TIER 4 (G)
TIER 4 (G)
TIER 4 (G)
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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 />
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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 />
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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 />
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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 />
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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