Application for Student Finance 2013/14...Student Finance 2013/14 2 SFW/PN1F/1314 1section finance available You can apply for the following student finance by completing this form:

SFW/PN1F/1314/B

If you have applied for student finance before, please provide your Customer Reference Number

You should complete this form if you are starting one of the following courses:• A full-time or sandwich course of higher education;• A full-time Initial Teacher Training (ITT) course;• A full-time distance learning course (If you are starting a full-time distance learning course,

for reasons not relating to disability, on or after 1 September 2012 you can apply for aTuition Fee Loan and a Fee Grant only.);

• A diploma or degree course in a health related discipline and you are eligible to apply for anincome assessed bursary from the National Health Service (NHS), Department of Health(DoH) or the Scottish Government Health Directorate Bursary (Scottish Healthcare Allowance).

We have provided guidance notes to help you so please refer to these each time yousee this icon.

You will have to send evidence with your application whenever you see this icon. Details about the evidence can be found in the guidance notes.

DeadlineTo make sure you receive your first payment at the start of term, you must return this form andall of the evidence we need by 19 April 2013. We will do our best to process your applicationas soon as possible, however if the deadline date has passed your first payment may not beready for the start of term.If your application form is returned more than 9 months from the start of your academic year itwon’t be processed, and you may lose your full entitlement to student finance.

Your forename(s)

Your surname

1

You can also apply online atwww.studentfinancewales.co.uk

Application forStudent Finance2013/14

2 SFW/PN1F/1314

section

1 finance availableYou can apply for the following student finance by completing this form:

If you start your course on or after 1 September 2012 you can also apply for a Fee Grant.

You can find more detailed information on what is available and what you might be entitled to in‘A guide to financial support for higher education students in 2013/14 (new students)’, or by visiting ourwebsite www.studentfinancewales.co.uk

For all students• Complete sections 2–6;• Remember if you are applying for a loan you need to tell us how much you want by

completing the loan request section on page 16;• You do not need to complete section 6 if you are only applying for a Tuition Fee Loan

or/and a Fee Grant;

For students who want student finance based on household income• Complete sections 7 and 8;• If you think you qualify for the Special Support Grant, please tick this box.

Detailed information about who can qualify for the Special Support Grant and whatevidence needs to be provided can be found in the notes.

If you only want to apply for a Tuition Fee Loan, Fee Grant or a reduced rate of Maintenance Loanyou can go directly to Step 5. If you are starting a full-time distance learning course on or after 1September 2012 (for reasons not relating to disability) you can only apply for a Tuition Fee Loan anda Fee Grant.

If you are a single independent student go directly to Step 5.

Tick

For students who have dependants• Complete section 9;• You should complete this section if you have any children or adult dependants and want

to apply for financial help in relation to them.

Step

1

Step

2Step

3

• Maintenance Loan• Tuition Fee Loan• Assembly Learning Grant• Special Support Grant

• Adult Dependants’ Grant• Childcare Grant• Parents’ Learning Allowance• Disabled Students’ Allowances

• Bursaries and Scholarships• Travel Grant

!

!For students who want student finance based on household income• Complete section 10;• Depending on your answers in section 10 you may need to ask your parent(s) or partner

to provide details about their income in section 11 so we can work out what your fullentitlement to student finance will be.

For all students• Make sure that you have read and signed the student declaration on pages 23/24 and

if you asked someone to complete section 11, make sure that they have signed theirdeclarations on page 35.

Step

4Step

5

You can apply in 5 easy steps (Depending on your circumstances you may not need to complete all the steps)

3SFW/PN1F/1314

What if I have further questions?

If you have further questions you can:

• visit www.studentfinancewales.co.uk

• refer to ‘A guide to financial support for higher education students in 2013/14 (additionalinformation)’

• call us on 0845 602 8845

Where do I send my form?

Return this form to us at the address shown on the back of this form or on the letter thataccompanies this form. You can also find the address you need by going online towww.studentfinancewales.co.uk and then selecting ‘Find your local authority’.

Please remember to pay the correct postage.

