TOC - UK Border Agency

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PAYMENT DETAILS:TOCPlease complete this page in block capitals and black ink after first reading the payment guidance.1Contact address in the UK for correspondencePostcode2Contact name in the UK if different from that of the applicant3Applicant’s full name4Date of birthDay Month YearPAYMENT DETAILS5 Amount - please tick the amount you are payingSingle applicant -no dependants£107Main applicant andtwo dependants£321Main applicant andone dependant £214Main applicant andthree dependants £4286How are you paying? Please tick a box.PostalorderChequeDebit orcredit cardBanker’sdraftIf more than 3 dependants are applying with you, please state the number in the space below and enter the correct amountspecified in the payment guidance in the appropriate box.Main applicant and .............. dependants £ - postal7Paying by cheque - please give cheque details belowCheque numberAccount numberSort codePaying by card - please complete 8-12 below8Which card are you using for payment?Please tick a box.Visa /ElectronMasterCard/ AmexDelta Maestro /Solo9Name oncard10Cardnumber1112Card detailsCardholder’ssignatureValid fromExpiry dateCard security number - CVV(3 digit number or4 digit number forAmex)DateIssue No.(whereavailable)TOC Application Form (Version 10/2014) - Page 4 of 22
If you are producing a double-sided copy ofthis application form, please include this pageand make sure it falls on the reverse of thepayment details page in the two-sided copy.For administrative reasons, it’s important thatthe rest of the form begins with Section 1 -Applicant’s Details facing upwards.TOC Application Form (Version 10/2014) - Page 5 of 22
Page 1 and 2: TOCVersion 10/2014Application For A
Page 3: • Debit card - Delta, Maestro* (i
Page 7 and 8: 1.15 Please re-enter your email add
Page 9 and 10: SECTION 2 - DEPENDANTS WHO ARE ALSO
Page 11 and 12: SECTION 3 - BIOMETRIC RESIDENCE PER
Page 13 and 14: SECTION 4 - PERSONAL HISTORYPersona
Page 15 and 16: You must answer questions 4.5 to 4.
Page 17 and 18: SECTION 4 - PERSONAL HISTORYDEFINIT
Page 19 and 20: SECTION 7 - Consent for the Home Of
Page 21 and 22: SECTION 7 - DECLARATIONYou must now

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