carig for childre ad youg people, a volutary orgaisatio providig facilities or carryig out similar activities or a Local Authority actig i the exercise of public health fuctios i the UK; the priso or probatio sector or after-care services i the UK; upaid research i a UK or overseas istitutio; or a upaid placemet i the Houses of Parliamet a upaid placemet that is ot listed above. 8

9 Sectio 4 Your bak or buildig society accout details This accout must be i your ow ame (ot a joit accout) ad be able to accept direct credits. Please ote that missig or icorrect bak or buildig society details will result i your Maiteace Loa, Bursary (if applicable) or ay grat paymets beig delayed. You do ot eed to provide your bak or buildig society accout details if you are oly applyig for a Tuitio Fee Loa because this will be paid directly to your uiversity or college ad ot to you. Sort code Accout umber Buildig society roll umber (if applicable) 9

10 Loa request sectio If you are applyig for a Maiteace Loa, Special Support Loa ad/or a Tuitio Fee Loa please complete this sectio to tell us how much you wat to apply for. Maiteace Loa Amout of Maiteace Loa you would like to apply for: Maximum available to you If you wish to apply for less tha the maximum available to you, please state the amout. Tick Tuitio Fee Loa Your tuitio fee is set by the uiversity or college you go to. Ay Tuitio Fee Loa you borrow will be paid directly to your uiversity or college. You should fid out how much your uiversity or college is chargig before you apply for a Tuitio Fee Loa. Amout of Tuitio Fee Loa you would like to apply for: Maximum available to you Tick If you wish to apply for less tha the maximum available to you, please state the amout. Special Support Loa The special support loa is for studets aged 60 ad over. Amout of Special Support Loa you would like to apply for: Maximum available to you Tick If you wat to apply for less tha the maximum available to you, please state the amout. 10

11 Loa request sectio Cotact details We eed you to give the ame ad address of two additioal cotacts. We ll oly cotact them if we ca t get i touch with you, for example if you move address ad forget to tell us. By eterig these details, you re cofirmig you ve told your additioal cotacts about this ad they re happy for Studet Loas Compay to cotact them if ecessary. Cotact 1 Foreame(s) Cotact 2 (Cotact 2 must live at a differet address from cotact 1) Foreame(s) Surame Surame Relatioship to you Relatioship to you Address Address Postcode Phoe umber Postcode Phoe umber If you do t wat studet fiace based o your household icome go straight to the Studet Declaratio o pages 18 ad

12 Sectio 5 Depedet ad idepedet studets This sectio determies whether you are a depedet or a idepedet studet. This is importat as it establishes whose icome we eed to take ito accout from your household before we calculate your etitlemet. a1 Will you be 25 or over o the first day of the academic year? if, you are a idepedet studet, go to sectio 6 a2 a3 Have you bee married or i a civil partership at ay time before the first day of the academic year? if, you are a idepedet studet, go to sectio 6 Will you have the care of a perso uder the age of 18 o the first day of the academic year? e if, you may be cosidered a idepedet studet go to sectio 6 If you have previously bee cosidered idepedet because you have supported yourself fiacially for a total of 3 years or more before the start of the first academic year of your course, you will cotiue to be cosidered idepedet. if this applies to you go to sectio 6 b Please tick the relevat box if ay of the followig apply to you. Your parets caot be foud or it is ot reasoably practicable to get i touch with them. You are irrecocilably estraged from (have o cotact with) your parets ad this will ot chage. For ay three moth period edig after your 16th birthday ad before the first day of the first academic year of your course you have bee i the custody of, i legal care of, or have bee give accommodatio by a local authority but you have ot bee uder the legal care of your parets. Both your parets are deceased. Your parets are livig outside the Europea Uio ad the assessmet of their fiacial circumstaces would place them i jeopardy. You have bee assessed for studet fiace before, ad the paret who was assessed for a cotributio has died. Your parets are livig outside the Europea Uio ad it would ot be reasoably practicable or possible for them to sed you moey. If you have ticked ay of the boxes above, you will be cotacted for evidece ad subject to this, you may be cosidered idepedet. 12

