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APPLICATION FOR A GRANT OF LEAVE AND<br />

BIOMETRIC IMMIGRATION DOCUMENT<br />

UNDER <strong>TIER</strong> 4 (GENERAL) STUDENT -<br />

MAIN APPLICANT<br />

This form is for students who are already<br />

in the United Kingdom to apply to study<br />

under Tier 4 (General).<br />

In accordance with paragraph 34 of the Immigration Rules, this form is<br />

specified for applications made on or after 01 October 2012.<br />

Please check on the website at www.ukba.homeoffice.gov.uk that this is the<br />

current form for use on the date that you apply.<br />

You are advised to read the help text and separate guidance notes that<br />

are available to help with this form. Please read them before making your<br />

application. If you do not already have them, you can download them from our<br />

website.<br />

Applications made on this form may be made by post, courier or in person<br />

at one of our Public Enquiry Offices. To apply in person you must make an<br />

appointment.<br />

Details of our Public Enquiry Offices can be found on our website:<br />

www.ukba.homeoffice.gov.uk/contact/applyinginperson/<br />

Postal address:<br />

UK Border Agency<br />

Tier 4<br />

PO Box 500<br />

Durham<br />

DH99 1WJ<br />

Courier address:<br />

UK Border Agency<br />

Tier 4<br />

Millburngate House<br />

Millburngate<br />

Durham<br />

DH97 1PA<br />

Postal address<br />

(Student Batch):<br />

UK Border Agency<br />

PBS Dependants<br />

PO Box 505<br />

Durham<br />

DH99 1WD<br />

<strong>TIER</strong> 4<br />

(G)<br />

version 10/12<br />

This form is<br />

specified for<br />

applications<br />

made on or after<br />

01 October 2012


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Intentionally Blank<br />

Tier 4 (G) Application Form (version 10/12) - page 2


A. Payment Details<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

There is a separate help text leaflet available with this form. Where a question in this form has information<br />

available in the help text leaflet it will be marked with (ht)<br />

Please complete this form in block capitals and black ink<br />

A1. Is your sponsor a Highly Trusted Sponsor?<br />

A2. Tick the applicable fee (ht):<br />

YeS nO<br />

The student is making a Tier 4 (General) student application by post - £394<br />

The student is making a Tier 4 (General) student application at a Public Enquiry Office<br />

A3. Address for correspondence in the UK (ht)<br />

House number/name<br />

Address line 1<br />

- £716<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Postcode<br />

A4. If you are using a solicitor or other authorised immigration advisor to help you with this<br />

application form, you should enter the name of that person here (ht)<br />

A5. Your full Name (ht):<br />

A6. Your date of birth: (ht)<br />

D D M M Y Y Y Y<br />

A7. Please select the method of payment from the list below (ht)<br />

United Kingdom postal order (payable to<br />

‘Home Office’) - go to question A20<br />

Cheque/bankers draft (payable to<br />

‘Home Office’) - go to question A8<br />

Visa/Mastercard/Amex - go to question A11 Delta / Maestro - go to question A11<br />

A8. Account number A9. Sort code A10. Cheque number - go to question A20<br />

A11. Name on card (ht)<br />

A12. Card number (the long number across the centre of the card):<br />

A13. Valid from: A14. Valid to: A15. Issue number A16. CVV security number<br />

/ / (where<br />

available)<br />

A17. Amount - please tick appropriate box (ht) - £394 - £716<br />

A18. Cardholder’s signature: A19. Date<br />

D D M M Y Y Y Y<br />

Tier 4 (G) Application Form (version 10/12) - page 3<br />

(3 digit number or<br />

4 digit number for<br />

Amex)<br />

A20. Please provide details of any dependant applications that are being submitted with this form.<br />

Please photocopy this page if more space is needed.<br />

IMPORTANT – each dependant must also complete their own Tier 4 Dependant form (ht).


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

If you are producing a double-sided copy of this<br />

application form, please include this page and make<br />

sure it falls on the reverse of the payment details<br />

page in the two-sided copy.<br />

For administrative reasons, it is important that<br />

the rest of the form begins with Section B -<br />

Your Personal Details facing upwards<br />

Tier 4 (G) Application Form (version 10/12) - page 4


Dependant 1 - First name<br />

Last name<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 2 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 3 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 4 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 5 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 6 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 7 - First name<br />

Tier 4 (G) Application Form (version 10/12) - page 5


Last name<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 8 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 9 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Dependant 10 - First name<br />

Last name<br />

Date of birth D D M M Y Y Y Y<br />

Tier 4 (G) Application Form (version 10/12) - page 6


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

You must complete all of the sections and questions in this form that apply to you. The form will not<br />

be valid if it is not fully completed and your application will be rejected and returned to you.<br />