Childcare GrantIf you want to apply for the Childcare Grant youneed to complete this form first, then complete aChildcare Grant (CCG) application form.Please send me a CCG application form

Disabled Students’ Allowances (DSAs)If you want to apply for DSAs you need tocomplete this form first, then complete a DisabledStudents’ Allowances (DSAs) application form.Please send me a DSA application form

Other student finance available

TickTick

CCG and DSA application forms can also be downloaded from www.studentfinancewales.co.ukor requested by calling us on 0845 602 8845.

section

1finance availablecontinued

4 SFW/PN1F/1314

YEARMONTHDAY

section

2 personal detailsa Personal details

Title Mr Mrs Miss Ms

Forename(s)

Surname If you have a double barrelled surname please ensure you put both parts of your surname with hyphen in between.

Sex Male Female

Date of birth

Place of birth (the name of the town or village)

Nationality

Previous loans

b Have you ever had any other loans from theStudent Loans Company (SLC)?

If ‘Yes’, are you behind with the repayments?

c Did you receive a loan from the SLCwhen you were under 18?

If ‘Yes’, have you signed credit agreements for all of them?

Please complete the following questions with the details as exactly stated on your birth certificate or passport.

Yes No

Yes No

Yes No

Yes No

if ‘No’ go to d1

if ‘No’ go to d1

5SFW/PN1F/1314

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2personal detailsContact details

d1 Please give your current home address. If you know it, please also give your term-time correspondence address.

Marital statuse Please tick one box:

Single

Living with a partner

Married/civil partnership Please give the date of marriage/civil partnership

Separated

Divorced/dissolved civil partnership

Widowed/surviving civil partner

YEARMONTHDAY

Home address

PostcodeHome phone number

Term-time address

PostcodeDate on which you will move to your term-time address

Mobile phone number

Email address

YEARMONTHDAY

d2 Did you move to Wales wholly or mainly for the purposeof receiving education? Yes No

if ‘Yes’ please contactyour LA for advice

continued

6

Nationalitya1 Are you a UK national?

a2 Are you an EU national?

a3 Are you the child of a Swiss national?

a4 Will your Swiss national parent be living in the UK on the first day of the academic year?

Residence statusa5 Are you or your:

• husband, wife, civil partner; or• parent(s), a step-parent; or• child, son or daughter-in-law, child’s civil partner;a European Economic Area (EEA) national or Swiss national who is working, has worked or is looking for work in the UK?

If ‘Yes’, please give details below.You should also give details of your previous studies.

If you are currently working, are you going to continue working during your studies?

a6 Do you have ‘settled status’ in the UK?

If ‘Yes’, give the date you received this status

a7 Have you or your:

• husband, wife, civil partner; or• parent(s), a step-parent;been granted ‘refugee status’ by the UK Government?If ‘Yes’, and if applicable, give the following:

Home Office reference number

Date this status is due to expire

section

3 residence

YEARMONTHDAY

YEARMONTHDAY

if ‘Yes’ go to b1

go to b2

Yes No

Yes No

if ‘No’ go to a8

Yes No

Yes No

Yes No

Yes No

if ‘No’ go to a7

go to b2

go to b2

Yes No if ‘No’ go to a6

SFW/PN1F/1314

If ‘Yes’, please give details.

Yes No if ‘Yes’ go to b2

if 'No' go to a5

7SFW/PN1F/1314

section

3residencecontinued

b1 In the three years prior to the start of the first academic year of your course, did you live outside the UK and Islands at any time?

YEARMONTHDAY

From

YEARMONTHDAY

To

YEARMONTHDAY

From

YEARMONTHDAY

To

YEARMONTHDAY

From

YEARMONTHDAY

To

If you require further space to provide your answer, please give the details requested aboveon the Additional notes section at the back of this form.

Yes No if ‘No’ go to b3

Yes No

a8 Have you or your husband, wife, civil partner or parent(s) or a step-parent been given:• ‘leave to enter or remain’ in the UK as a result of a failed asylum application; or

•discretionary leave where no application for asylum has been made?

If ‘Yes’, and if applicable, give the following:

Home Office reference number

Date this status is due to expireYEARMONTHDAY

go to b2

Residence history

If you answered ‘No’ to all the residency and nationality questions in this section you arenot eligible for student finance from Student Finance Wales. Do not continue with thisapplication.