13 Sectio 6 Studet fiacial questios a If you leave ay questios blak we will ot be able to process your applicatio. If a questio does ot apply to you, please eter e or N/A as the aswer. Ueared icome Taxable ueared icome is ay icome you receive from the followig sources: Bak or buildig society gross iterest Property, lettigs or ret Divideds or ivestmets Trusts or sposorships Ay other paymet received for attedig the course Please estimate the total taxable ueared icome, before deductios, that you expect to receive for this academic year. What is the source of this icome? Paymets from a employer b1 Will your employer be releasig you to atted your course for the academic year? if go to c If, how much will your employer pay you for time spet attedig your course durig this period? b2 Durig the academic year, will you or your employer pay ay moey ito a pesio fud o your behalf? If, how much durig this period? c Depedet childre Give details of ay childre who will be wholly or maily fiacially depedet o you durig the academic year. Your child s icome icludes their icome from all sources after icome tax ad Natioal Isurace cotributios i the tax year. Child s full ame Date of birth e Relatioship to you Who will they live with? Child s icome e (DD MM YYYY) 13

14 Sectio 7 Special Support Tick ay of the boxes below that are relevat to you. You must sed supportig evidece with your applicatio. Read the otes to fid out what evidece to sed. I m a loe paret or loe foster paret with a child or youg perso uder 20 who is i full-time educatio below higher educatio level or o a approved traiig course I have a parter who is also a studet, ad oe or both of us are resposible for a child or youg perso uder 20 who is i full-time educatio below higher educatio level or o a approved traiig course I have a disability ad qualify for the Disability Premium or Severe Disability Premium I m deaf ad qualify for Disabled Studets Allowaces e I have bee treated as icapable of work for a cotiuous period of at least 28 weeks I have a disability ad qualify for icome-related Employmet ad Support Allowace I m waitig to go back to a course havig take agreed time out from that course due to a illess or carig resposibility that has ow eded I m etitled to Persoal Idepedece Paymet (PIP) I m etitled to Disability Livig Allowace (DLA) I m etitled to Armed Forces Idepedece Paymet (AFIP) e of the above 14

15 Sectio 8 Parets Learig Allowace, Adult Depedats Grat ad Childcare Grat Oly complete this sectio if you wat to apply for Parets Learig Allowace, Adult Depedats Grat or Childcare Grat. a Are you a loe paret? if go to d b Are you uder 25, livig with a parter ad applyig for Childcare Grat or Parets Learig Allowace? if go to d c Give the total estimated icome after icome tax ad Natioal Isurace deductios i the academic year for: You Your parter How much of this will be Child Tax Credit or the child elemet of Uiversal Credit for the academic year? You Your parter If you are ot applyig for Childcare Grat go to e1 d Durig the academic year, do you or your parter expect to receive: the childcare elemet of Workig Tax Credit or Uiversal Credit; or Tax-Free Childcare from HM Reveue ad Customs (HMRC) Childcare Allowace from the NHS! If `, you ca t get Childcare Grat if you receive childcare support from oe of these sources at the same time. You ca still apply for Childcare Grat however, you ll oly get it if you stop receivig support from these sources. e1 Are you applyig for Adult Depedats Grat? if go to f e2 Who is your adult depedat? husbad, wife, civil parter or parter (if you are over 25) other adult depedat go to f e3 Will your other adult depedat s icome be more tha 3,796 i the academic year?! If you will ot be able to apply for Adult Depedats Grat if go to f 15

16 Sectio 8 Parets Learig Allowace, Adult Depedats Grat ad Childcare Grat e4 Give your adult depedat s icome for the tax year. e Total gross icome All salary/wages ad self-employed icome (iclude icome from property) All pesio icome, icludig private, occupatioal ad state All gross taxable icome ad iterest from savigs, ivestmets ad divideds Taxable state beefits All other taxable icome Deductios Private pesio cotributios ad Additioal Volutary Cotributios (AVCs) Allowable expeses o which tax relief is claimed Oly complete this questio if you started your course i or before academic year 2012/13. f Give details of fiacial commitmets you have before the start of the course which you, your husbad, wife or parter will cotiue to pay durig the academic year. e Type Type Type Type Type Type Type Type 16

17 Sectio 9 About your family If you are a depedet studet, go to questio a. If you are a idepedet studet with a parter, go to the Studet Declaratio o pages 18 ad 19 ad the pass this form to your parter to complete sectio 10. If you are a sigle idepedet studet, go to the Studet Declaratio o pages 18 ad 19. a With which paret do you ormally live, or have more cotact with? Mother Father or Both parets N/A b c What is the curret relatioship status of this paret? Sigle Livig with a parter Married/civil partership Separated Divorced/dissolved civil partership Widowed/survivig civil parter Have your parets divorced, separated, bee i a civil partership which has bee dissolved, or bee widowed sice 1 September 2016? e What you eed to do ext Read ad sig the Studet Declaratio o pages 18 ad 19 ad the pass this form to your paret(s). What your paret(s) eed to do ext The paret(s) you ormally live with should complete sectio 10. If the paret idicated i a is married, i a civil partership or livig with a parter, their parter must also complete sectio