There is a separate help text leaflet available with this form. Where a question in this form has<br />

information available in the help text leaflet it will be marked with (ht)<br />

B. Your Personal Details<br />

In this section you will be asked to provide information about your personal situation, for example<br />

your name, date of birth and nationality as well as information about any other names you have<br />

used, or other nationalities you have held.<br />

Photographs<br />

For your application to be valid, you must provide two recent identical passport-size photographs<br />

of yourself with your full name written on the back of each one. The photographs must be in the<br />

format specified in the separate photograph guidance, including the mandatory requirements,<br />

which can be found on our website at http://www.ukba.homeoffice.gov.uk. Please ensure that<br />

you place the photographs in a small sealed envelope attached to this part of the form - and<br />

without allowing any staples, clips, pins or anything else to mark or damage the photographs. The<br />

photographs will be checked against the images taken when your biometric features are recorded.<br />

I have enclosed the required photographs as outlined in the box above.<br />

I am a low risk student and I am applying under the differentiation arrangements<br />

(please see paragraph 10 and 11 of the Tier 4 guidance for more information about<br />

this arrangement)<br />

B1. What is your name, as given in your passport or travel document? (ht)<br />

Title - please select from the following list:<br />

Mr Mrs Miss Ms Dr<br />

First name(s) or given name(s):<br />

Last name(s) or family name(s):<br />

B2. What is your gender? (ht):<br />

Male Female<br />

B3. What is your date of birth?<br />

D D M M Y Y Y Y<br />

B4. What is your relationship status? (ht):<br />

Married Dissolved Civil Partnership<br />

Civil Partner Surviving Civil Partner<br />

Single Unmarried Partner<br />

Divorced Separated<br />

Widow/Widower Separation Order<br />

Tier 4 (G) Application Form (version 10/12) - page 7


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

B5. What village, town or city were you born in?<br />

B6. What is your country of birth?<br />

B7. What is your current nationality? (ht)<br />

B8. If you currently hold or have ever held any other Nationality, please provide details in<br />

the box below: (ht)<br />

What Nationality did you or do you hold? Date held from: Date held to:<br />

Please tick to confirm that you are submitting the required evidence relating to this other<br />

Nationality with this application.<br />

B9. If you are currently known by or have ever been known by any other name, please<br />

provided details in the box below: (ht)<br />

What name are you or were you<br />

known by?<br />

Date of Birth when<br />

using this name:<br />

Dates that you used<br />

this name from:<br />

Tier 4 (G) Application Form (version 10/12) - page 8<br />

Dates that you used<br />

this name to:<br />

Please tick to confirm that you are submitting the required evidence relating to this other<br />

name with this application.<br />

Now go to Section C


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section C - Your Contact details in the UK<br />

In this section you will be asked to provide information about how we can contact you, including<br />

your correspondence address in the UK, contact telephone numbers, email address, etc.<br />

C1. What is your current address? (ht)<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Postcode:<br />

C2. What date did you move to this address?:<br />

D D M M Y Y Y Y<br />

C3. Is your correspondence address the same as your current address (as given above)?<br />

(ht)<br />

Yes - go to C5 No - go to C4<br />

C4. What is your correspondence address? (ht)<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Country<br />

Postcode:<br />

C5. Please provide the following contact details:<br />

Work telephone number<br />

Home telephone number<br />

Mobile telephone number<br />

Fax number<br />

Email address line 1<br />

Email address line 2<br />

C6. Please tick to indicate what your preferred contact telephone number is:<br />

Work Home Mobile<br />

now go to Section D<br />

Tier 4 (G) Application Form (version 10/12) - page 9


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section D - Details of your Representative<br />

In this section you will be asked to provide information about your representative such as their name,<br />

address and contact details. It also asks whether or not they are appropriately registered or regulated<br />

to provide immigration advice. If you have a representative, then they will also need to complete the<br />

representative’s declaration at section Q of this form.<br />

D1. Do you have a representative acting on your behalf on this application?<br />

Yes - go to D2 No - go to Section E<br />

D2. What is the name of your representative? (ht)<br />

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

D4. Is your representative based in the UK?<br />

Yes - go to D5 No - go to D6<br />

D5. What is their UK address?<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Postcode:<br />

Now go to D7<br />

D6. What is their overseas address?<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Country<br />

Postcode:<br />

D7. Please provide your representative’s contact details:<br />

Work telephone number<br />

Mobile telephone number<br />

E-mail address line 1<br />

E-mail address line 2<br />

Fax number<br />

Tier 4 (G) Application Form (version 10/12) - page 10


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

D8. Is your representative regulated by the Office of the Immigration Services<br />

