AB36 - Student Awards Agency For Scotland

Student Awards Agency for Scotland
Gyleview House, 3 Redheughs Rigg, Edinburgh, EH12 9HH
Telephone: 0300 555 0505 Fax: 0131 244 5887
website: www.saas.gov.uk
Household income for the year ended 5 April 2014
Who should fill in this form
Parts A, B and C - the student
Parts D, E and F - the parent, step parent, parent's partner or husband, wife, civil partner or partner. If this
is the first time the student is applying for support, you must send us a copy of the relevant documents to support
the income details you give us in part E. For example, P60, self assessment, tax credit award, benefits letter etc.
Any income documentation must cover the whole year. If you are not sure what documents to send then contact
us for help.
Important - If you do not fill in the form correctly, we will have to ask you to fill it in again. This will seriously delay
the student receiving their full entitlement. If you need help filling in the form, contact us for help.
Part A - student details
Name Date of Birth D D / M M / Y Y Y Y
SAAS reference number
Part B - student income
In the table below, please give us an estimate of how much income you expect to receive during the academic
year. DO NOT enter income from employment or additional living cost benefits, for example, Child Benefit, Child
Tax Credit, Disability Living Allowance etc. DO enter maintenance you receive from an absent parent, private
pensions, trust income, interest from bank/building society or other savings accounts and all replacement living
cost benefits, for example, Working Tax Credits, Incapacity Benefit, Employment Support Allowance, War Pension
etc. If you are not sure what income to tell us about, then contact us for help.
Type of income
NONE
NONE
Estimate of income you expect to receive
between 1 August 2014 and 31 July 2015
NONE
NONE
Part C - student declaration
As far as I know, the details above are complete and accurate.
I agree to give you any further information you may ask for.
I agree to tell you immediately if I do not matriculate, if I withdraw from my course of study or if my
circumstances change in any way that might affect any amount I have received, or had paid on my behalf.
I understand that if I give you false information or do not give you complete information, you may
prosecute me and withdraw my support.
I agree to pay any amount I have received, or that has been paid on my behalf, which is more than the
award due to me.
Your signature Date D D / M M / Y Y Y Y
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Part D - person 1 and person 2 details
Name
Relationship to student
National Insurance Number
Are you retired or unemployed
Address of person 1 and 2
Father, stepfather, parent’s partner or
husband, wife, civil partner (Person 1)
Mother, stepmother, parent’s partner
(Person 2)
Part E - person 1 and person 2 gross income and deductions
Important - if you do not enter income for both person 1 and 2, please tell us why in the box below, for example,
'separated'. You will need to send us relevant evidence that proves your single status.
Reason for one person’s income
Gross yearly income and deductions Person 1 Person 2
PAYE income for year ending 5 April 2014 from salary, wages, commission, bonuses
and overtime. Write the total before deduction of income tax, National Insurance and
superannuation contributions.
Net Profit from self-employment income from year ending between 6 April 2013 and
5 April 2014.
NONE
NONE
NONE
NONE
Taxable income from property and land. NONE NONE
Income from Working Tax Credit (DO NOT include Child Tax Credit). NONE NONE
Income from private, employers or retirement pensions. NONE NONE
Social Security benefits, including pensions and allowances. Enter the yearly amount
(DO NOT include Child Tax Credits or Child Benefit).
NONE
NONE
Income from bonds, trusts, bank and building society accounts or investments. NONE NONE
Dividends you receive. NONE NONE
Other income (DO NOT include Child Tax Credit or Child Benefit). If you RECEIVE
maintenance, you only need to enter this if it is for another student in further or higher
education. DO NOT enter maintenance for a child still at school.
If you PAY maintenance for a child in further or higher education (not the applicant in
part A), enter their name, date of birth and how much you pay.
NONE
NONE
Important - if you did not enter income in any of the boxes above, please tell us why in the box below, for
example, 'housewife/husband/partner’ or ‘unemployed and not entitled to benefits’.
Reason for no income
NONE
Part F - person 1 or person 2 declaration
As far as I know, the details above are complete and accurate.
I agree to give you any further information you may ask for.
I agree to tell you immediately if my circumstances change in any way that might affect this application for
support.
I understand that if I give you false information or do not give you complete information, you may
prosecute me and withdraw the support.
Your signature Date D D / M M / Y Y Y Y
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