18 Studet Declaratio Before sigig ad returig your completed form, you should read the Data Protectio Statemet i the accompayig otes. This declaratio covers all of the studet fi ace available to studets for academic year 2017/18. By sigig this declaratio you are cofi rmig that you have read the specifi c terms ad coditios about loas, Childcare Grat ad Disabled Studets Allowaces because they will affect you if you apply for them at ay time i academic year 2017/18. If you do t apply for these i academic year 2017/18 their specifi c terms ad coditios will ot affect you. Your applicatio for fiacial support may be delayed uless you sig ad date this declaratio. Geeral Declaratio I cofirm that to the best of my kowledge ad belief, the iformatio I have provided is true ad complete. If it is ot I uderstad I may ot receive fiacial support, ay support I have received may be withdraw ad I could be prosecuted. I agree to give the Studet Loas Compay (SLC) ay iformatio they require to process my applicatio ad agree to tell them immediately if my circumstaces chage i ay way that might affect my etitlemet to fiacial support. I uderstad that if I do ot do this, I may ot receive ay further paymets, ad may have to repay the fiacial support I have already received. I agree that i the evet of receivig a overpaymet of fiacial support, I am obliged to repay this i full. Loa Cotract a I cofi rm I have read ad uderstood the guide to terms ad coditios available olie at b I ackowledge ad agree that ay loa(s) made to me by the Secretary of State for Educatio, the leder (which icludes ay persos exercisig fuctios o behalf of the Secretary of State pursuat to sectio 23(4) of the Teachig ad Higher Educatio Act 1998 as ameded from time to time or successor legislatio, the Act ) will be o the terms set out i these declaratios ad i Regulatios which are made uder sectio 22 of the Act as ameded from time to time. c I ackowledge ad agree that i the evet that I have: (i) reached the age of 18 years; ad (ii) have etered ito oe or more agreemets for a loa uder sectio 22 of the Teachig ad Higher Educatio Act 1998 (ad relative secodary legislatio) before I reached the age of 18 years, upo sigig this declaratio I am agreeig to ratify ay ad all such studet loas. I uderstad that ratifi catio of ay agreemet for a loa made with me before I reached the age of 18 years is a statutory precoditio of my eligibility for studet support after attaiig the age of 18 years. d I udertake to repay the leder ay loa(s) made to me, together with all ad ay iterest, pealties ad charges which apply. e I agree that ay loa(s) made to me as a cosequece of the acceptace of my applicatio by the leder is a/are cotract(s) betwee me ad the leder which bids me from the paymet to me of the fi rst loa advace ad that the repaymet of ay such loa(s), together with all ad ay iterest, pealties ad charges which apply, will be due by me to the leder as a debt. f I agree that I shall be obliged to make repaymet of my loa(s), together with all ad ay iterest, pealties ad charges which apply, to such address as shall be otifi ed to me i writig ad that ay services i respect of my loa(s) may be provided at such address or other address(es) as the leder may from time to time determie ad that the service of providig the loa is provided at the leder s pricipal address. g I agree that ay actio for repaymet ad/or i respect of or i coectio with my loa(s) ad/ or all ad ay iterest, pealties ad charges which apply, will be brought before the ordiary civil courts ad shall be govered by the geeral rules of civil procedure. h I agree that my request for a loa, the loa ad the cotract betwee me ad the leder shall be govered by the law of the place of my home address as stated i this applicatio form (or, if my address is outside the Uited Kigdom, Eglish law). i I irrevocably agree that the courts of the part of the Uited Kigdom i which my home address stated i this applicatio form is situated (or the Eglish, Scottish ad rther Irelad courts where my address is outside the Uited Kigdom) shall have o-exclusive jurisdictio to hear ay actio or proceedigs arisig out of or i coectio with the loa ad the cotract betwee me ad the leder ad I irrevocably submit to the jurisdictio of those courts ad waive ay objectio to the jurisdictio of those courts, provided that this shall ot limit the leder s rights to take proceedigs agaist me i ay other court of competet jurisdictio. 18