!

b2 Give details of your residence for the three years before the start of the first academicyear of your course.Full address Why were you there?

8 SFW/PN1F/1314

section

3 residencecontinued

Yes No

b3 At any time since 1 September 2010 has:• either of your parents, step-parents, guardians; or• your husband, wife, civil partner lived or worked outside the UK and

Islands or, in the case of an EU, EEA or Swiss national, outside the EEA or Switzerland?

If ‘Yes’, please give details below.

DAY MONTH YEAR DAY MONTH YEARFull address From To Why did they live there?

9SFW/PN1F/1314

section

4about your course and your university or college

University or college detailsa University or college name and address

Postcode

UCAS personal identification number UCAS university or college code UCAS campus code (if applicable)

Course detailsb Course name

If you are following a combined studies or modular course, please list all subjects being studied.

! In this section, please give details of your first choice university or college and course.

YEARMONTH

YEARMONTH

FoundationFirst yearSecond year

Third yearFourth year

Other (give details)

UCAS course codeQualification you expect to gain(for example BSc Physics)

Course start date

Course end date

Course length (years)

Year of course

10 SFW/PN1F/1314

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4 about your course and your university or collegecontinued

c Full tuition fee amount for academic year 2013/14

If the course is franchised to another university or college, give their address below

Postcode

d Course type (please tick one box):

Full-time undergraduate

Full-time postgraduate Initial Teacher Training (ITT)

Full-time distance learning

Full-time foundation degree

Full-time involving a placement (sandwich course)

Do you have a disability which prevents youfrom attending your university or college inperson? Yes No

£

11SFW/PN1F/1314

section

4about your course and your university or college continued

Term detailse1 Where will you live during the academic year 2013/14?

Term 1 Living with parent(s) Elsewhere or own home



e2 Where will you spend most of your time studying in the academic year 2013/14?

Term 1 University or college Study abroad Placement in the UK or abroad



if you have ticked ‘University or college’for all 3 terms go to section 5

f Have you been accepted onto the Erasmus exchange scheme? Yes No

if ‘yes’ and/or you’ll be studying abroadgo to section 5

12 SFW/PN1F/1314

section

4 about your course and youruniversity or collegecontinued

Placement details

g Where will your placement be?

Abroad

UK

Don’t know

Placement name and address

Postcode

Is the placement:

paid

unpaid

If ‘unpaid’, please tick which type:

a hospital, Public Health Service Laboratory or with a Primary Care Trust;

a Health Authority, Strategic Health Authority, Local Health Board, Special Health Authority,Health Board, Special Health Board or a Health and Social Services Board;

a Local Authority carrying out its duties relating to health, welfare or caring for children andyoung people, a voluntary organisation providing facilities or carrying out similar activities;

the prison or probation sector or after-care services;

unpaid research in a UK or overseas institution; or

an unpaid placement that is not listed above.

13SFW/PN1F/1314

a1 Have you attended any full-time, ITT or sandwich courses ofHigher Education since you left school?

a2 Have you been awarded an honours degree from a UK university?

If you answered ‘Yes’ to either a1 or a2, please give course details below. Do not list A Level/AS Level examinations or equivalent.

Title of course Name of university Date you Date you Did you finish(for example, or college started left this course?BA History or BAHonours History)

If you did not finish any course listed above, why was this?

MONTH YEAR MONTH YEAR

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

section

5previous financial support and other information

Previous study

Full-time, Part-time or Full-timedistance learning

14 SFW/PN1F/1314

section

5 previous financial support and other information

b Have you applied for financial support for Higher Education before (for example, a grant or loan, tuition fees or bursary including support for fees) from a local authority or any other organisation inthe UK (for example, Department of Health)?

If you applied for support, whether or not you received it, tick ‘Yes’.

If ‘Yes’, give details below.