Commissioner? (ht)<br />

Yes - go to D9 No - go to D10<br />

D9. What is their OISC registration number?<br />

Now go to D11<br />

D10. What is the reason that they are not OISC registered?<br />

They are authorised by designated professional body or regulator<br />

They are registered or authorised in an EEA State<br />

They are supervised<br />

They are exempt or employed or supervised by exempt person<br />

They are specified by an order<br />

I don’t know<br />

D11. Is your representative listed with one of the UK Border Agency’s Public Enquiry Office<br />

(PEO) services?<br />

Yes No<br />

Now go to Section E<br />

Tier 4 (G) Application Form (version 10/12) - page 11


Section e - Your reference numbers<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

In this section you will be asked to provide information about any UK Border Agency or Home Office<br />

reference numbers that you might have. These can be found on documents and correspondence<br />

that we have previously sent to you. You will also be asked to provide any current and previous<br />

National Insurance number.<br />

E1. Have you ever had a Home Office or UK Border Agency reference number assigned to<br />

you? (ht)<br />

Yes - go to E2 No - go to E3<br />

E2. What is/are your Home Office or UK Border Agency reference number? You may enter up<br />

to 3 reference numbers below:<br />

Reference number 1<br />

Reference number 2<br />

Reference number 3<br />

E3. Do you currently have a National Insurance number? (ht)<br />

Yes - go to E4 No - go to E5<br />

E4. What is your National Insurance number?<br />

E5. Have you previously had a National Insurance number? (ht)<br />

Yes - go to E6 No - go to Section F<br />

E6. What was your previous National Insurance number?<br />

Now go to section F<br />

Tier 4 (G) Application Form (version 10/12) - page 12


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section F - About your Passport or Travel Document<br />

In this section you will be asked to provide information about your current and previous passports or<br />

travel documents. If you have lost or had any passports or travel documents stolen then you should<br />

have reported this to the Police and you will be asked to provide information about this.<br />

F1; Please provide the following details:<br />

Current Passport or Travel Document<br />

What<br />

is your<br />

current<br />

passport<br />

or travel<br />

document<br />

number?<br />

What<br />

is the<br />

nationality<br />

on the<br />

passport?<br />

What is<br />

the issue<br />

date?<br />

What is<br />

the expiry<br />

date?<br />

F2; Please explain how you lost your passport: (ht)<br />

F3; Please provide the following details:<br />

What was the Police<br />

report number?<br />

What was the crime<br />

reference number?<br />

What is<br />

the place<br />

of issue?<br />

Is the<br />

passport<br />

or travel<br />

document<br />

enclosed?<br />

go to F4<br />

Tier 4 (G) Application Form (version 10/12) - page 13<br />

If the passport or<br />

travel document is<br />

not enclosed, please<br />

indicate why:<br />

Yes - Lost - go to F2<br />

No -<br />

go to next<br />

column<br />

Which police station<br />

was this reported at?<br />

Stolen - go to<br />

F3<br />

Expired and<br />

returned<br />

to national<br />

authorities - go<br />

to F4<br />

Already with<br />

UKBA - go to<br />

F4<br />

What date was this<br />

reported to the Police<br />

on?


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

F4: Have you had a previous Passport or Travel Document? (ht)<br />

Yes go to F5 No go to Section G<br />

F5; Please provide the following details:<br />

Previous Passport or Travel Document<br />

What<br />

is the<br />

passport<br />

or travel<br />

document<br />

number?<br />

What<br />

is the<br />

nationality<br />

on the<br />

passport?<br />

What is<br />

the issue<br />

date?<br />

What is<br />

the expiry<br />

date?<br />

F6; Please explain how you lost your passport: (ht)<br />

F7; Please provide the following details:<br />

What was the Police<br />

report number?<br />

Now go section G<br />

What was the crime<br />

reference number?<br />

What is<br />

the place<br />

of issue?<br />

Is the<br />

passport<br />

or travel<br />

document<br />

enclosed?<br />

Tier 4 (G) Application Form (version 10/12) - page 14<br />

If the passport or<br />

travel document is<br />

not enclosed, please<br />

indicate why:<br />

Yes - Lost - go to F6<br />

go to<br />

Section G<br />

Stolen - go to<br />

F7<br />

No - Expired and<br />

go to next<br />

column<br />

Which police station<br />

was this reported at?<br />

returned<br />

to national<br />

authorities go<br />

to Section G<br />

Already with<br />

UKBA<br />

What date was this<br />

reported to the Police<br />

on?