19 j I agree that from the date I submit this form util the date whe my loa(s), together with all ad ay iterest, pealties ad charges which apply, is fully repaid I will otify the leder of ay chages i the persoal details (icludig Natioal Isurace umber) ad cotact details I have provided as required i accordace with the regulatios referred to i paragraph b. k I the evet that I leave the Uited Kigdom to reside outside the Uited Kigdom or that for ay other reaso I am outside the UK tax system, I udertake to iform the leder i accordace with the regulatios referred to i paragraph b ad I udertake to provide the leder with my ew ad ay subsequet cotact details util my loa, together with all ad ay iterest, pealties ad charges which apply, is fully repaid. l I agree to take all future actio requested by the leder ad provide the leder with all iformatio required to esure repaymet, i accordace with the regulatios referred to i paragraph b. m If I breach ay of the terms uder which ay loa(s) will be made I agree that I will be obliged to pay ay charges ad pealties which may apply uder the Teachig ad Higher Educatio Act 1998 ad the regulatios made uder that Act, as ameded from time to time or successor legislatio ad/or regulatios. I uderstad that the Studet Loas Compay (SLC) will check my Natioal Isurace umber ad persoal details with the Departmet for Work ad Pesios (DWP). If I do ot kow my Natioal Isurace umber, or if the umber I provide caot be autheticated, DWP will trace ad give my umber to the leder. o If I have broke the terms of this cotract I agree that the leder may share iformatio held about me ad my accout with ay perso, icludig the govermet or a govermet agecy of aother coutry, who may assist i establishig my whereabouts ad/or i takig actio to recover outstadig loa amouts. Disabled Studets Allowaces (DSAs) I uderstad that ay equipmet I receive through DSAs must be used for my course of study ad SLC is ot resposible for payig ay repair costs. I uderstad Studet Fiace Eglad will pay the suppliers of ay equipmet ad support directly. Childcare Grat I uderstad that if I do ot take up my childcare, or if I chage to a childcare provider who is ot registered or approved, I will have to pay back ay overpaymet. I uderstad that if I do ot provide the evidece of childcare costs withi the timescales set, I might lose my etitlemet. Also if my paymets to my childcare provider are differet from the estimates I provide, I uderstad that further paymet will icrease or decrease accordigly, or if o further Childcare Grat paymets are due to be paid to me, I may be liable to repay ay differece. I cofirm that either I or my husbad, wife, civil parter or cohabitig parter have chose to receive support for childcare from the childcare elemet of: (i) the Workig Tax Credit; (ii), the Uiversal Credit; (iii) Tax-Free Childcare; ad/ or (iv) the NHS Childcare Allowace; ad I agree to tell SLC immediately if I or my husbad, wife, civil parter or cohabitig parter does receive this support. I uderstad that SLC reserves the right to share my persoal data with HMRC to check whether I am i receipt of childcare support from HMRC. Customer Referece Number Your full ame (i BLOCK CAPITALS) Your sigature r (i ik) Today s date DAY MONTH YEAR Bursary ad scholarship data sharig coset will ot affect your etitlemet to ay other fiacial support available. You may be eligible for a bursary or scholarship. I order for your uiversity or college to determie ad pay ay bursary or scholarship to which you may be etitled, we will share some of your persoal, fiacial ad course details as well as iformatio about your eligibility for studet fiace with them. Most uiversities ad colleges will ot pay bursaries ad scholarships if you do ot give coset.! If you do ot wish your details to be shared for this purpose, please tick this box. The relevat perso(s) you idicated i sectio 9 must complete sectio 10, as well as the declaratio(s) o page 28. Please pass this form to them ow. If you are a sigle idepedet studet please ow go to page 32 to fialise your applicatio. 19

20 Sectio 10 Fiacial details for tax year for parets ad parters Who eeds to complete this sectio? Sectio 9 of this form tells you who eeds to complete this sectio. What details do I eed to provide i this sectio? You eed to tell us some persoal details ad what your fiacial icome was for tax year You must tell us your icome details as we caot accept amouts from ay other tax year. We eed your icome amouts so we ca work out what the studet(s) you are supportig is etitled to. About this sectio Sectio 10 is split ito five parts: Part A - Tell us your ame ad address ad some other persoal iformatio Parts B - Tell us your Natioal Isurace umber Parts C ad D - Aswer every questio Part E - Aswer every questio ad tell us about ay icome deductios for tax year where appropriate How to complete this sectio If you are a sigle paret of the studet Eter your iformatio as Perso 1, leave Perso 2 blak. If there are two parets i the studet s household Complete this sectio with iformatio for both Perso 1 ad Perso 2. If you are a idepedet studet with a parter Your parter eeds to eter their iformatio as Perso 1, leave Perso 2 If you re self assessed read page 13 of the otes for more iformatio. If you re ot self assessed you ca use your P60 to complete this sectio. What happes if my household icome has dropped sice tax year ? If your household icome has dropped by 15% or more sice tax year you ca apply for a Curret Year Icome Assessmet. This meas we would use your expected icome for tax year istead of your actual icome from tax year whe calculatig the studet s etitlemet. However, there must be at least a 15% drop i the overall household icome (ot just your ow icome) betwee these two tax years for us to do this ad we will ask for evidece of your icome at the ed of that tax year. 20