Name of the local What type of support Period the support coveredauthority or organisation did you receive?you applied to from to

If any of the periods of support you have given above involved a period of suspended studywhere you did not receive any support, for example, if you received support from 2006 to2011 but between 2007 and 2008 you did not receive support because you suspended studythat year, please give the suspension date periods below and give the reasons why yoususpended study.

c Are you eligible to apply for any bursary or award, excluding a social work bursary for theacademic year 2013/14 from any of the following?• National Health Service (NHS)• Department of Health (DoH)• Scottish Government Health Directorate Bursary

(Scottish Healthcare Allowance)

If ‘Yes’, is this bursary or award Income assessed

Non-income assessed

continued

Yes No

YEARMONTH YEARMONTH

YEARMONTH YEARMONTH

YEARMONTH YEARMONTH

if ‘No’ go to c

Yes No

15SFW/PN1F/1314

section

6your UK bank or buildingsociety account details

This account must be in your own name and be able to accept direct credits.

Please note that missing or incorrect bank or building society details will result in yourMaintenance Loan, bursary (if applicable) or any grant payments being delayed.

Sort code

Account number

Building society roll number

–

If you are only applying for a Tuition Fee Loan and/or a Fee Grant you do not need tocomplete this section.

–

SFW/PN1F/131416

National Insurance Number: – –

Maintenance LoanAmount of Maintenance Loanyou would like to apply for:

Tuition Fee LoanMake sure you find out from your university or college how much they will be charging beforeyou apply for a Tuition Fee Loan. To find out how much you can apply for visitwww.studentfinancewales.co.uk

Amount of Tuition Fee Loanyou would like to apply for:

Contact detailsPlease give the names and addresses of two contacts. The contacts you give should live atdifferent addresses and will only be contacted if, for example, you move address and do notinform us. You must inform your contacts that you are providing us with their details.Contact 1 Contact 2

Phone numberPhone number

CountryCountry

PostcodePostcode

AddressAddress

Relationship to youRelationship to you

SurnameSurname

Forename(s)Forename(s)

Maximum available to youIf you wish to apply for less than the maximumavailable to you, please state the amount

£

Maximum available to youIf you wish to apply for less than the maximumavailable to you, please state the amount

£

loan request sectionIf you are applying for a Maintenance Loan, Tuition Fee Loan or both please complete this section totell us how much you want to apply for.

Tick

Tick

SFW/PN1F/1314 17

This section is to be completed by students who want student finance based onhousehold income. The following questions will help to determine whether you are adependent or an independent student for the purposes of income assessment.

a1 Have you been married or in a civil partnership at any time before the first day of the academic year?

a2 Will you be 25 or over on the first day of the academic year?

a3 Will you have care of a person under the age of 18 on the first day of the academic year?

b Please tick the relevant box if any of the following apply to you

Your parents cannot be found or it is not reasonably practicable to get in touch withthem.

You are irreconcilably estranged from (have no contact with) your parents and this willnot change.

At any point from the age of 16 to the start of your course, you have not been under thelegal care of your parents; and, for three months or more, you have been in the custodyor legal care of, or have been given accommodation by, a local authority.

Both your parents have died.

You have applied for student finance before, and the parent who was assessed for acontribution has died.

Your parents are living outside the European Union and the assessment of their financialcircumstances would place them in jeopardy.

Your parents are living outside the European Union and it would not be reasonablypracticable or possible for them to send you money.

If you have ticked any of the boxes above, you will be contacted for evidence and,subject to this, you may be considered independent.

Yes No

if ‘Yes’, you are anindependent student,go to section 8if ‘Yes’, you are anindependent student,go to section 8

if ‘Yes’, you may beconsidered an independentstudent, go to section 8

section

7dependent and independent students

Yes No

Yes No

if you have ticked any of theboxes above go to section 8

SFW/PN1F/131418

c Have you supported yourself financially for a total of three years or more prior to the start of the first academic year of your course?

If ‘Yes’, you may be considered an independent student. Please give details below.

Name and address of Did you work From To Amount of salary,your employer or your full or part-time? wages or benefit youbenefit office have received (state

whether it was weekly,monthly or yearly)

If you have answered ‘No’ to all the questions in section 7 you will be considered a dependent student.

MONTH YEAR MONTH YEAR

Yes No

section

7 dependent and independent studentscontinued

!

SFW/PN1F/1314 19

If you leave any questions blank we will not be able to process your application. If a questiondoes not apply to you, please enter ‘None’ or ‘N/A’ as the answer.

Unearned incomea Taxable unearned income is any income you receive from the following sources:

• Bank or building society gross interest.• Property, lettings or rent.• Dividends or investments.• Trusts or sponsorships.• Any other payment received for attending the course.