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section G - About your Biometric Residence Permit<br />

In this section you will asked to provide information about any Biometric Residence Permit(s) that<br />

have previously been issued to you.<br />

G1; Do you have a BRP?<br />

Yes go to G2 No go to Section H<br />

G2; Please provide the following details: (ht)<br />

Biometric Residence Permit<br />

What is your<br />

BRP number?<br />

What is your<br />

nationality on<br />

the BRP?<br />

What is<br />

the issue<br />

date?<br />

G3; Please explain how you lost your BRP: (ht)<br />

G4; Please provide the following details:<br />

What was the Police<br />

report number?<br />

What was the crime<br />

reference number?<br />

What<br />

is the<br />

expiry<br />

date?<br />

Is your BRP<br />

enclosed<br />

with this<br />

application?<br />

Yes - go to<br />

Section H<br />

No - go<br />

to next<br />

column<br />

Which police station<br />

was this reported at?<br />

G5; Have you reported this to the UKBA card management service?<br />

Yes go to G6 No go to Section H<br />

G6; What date did you report this?<br />

D D M M Y Y Y Y<br />

Now go to Section H<br />

Tier 4 (G) Application Form (version 10/12) - page 15<br />

If your BRP is not<br />

enclosed please<br />

indicate why:<br />

Lost - go to G2<br />

Stolen - to go<br />

G3<br />

Expired and<br />

returned<br />

to national<br />

authorities - go<br />

to Section H<br />

Already with<br />

UKBA - go to<br />

Section H<br />

What date was this<br />

reported to the Police<br />

on?


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section H - About your Previous Addresses<br />

In this section you will be asked to provide information about any previous addresses in the UK,<br />

including Northern Ireland, where you have lived in the last five years.<br />

H1; Have you previously lived in Northern Ireland?<br />

Yes go to H2 No go to H5<br />

H2; What was your address?<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Country<br />

Postcode<br />

H3; What date did you move to this address?<br />

D D M M Y Y Y Y<br />

H4; What date did you move from this address?<br />

D D M M Y Y Y Y<br />

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

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

Yes go to H6 No go to Section I<br />

H6; What was your address?<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Postcode<br />

Tier 4 (G) Application Form (version 10/12) - page 16


H7; What date did you move to this address?<br />

D D M M Y Y Y Y<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

H8; What date did you move from this address?<br />

D D M M Y Y Y Y<br />

If you have lived at more than one address in the last five years, please continue on a seperate<br />

sheet.<br />

Now go to Section I<br />

Tier 4 (G) Application Form (version 10/12) - page 17


Section I - About your Personal History<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

In this section you will be asked to provide information about any criminal convictions you have, any<br />

civil judgements or immigration civil penalties against you and details of any involvement you may<br />

have had in war crimes, genocide, crimes against humanity or terrorism.<br />

I1; Have you ever been convicted of a criminal offence either in the UK or in another country?<br />

(ht)<br />

Yes go to I2 No go to I7<br />

I2; What was the offence?<br />

I3; What was the sentence given?<br />

I4; If you were sentenced to a period of imprisonment, what was the length of the prison<br />

sentence in months?<br />

I5; What date were you sentenced on?<br />

D D M M Y Y Y Y<br />

I6; Which country were you convicted in?<br />

I7; Have you ever had any civil judgements issued against you or received a civil penalty<br />

under the UK Immigration Acts? (ht)<br />

Yes go to I8 No go to I11<br />

I8; Please provide details of the judgement or civil penalty:<br />

Tier 4 (G) Application Form (version 10/12) - page 18


I9; Date of the judgement or civil penalty<br />

D D M M Y Y Y Y<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

I10; Which country was the judgement issued in?<br />

I11; Have you ever been charged or indicted in any country with a criminal offence for which<br />

you have not yet been tried in court? (ht)<br />

Yes go to I12 No go to I13<br />

I12; Please provide details of the offence:<br />

I13; In either peace or war time, have you ever been involved in, or suspected of involvement<br />

in, war crimes, crimes against humanity or genocide? (ht)<br />

Yes go to I14 No go to I15<br />

I14; Please provide details:<br />

I15; Have you ever been involved in, supported or encouraged terrorist activities in any<br />

country? (ht)<br />

Yes go to I16 No go to I17<br />

I16; Please provide details:<br />

Tier 4 (G) Application Form (version 10/12) - page 19


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

I17; Have you ever been a member of, or given support to an organisation which has been<br />

concerned with or involved in terrorism? (ht)<br />

Yes go to I18 No go to I19<br />

I18; Please provide details:<br />

I19; Have you, by any means or medium, expressed views that justify or glorify terrorist<br />

violence or that may encourage othes to commit terrorists acts or activities or other serious<br />

criminal activites? (ht)<br />

Yes go to I20 No to to Section J<br />

I20; Please provide details:<br />

Now go to Section J<br />

Tier 4 (G) Application Form (version 10/12) - page 20


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section J - About your Immigration History<br />