21 Sectio 10 Fiacial details for tax year for parets ad parters Part A Your persoal details Perso 1 Your Customer Referece Number (If you have oe) Perso 2 Your Customer Referece Number (If you have oe) Relatioship to the studet Relatioship to the studet Title Title Foreame(s) Foreame(s) Surame Surame Date of birth Place of birth (ame of tow or village exactly as it appears o your birth certificate or passport) / / / / Date of birth Place of birth (ame of tow or village exactly as it appears o your birth certificate or passport) Home address Home address Postcode Postcode address Home telephoe umber Postcode Home telephoe umber address address You do ot have to disclose your fiacial iformatio to the studet. If you would like to provide your fiacial iformatio separately, you ca dowload a form at or alteratively, you ca have the form set to you by tickig the box below: Perso 1 Sed me a separate form Tick Perso 2 Sed me a separate form Tick 21

22 Sectio 10 Fiacial details for tax year for parets ad parters Part B - Data sharig ad you We will share ad check the details you give us with HM Reveue & Customs, allowig us to gai the most accurate iformatio possible. This ca oly be doe if you have a valid Natioal Isurace (NI) umber. Perso 1 Perso 2 I have a NI umber Tick I have a NI umber Tick Please provide your NI umber below: Please provide your NI umber below: You are ow ready to provide your fiacial iformatio. go to Part C You are ow ready to provide your fiacial iformatio. go to Part C I do ot have a NI umber Tick I do ot have a NI umber Tick If you do ot have a NI umber because you receive o-uk taxable icome, please provide the equivalet fiacial iformatio i pouds sterlig. If you do ot have a NI umber because you receive o-uk taxable icome, please provide the equivalet fiacial iformatio i pouds sterlig. You are ow ready to provide your fiacial iformatio. go to Part C You are ow ready to provide your fiacial iformatio. go to Part C 22

23 Sectio 10 Fiacial details for tax year for parets ad parters Part C - Your fiacial iformatio Istructios Please give gross fiacial details for the tax year from 6 April 2015 to 5 April Aswer or to every questio, if you aswer please provide the icome amout. If ay questios are left blak we will ot be able to process this applicatio.! You do ot eed to sed us ay evidece. However, you should keep all of your fiacial evidece as we may ask for it at a later date to verify the details you have provided. Q1 Did you receive ay icome from salary, wages, taxable state beefits or from occupatioal or private pesios? Perso 1 Perso 2 a Total icome from salary/wages b Total icome from taxable state beefits c Total icome from occupatioal pesio(s) d Total icome from private pesio(s) Q2 Did you receive ay icome from a state retiremet pesio? Perso 1 Perso 2 a b Total lump sum amout received Total o-lump sum amout received Q3 Did you receive ay icome from savigs ad ivestmets? Perso 1 Perso 2 a Total iterest from UK baks, buildig societies ad uit trusts b Total icome from UK life isurace gais, securities ad parterships c Total icome from UK ivestmets ad divideds d Total icome from foreig ivestmet ad divideds 23

24 Sectio 10 Fiacial details for tax year for parets ad parters Q4 Did you receive ay taxable beefits i kid? Perso 1 Perso 2 Total icome received from taxable beefits i kid Q5 Did you receive ay other icome durig tax year that you have t yet told us about? Perso 1 go to Part D Perso 2 go to Part D go to Part E go to Part E Part D - Other icome Istructios Complete Part D i the same way you completed Part C givig gross fiacial details for the tax year from 6 April 2015 to 5 April Q1 Did you receive ay icome from self-employmet? Perso 1 Perso 2 a Total adjusted profit from busiesses b Total adjusted profit from parterships Q2 Did you receive ay icome as a Miister of religio? Total taxable icome mius expeses that are ot icluded o your P60 or P11D 24