Please estimate the total taxable unearned income, before deductions, that you expect to receive in academic year 2013/14.

What is the source of this income?

Payments from an employerb Will your employer be releasing you to attend your course for

the academic year 2013/14?

If ‘Yes’, how much will your employer pay you for time spent attending your course during this period?

c During the academic year 2013/14, will you or your employer pay any money into a pension fund on your behalf?

If ‘Yes’, how much during this period?

Dependent childrend Give details of any children who will be wholly or mainly financially dependent on you during

the academic year 2013/14.

When stating the child’s income, include their income from all sources after income tax and social security contributions.Child’s full name Date Relationship Who will Child’s income

of birth to you they live with?

£

£

£

Yes No if ‘No’ go to d

Yes No

section

8student financial details

SFW/PN1F/131420

You only need to complete this section if you are a student who has children or adultdependants and you want to apply for financial help in relation to them.

a Are you a lone parent?

b Are you under 25, living with a partner and applying for a Childcare Grant or Parents’ Learning Allowance?

c Give the total estimated income after income tax and National Insurance deductions in the academic year 2013/14 for:

You Your partner

How much of this will be Child Tax Credit for the academic year 2013/14?

You Your partner£ £

£ £

Yes No

section

9 Parents’ Learning Allowance, AdultDependants’ Grant and Childcare Grant

d If you are a lone parent and are not claiming Adult Dependants’ Grant

Give an estimate of your husband’s, wife’s, partner’s or other adult dependant’s income for the academic year 2013/14.

Husband, wife or partner Other adult dependant

Income from earningsafter deductions

Adoption Agency payments

Any disability pension or benefit

Child Benefit

Guardian’s Allowance

Fostering orBoarding Out Payments

Residence Order Allowance

Child Tax Credit

Working Tax Credit

Yes No

if ‘Yes’ go to d

if’ ‘No’ go to d

go to f

£ Other adult dependant£ Husband, wife or partner

£ Husband, wife or partner £ Other adult dependant




£ Husband, wife or partner




£ Other adult dependant




SFW/PN1F/1314 21

Husband, wife or partner Other adult dependant

All other income

If other, what is it?

If applying for Adult Dependants’ Grant, please indicate who the adult dependant is:

Your Your Your partner Other adult husband wife (if you are 25 or over) dependant

e Give details of financial commitments you have before the start of the course which you, your husband, wife or partner will continue to pay for you during the academic year.

Please enter the annual amount.

Type Type

Type Type

Type Type

Type Type

f Are you applying for a Childcare Grant?

Do you, your husband, wife or partner receive, or expect to receive, the childcare element of Working Tax Credit?

If ‘Yes’, you cannot also get Childcare Grant. However you can choose to receive Childcare Grant instead of the childcare element of Working Tax Credit if you wish.

£ £

£ £

£ £

£ £

Yes No

Yes No

section

9Parents’ Learning Allowance, AdultDependants’ Grant and Childcare Grant

continued


SFW/PN1F/131422

section

10 about your family

a With which parent do you normally live, or have more contact?

If you are a single independent student, go to the Student Declaration on pages 23 and 24.

If you are an independent student with a partner, read and sign the Student Declarationon pages 23 and 24 and then pass this form to your partner to complete section 11.

If you are a dependent student, go to question a.

Mother Father Both N/A or

What is the current marital status of thisparent?

Single

Living with a partner

Married/civil partnership

Separated

Divorced/dissolved civil partnership

Widowed/surviving civil partner

What you need to do nextRead and sign the StudentDeclaration on pages 23 and 24 andthen pass this form to your parent(s).What your parent(s) need to do nextThe parent(s) you normally live withshould complete section 11.If the parent indicated in `a' is married,in a civil partnership or living with apartner, their partner must alsocomplete section 11.

b

23

Student DeclarationBefore signing and returning your completed form,you should read the Data Protection statement inthe accompanying notes.