In this section you will be asked to provide information about your current and previous immigration<br />

status in the UK, including previous applications that you have made.<br />

J1; What is your current immigration status?<br />

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

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

I am exempt from immigration control - Go to J4<br />

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

None of the above - Go to J4<br />

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

Yes - Go to J3<br />

No - Go to J4<br />

J3; I am submitting evidence of exceptional circumstances which prevented me from<br />

submitting my application within 28 days of overstaying.<br />

Tick to confirm<br />

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

Yes No<br />

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

Yes go to J6 No go to J10<br />

J6; In which country did you obtain your visa or entry clearance?<br />

J7; What is the reference number of the visa or entry clearance?<br />

J8; What date was your visa or entry clearance valid from?<br />

D D M M Y Y Y Y<br />

J9; What date was your visa or entry clearance valid to?<br />

D D M M Y Y Y Y<br />

Tier 4 (G) Application Form (version 10/12) - page 21


J10. How did you enter the UK?<br />

By air<br />

By sea<br />

By the Channel Tunnel<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Travelling overland via the Republic of Ireland<br />

J11. At which Port did you enter the UK?<br />

J12. What was your ticket booking reference number?<br />

J13. What was the name of your transport operator?<br />

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

Yes - go to J15 No - go to J16<br />

J15. Please provide details:<br />

J16. Have you ever knowingly used deception when seeking leave to enter or remain,<br />

entered the United Kingdom illegally or worked in the united Kingdom without immigration<br />

permission to do so (contrary to your conditions of stay)? (ht)<br />

Yes - go to J17 No - go to J18<br />

J17. Please provide details:<br />

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

Yes - go to J19 No - go to J20<br />

J19. Please give details:<br />

Tier 4 (G) Application Form (version 10/12) - page 22


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

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

Yes - go to J21 No - go to J22<br />

J21. Please provide details:<br />

J22. Do you currently have any other applications with the UK Border Agency on which you<br />

are awaiting a decision? (ht)<br />

Yes - go to J23 No - go to J24<br />

J23. Please provide details :<br />

J24. Do you currently have an immigration appeal before the Tribunal which has not yet been<br />

finally determined? (ht)<br />

Yes - go to J25 No - go to Section K<br />

J25. Please provide details :<br />

Now go to Section K.<br />

Tier 4 (G) Application Form (version 10/12) - page 23


Section K - Public Funds<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

In this section you will be asked to provide information about whether or not you have claimed public<br />

funds (benefits and housing) in the UK and details about any claims you have made.<br />

K1; Have you ever claimed any public funds? (ht)<br />

Yes go to K2 No go to Section L<br />

K2; Have you claimed Attendance Allowance?<br />

Yes No<br />

K3; Have you claimed Carer’s Allowance?<br />

Yes No<br />

K4; Have you claimed Child Benefit?<br />

Yes No<br />

K5; Have you claimed Tax Credit?<br />

Yes No<br />

K6; Have you claimed Council Tax Benefit?<br />

Yes No<br />

K7; Have you claimed Disability Living Allowance?<br />

Yes No<br />

K8; Have you claimed Housing or Homelessness Assistance?<br />

Yes go to K9 No go to K10<br />

K9. What is the name of the local housing authority or housing association that provided<br />

this?<br />

Tier 4 (G) Application Form (version 10/12) - page 24


K10. Have you claimed Housing Benefit?<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Yes No<br />

K11. Have you claimed Income-based Jobseekers Allowance?<br />

Yes No<br />

K12. Have you claimed Income Support?<br />

Yes No<br />

K13. Have you claimed Severe Disablement Allowance?<br />

Yes No<br />

K14. Have you claimed Social Fund Payments?<br />

Yes No<br />

K15. Have you claimed State Pension Credit?<br />

Yes No<br />

K16. Have you claimed Working Tax Credit?<br />

Yes No<br />

K17. Have you claimed Income-related Employment and Support Allowance?<br />

Yes No<br />

K18. Is your housing provided by a local authority or housing authority as part of an<br />

agreement between your employer and a housing authority? (ht)<br />

Yes No<br />

Now go to Section L<br />

Tier 4 (G) Application Form (version 10/12) - page 25


Section l - About your course<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

In this section you will be asked to provide information about the course you are studying (if you<br />

are applying to continue on your current course) or intending to study. In some cases you will need<br />

approval from someone else for your studies and we will also ask for information about that.<br />

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

L2. What is the name of your Tier 4 sponsor?<br />

L3. Please provide your Tier 4 sponsor’s address: (ht)<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Country<br />