25 Sectio 10 Fiacial details for tax year for parets ad parters Q3 Did you receive ay other taxable icome or lump sums? Perso 1 Perso 2 Total icome received Q4 Did you receive ay icome from property lettigs? Total icome received Q5 Did you receive ay icome from UK trusts? Total icome received Q6 Did you receive ay foreig icome? Total icome received Q7 Did you receive ay icome from a overseas pesio? Total icome received Q8 Did you receive ay other overseas icome ad gais? Total icome received 25

26 Sectio 10 Fiacial details for tax year for parets ad parters Part E Icome deductios Istructios Complete Part E i the same way you completed Part C givig gross fiacial details for the tax year from 6 April 2015 to 5 April Perso 1 Perso 2 Q1 Did you pay ay private pesio cotributios? Total amout you paid Q2 Did you pay ay Additioal Volutary Cotributios (AVCs)? Perso 1 Perso 2 Total amout you paid Q3 Did you have ay allowable expeses o which you claimed tax relief? Perso 1 Perso 2 Total amout o which you claimed tax relief 26

27 Sectio 10 Fiacial details for tax year for parets ad parters Part F Your depedats Idetify ay childre who will be wholly or maily fiacially depedet o you. Q1 Child depedats ot i further or higher educatio i academic year 2017/18 Iclude ueared icome for all depedats. Oly iclude eared icome details for persos aged 16 ad over. Do ot cout casual earigs of persos uder 16. Full ame Date of birth Icome for the year (DD MM YYYY) Q2 Child depedats i further or higher educatio i academic year 2017/18 Do ot iclude the applicat whe completig this questio. If the studet is your parter, please iclude ay childre they amed i sectio 6 of this form if the childre have applied for studet fiace. Full ame Date of birth School, college or uiversity Course Are they receivig fiacial support? If so, from which authority or orgaisatio? (DD MM YYYY) 27

28 Declaratio for parets ad parters Before sigig, you should read the Data Protectio Statemet i the otes that accompay this form. This applicatio for fiacial support may be delayed uless you sig ad date this declaratio. I cofirm that to the best of my kowledge ad belief, the iformatio I have provided is true ad complete. If it is ot I uderstad the studet(s) I am supportig may ot recieve fiacial support, ay support they have had may be withdraw ad I could be prosecuted. I agree to supply ay further iformatio i relatio to the applicat s applicatio for fiacial support that the SLC may ask for ad agree to tell them immediately if my circumstaces chage i ay way that might affect this applicatio for fiacial support. Perso 1 Your full ame (i BLOCK CAPITALS) Perso 2 Your full ame (i BLOCK CAPITALS) Your sigature (i ik) r Your sigature (i ik) r Today s date DAY MONTH YEAR Today s date DAY MONTH YEAR Your decisio about bursary ad scholarship data sharig coset will ot affect the studet s etitlemet to ay other fiacial support available. I order for a uiversity or college to determie ad pay ay bursary or scholarship to which the studet(s) you are supportig may be etitled, we will share some of your persoal ad fiacial details with them. If you do ot wish your details to be shared for this purpose, please tick this box. Your decisio about bursary ad scholarship data sharig coset will ot affect the studet s etitlemet to ay other fiacial support available. I order for a uiversity or college to determie ad pay ay bursary or scholarship to which the studet(s) you are supportig may be etitled, we will share some of your persoal ad fiacial details with them. If you do ot wish your details to be shared for this purpose, please tick this box. Deadlie To make sure the studet receives their first paymet at the start of term, this form must be retured with all of the evidece we eed by 23 Jue We will do our best to process the applicatio as soo as possible, however if the deadlie date has passed, the first paymet may ot be ready for the start of term.! w pass this form back to the studet. 28

29 Additioal otes If you are providig extra iformatio please clearly mark what sectio ad questio the iformatio is about. 29

30 Additioal otes If you are providig extra iformatio please clearly mark what sectio ad questio the iformatio is about. 30

31 Additioal otes If you are providig extra iformatio please clearly mark what sectio ad questio the iformatio is about. 31

32 Checklist Before returig this form, please make sure you have doe the followig: Fully aswered all questios that apply to you Eclosed all the documets we ve asked for as evidece where you ve see this ico ext to a questio e Siged ad dated the studet declaratio o pages 18 ad 19 Checked your paret(s) or parter have siged their declaratio o page 28 (if applicable) Tick Tick Tick Tick What happes ext It ca take at least 6 weeks to assess your applicatio ad all the relevat evidece. We ll the sed you a letter showig the amout of fiacial support you ll receive. Please remember to pay the correct postage. You must retur your completed form to the address show below: Studet Fiace Eglad PO Box 210 Darligto DL1 9HJ 32