Postcode:<br />

L4. Do you have a CAS? (ht)<br />

Yes - go to L5 no - go to L6<br />

L5. What is your CAS number?<br />

L6. What type of qualification are you studying for? (ht)<br />

L7. What is the title of your course?<br />

L8. What date does your course start? (ht)<br />

D D M M Y Y Y Y<br />

Tier 4 (G) Application Form (version 10/12) - page 26


L9. What date does your course end? (ht)<br />

D D M M Y Y Y Y<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

L10. Is the address of your primary site of study the same as your Tier 4 sponsor’s address<br />

(as given above)? (ht)<br />

Yes - go to L12 no - go to L11<br />

L11. Please provide the address of your main site of study:<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Country<br />

Postcode:<br />

L12. What is the study level of your course? (ht)<br />

Below NQF Level 6 - go to L13<br />

At or above NQF Level 6 - go to L14<br />

L13. How can you demonstrate your English Language ability? (ht)<br />

I am a national of a listed country.<br />

I am providing a degree-level qualification from a listed country.<br />

I have previously studied in the UK as a Tier 4 (Child) Student.<br />

I am providing an English Language test certificate at level B1 of the CEFR which is<br />

from an approved and registered provider.<br />

Now go to L15<br />

L14. How can you demonstrate your English Language ability? (ht)<br />

I am a national of a listed country.<br />

I am providing a degree-level qualification from a listed country.<br />

I have previously studied in the UK as a Tier 4 (Child) Student.<br />

I am providing an English Language test certificate at level B2 of the CEFR which is<br />

from an approved and registered provider.<br />

I am studying at a Sponsor who is an HEI or Recognised Body and who have tested<br />

my ability and has confirmed on my CAS that I can speak English to the required<br />

standard.<br />

I am studying at a Sponsor who is an HEI or Recognised Body and who has confirmed<br />

on my CAS that I am a gifted student.<br />

L15. Can you speak English to the required standard?<br />

Yes No<br />

Now go to Section M<br />

Tier 4 (G) Application Form (version 10/12) - page 27


Section M - About your maintenance<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

In this section you will be asked to provide information about maintenance, which is the money you<br />

will need for your course fees / boarding fees and living costs in the UK.<br />

It is essential that you ensure that the information you provide in this section is accurate, and<br />

that where appropriate, that it is the same as that given on your CAS. We use this information to<br />

advise you of the amount of money you will need for maintenance. If you do not provide accurate<br />

information, the figure you are given will not reflect the amount of money you need, and may result<br />

in you being advised that you will need less money than is actually required.<br />

Where there is an inconsistency between the information you provide and that given on the CAS by<br />

your Tier 4 sponsor, we will assess the money you require using the information we hold, including<br />

the CAS.<br />

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

Course Fees £ .<br />

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

Amount paid £ .<br />

M3. If you have paid something towards your course fees, what are you submitting as<br />

evidence of this? (ht)<br />

Receipts for payments<br />

It is stated on my CAS<br />

I am a low risk National<br />

M4. Do you have an established presence in the UK? (ht)<br />

Yes No<br />

M5. Where are you intending to study? (ht)<br />

Inside the Inner London area<br />

Outside the Inner London area<br />

M6. If you have paid anything to your sponsor for your accommodation, please provide the<br />

amount below: (ht)<br />

Accommodation £ .<br />

M7. If you have paid something to your sponsor towards your accommodation, what are you<br />

submitting as evidence of this? (ht)<br />

Receipts for payments<br />

It is stated on my CAS<br />

I am a low risk National<br />

M8. Are you receiving money from an Official Financial Sponsor? (ht)<br />

Yes go to M9 No go to M11<br />

Tier 4 (G) Application Form (version 10/12) - page 28


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

M9. If they are not covering the full amounts, please state how much your Official Financial<br />

Sponsor is paying towards:<br />

Maintenance £ .<br />

Course fees £ .<br />

M10. Please tick one of the following:<br />

I am enclosing a letter from my Official Financial Sponsor with this application<br />

My Official Financial Sponsorship is shown on my CAS.<br />

I am a low risk National<br />

M11. Will you receive any other financial sponsorship, such as a scholarship or bursary,<br />

from your Tier 4 educational sponsor?<br />

Yes go to M12 No go to M14<br />

M12. If they are not covering the full amounts, please state how much your Tier 4<br />

educational sponsor is paying towards:<br />

Maintenance £ .<br />

Course fees £ .<br />

M13. Your Tier 4 educational sponsor must show this on your CAS record:<br />

My Tier 4 sponsor has agreed to show this on my CAS record.<br />

M14. Please provide a summary of how much money you are still required to show for your<br />

outstanding fees and maintenance:<br />

Maintenance £ .<br />

Course fees £ .<br />

Total £ .<br />

M15. Are all of the funds you are using to demonstrate your ability to maintain yourself and<br />

any dependants in your own name or in the name of your parent(s) or legal guardian(s)?<br />

The funds are in my own name - go to M18<br />

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

M16. Please tick to confirm the following:<br />

I am providing a letter from my parent(s) or legal guardian(s)<br />

I am a low risk national and am not required to provide this evidence.<br />

M17. I am also providing one of the following:<br />

My full Birth Certificate naming both me and my parents.<br />

A Certificate of Adoption naming me and my adoptive parent(s).<br />

A formal Court document naming me and my legal guardian(s).<br />

I am a low risk national and am not required to provide this evidence.<br />

Tier 4 (G) Application Form (version 10/12) - page 29


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

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

Personal bank or building society statements.<br />

A building Society pass-book.<br />

A letter from a bank or building society confirming funds<br />

A letter from a regulated financial institution confirming the agreement of a loan.<br />

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

I am a low risk national and am not required to provide this evidence.<br />

Now go to Section N<br />

Tier 4 (G) Application Form (version 10/12) - page 30


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section n - Attributes and Financial Sponsorship<br />

In this section you will be asked to provide information about the course you are studying or<br />

intending to study. In some cases you will need approval from someone else for your studies and<br />

we will also ask for information about that.<br />

N1. What is the course level you are applying for?<br />

Below NQF/QCF level 6 - go to N6<br />

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

I am a Postgraduate Doctor or Dentist undertaking training - go to N3<br />

N2. If you need an ATAS certificate for your course, please enter the reference number<br />

below:<br />

Please also tick to confirm that you are enclosing your ATAS certificate with your<br />

application:<br />

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

Yes No<br />

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

Yes go to N5 No go to N6<br />

N5. When were you last granted this leave?<br />

D D M M Y Y Y Y<br />

N6. Are you currently being sponsored by or have you ever been sponsored by a<br />

Government or an International Scholarship Agency? (ht)<br />

Yes go to N7 No go to N9<br />

N7. Are there any restriction imposed on the length of stay in the United Kingdom as a result<br />

of this sponsorship?<br />

Yes go to N8 No go to N9<br />

N8. Please provide details of the restrictions:<br />

Please tick to confirm that you are enclosing written confirmation from your<br />

sponsor stating that they consent to your application.<br />

Tier 4 (G) Application Form (version 10/12) - page 31


N9. I am:<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Studying English as a Foreign Language course only - go to N10<br />

Studying any other type of course - go to N11<br />

A Student Union Sabbatical Officer - we will use the information provided on<br />

your CAS as evidence.<br />

Undertaking a Foundation course as a Post-graduate Doctor or Dentist - go to<br />

N12<br />

N10. If you have been assessed by means of an academic or professional reference, you<br />

must send us each original reference used by your sponsor as the basis for their offer to<br />

you. Please tick one of the following boxes:<br />

I am enclosing the original reference(s) with my application.<br />

I am enclosing copies of my reference(s) along with a letter from my sponsor<br />

confirming the content of the reference copies.<br />

n/a<br />

Now go to Section O<br />

I am a low risk national and am not required to include this document with my<br />

application.<br />

N11. You must send us the evidence that your Tier 4 sponsor used as the basis for<br />

assigning a CAS to you, unless you are exempt from doing so.<br />

Please tick one of the following boxes:<br />

I am enclosing all of the qualification certificates and transcripts of results used as the<br />

basis of my course offer.<br />

Now go to Section O<br />

I was assessed by my sponsor by other means.<br />

I am a low risk national and am not required to include this document with my<br />

application.<br />

N12. You must send us your original certificate of qualification and/or your original<br />

transcript of results of your UK qualification in Medicine or Dentistry, as listed by your Tier 4<br />

sponsor on your CAS:<br />

I am enclosing the required evidence.<br />

Now go to Section O<br />

I am a low risk national an am not required to include this document with my<br />

application.<br />

Tier 4 (G) Application Form (version 10/12) - page 32


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section O - About your Parent or legal Guardian<br />

You should only complete this section if you are a TIer 4 (General) student aged 16 or 17 years old.<br />

In this section you will be asked to provide information about your care and living arrangements in<br />

the UK and about your parents or legal guardians.<br />

O1. Are you in Local Authority care in the UK? (ht)<br />

Yes go to the next section No go to O2<br />

O2. What is the name of your Parent or Legal Guardian?<br />

Title - please select from the following list:<br />

Mr Mrs Miss Ms Dr<br />

First name(s) or given name(s)<br />

Last name(s) or family name(s)<br />

O3. What is their date of birth?<br />

D D M M Y Y Y Y<br />

O4. What country are they currently living in?<br />

O5. Please provide their address:<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Country<br />

Postcode:<br />

O6. How are you related to your Parent or Legal Guardian?<br />

O7. What is the name of your Parent or Legal Guardian?<br />

Title - please select from the following list:<br />

Mr Mrs Miss Ms Dr<br />

Tier 4 (G) Application Form (version 10/12) - page 33


First name(s) or given name(s)<br />

Last name(s) or family name(s)<br />

O8. What is their date of birth?<br />

D D M M Y Y Y Y<br />

O9. What country are they currently living in?<br />

10. Please provide their address:<br />

House number/name<br />

Address line 1<br />

Address line 2<br />

Address line 3<br />

Town/City<br />

County/District<br />

Country<br />

Postcode:<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

11. How are you related to your Parent or Legal Guardian?<br />

12. Please tick the following box:<br />

I am enclosing a letter from my Parent(s) or legal guardian(s) confirming they consent<br />

to this application.<br />

Tier 4 (G) Application Form (version 10/12) - page 34


Section P - Your Declaration<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

You must complete part P. If it is not complete, then your application will be invalid and will be<br />

returned to you.<br />

You must sign below to show that you have read and understood the following declaration. It must<br />

be authorised by you and not by a representative or other person acting on your behalf. If you are<br />

under 18, your parent or legal guardian may sign.<br />

The information given in my application is complete and is true to the best of my knowledge and<br />

belief.<br />

The photographs I have submitted with my application are a true likeness of me.<br />

The documents I have submitted in support of my application are complete and correct to the best<br />

of my knowledge and belief.<br />

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

Secretary of State for the Home Office with conducting pre-issue and post-issue checks in relation<br />

to this application.<br />

If there is a material change in my circumstances or any new information relevant to this application<br />

becomes available before it is decided, I will inform the UK Border Agency.<br />

I am aware that the rules and requirements for applications may change in the future and that I<br />

should not assume the current rules and requirements will continue to apply.<br />

I agree to the UK Border Agency using the data provided in this application in accordance with its<br />

Information Charter. I understand that my details may in certain circumstances be passed to other<br />

people, including fraud prevention agencies, to prevent and detect fraud, money laundering and<br />

other crimes. I also understand that the UK Border Agency may receive information about me.<br />

Name<br />

Signature Date<br />

D D M M Y Y Y Y<br />

Tier 4 (G) Application Form (version 10/12) - page 35


TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Section Q - Representative’s Declaration<br />

If you are a representative acting in relation to this application you must complete the declaration<br />

below to show you have read and understood the representative’s declaration and to confirm that<br />

you are authorised to act on behalf of the applicant(s).<br />

I have been appointed by the applicant(s) to act on their behalf in relation to this application which<br />

has been submitted online to the UK Border Agency.<br />

I confirm that I am aware of the contents of this application, including its supporting documents, and<br />

that the application is, to the best of my knowledge and belief, true and correct.<br />

I confirm that I will promptly give the applicant all correspondence I receive from the UK Border<br />

Agency about this application.<br />

I am permitted to give immigration advice and immigration services by virtue of section 84 of the<br />

Immigration and Asylum Act 1999.<br />

I am aware that it is an offence to do an act which facilitates a person who is not a citizen of the<br />

European Union to commit a breach of immigration law, knowing or having reasonable cause to<br />

believe that the act has this effect.<br />

Name<br />

Signature Date<br />

Name of your organisation:<br />

Your position within the organisation:<br />

Tier 4 (G) Application Form (version 10/12) - page 36<br />

D D M M Y Y Y Y


SUMMARY SHeeT<br />

TIeR 4 (GeneRAl) APPlICATIOn FORM<br />

Fill in this part of the form to help us to make sure that we have received the student’s<br />

documents and to keep a record of them while they are with us.<br />

At “A”, tell us how many of each of the listed documents the student has sent with this<br />

application. This is a standard list, students should only send in the documents from this<br />

list that are required for their application.<br />

At “B”, list any other documents and state how many in each case. Continue on a separate<br />

sheet if necessary.<br />

Part A - Type of document How many? Part B - listed Items How many?<br />

Passports<br />

Biometric Residence Permits and/<br />

or travel documents<br />

Police registration certificates<br />

Marriage or civil partnership<br />

certificates<br />

Birth certificates<br />

Driving Licences<br />

2 photographs<br />

Letter of consent from parent/<br />

guardian<br />

Fill in the summary sheet below listing the supporting evidence (documents) sent. You<br />

must send the required evidence as specified in this application form and the Tier 4 of the<br />

points based system Policy Guidance. Failure to submit required evidence is likely to lead to<br />

refusal of your application.<br />

Area Documents provided (please list)<br />

Possession of a Confirmation of<br />

Acceptance for Studies (CAS)<br />

Maintenance (Funds)<br />

Finally please ensure that your application is addressed correctly, as given on the front of<br />

this form.<br />

Tier 4 (G) Application Form (version 10/12) - page 37

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