This declaration covers all of the student financeavailable to students for Academic Year 2013/14.By signing and returning your completed form,you are confirming that you have read the specificterms and conditions concerning loans, ChildcareGrant and Disabled Students’ Allowances. If youapply for any of those types of finance at any timein academic year 2013/14, you will be bound bythe related terms and conditions below. If youdon’t apply for a loan, Childcare Grant or DisabledStudents’ Allowances in academic year 2013/14the specific terms and conditions relating to thattype of finance will not affect you.Your application for financial support may bedelayed unless you sign and date thisdeclaration.General Declaration• I confirm that to the best of my knowledge and

belief, the information I have provided is trueand complete. If it is not I understand I may notreceive financial support, any support I have hadmay be withdrawn and I could be prosecuted.

• I agree to give my Local Authority (LA) anyinformation they require to process myapplication and agree to tell them immediately ifmy circumstances change in any way that mightaffect my entitlement to financial support. Iunderstand that if I do not do this, I may notreceive any further payments, and may have torepay the financial support I have alreadyreceived.

• I agree that in the event of receiving anoverpayment of financial support, I am obligatedto repay this in full.

Loan Contract a I confirm I have read and understood 'Student

Loans: A guide to terms and conditions'available online atwww.studentfinancewales.co.uk

b I acknowledge and agree that any loan(s) madeto me by the Welsh Ministers, ‘the lender’(which includes any persons exercisingfunctions on behalf of the Welsh Ministerspursuant to section 23(4) of the Teaching andHigher Education Act 1998 ‘the Act’) will be onthe terms set out in these declarations and inRegulations which are made under section 22of the Act as amended from time to time.

c I undertake to repay the lender any loan(s)made to me, together with all and any interest,penalties and charges which apply.

d I agree that any loan(s) made to me as aconsequence of the acceptance of myapplication by the lender is a/are contract(s)between me and the lender which binds mefrom the payment to me of the first loanadvance and that the repayment of any suchloan(s), together with all and any interest,penalties and charges which apply, will be dueby me to the lender as a debt.

e I agree that I shall be obliged to makerepayment of my loan(s), together with all andany interest, penalties and charges which apply,to such address as shall be notified to me inwriting and that any services in respect of myloan(s) may be provided at such address orother address(es) as the lender may from timeto time determine and that the service ofproviding the loan is provided at the lender’sprincipal address.

f I agree that any action for repayment and/or inrespect of or in connection with my loan(s)and/or all and any interest, penalties andcharges which apply, will be brought before theordinary civil courts and shall be governed bythe general rules of civil procedure.

g I agree that my request for a loan, the loan andthe contract between me and the lender shallbe governed by the law of the place of myhome address as stated in this form (or, if myaddress is outside the United Kingdom, Englishand Welsh law).

h I irrevocably agree that the courts of the part ofthe United Kingdom in which my home addressstated in this form is situated (or the English,Welsh, Scottish and Northern Ireland courtswhere my address is outside the UnitedKingdom) shall have non-exclusive jurisdictionto hear any action or proceedings arising out ofor in connection with the loan and the contractbetween me and the lender and I irrevocablysubmit to the jurisdiction of those courts andwaive any objection to the jurisdiction of thosecourts, provided that this shall not limit thelender’s rights to take proceedings against mein any other court of competent jurisdiction.

i I agree that from the date I submit this formuntil the date when my loan(s), together with alland any interest, penalties and charges whichapply, is fully repaid I will notify the lender ofany changes in the personal details (includingNational Insurance Number) and contact detailsI have provided as required in accordance withthe Regulations referred to in paragraph b.

SFW/PN1F/1314

SFW/PN1F/131424

Your full name(in BLOCK CAPITALS)

Your signature DateYEARMONTHDAY

! The relevant person(s) you indicated in section 10 must complete section 11 as well asthe declaration(s) on page 35.Please pass this form to them now.If you are a single independent student, please turn to page 36 to finalise yourapplication.

j In the event that I leave the United Kingdom toreside outside the United Kingdom or that forany other reason I am outside the UK taxsystem, I undertake to inform the lender inaccordance with the Regulations referred to inparagraph b and I undertake to provide thelender with my new and any subsequent contactdetails until my loan, together with all and anyinterest, penalties and charges which apply, isfully repaid.

k I agree to take all future action requested by thelender and provide the lender with allinformation required to ensure repayment, inaccordance with the Regulations referred to inparagraph b.

l If I breach any of the terms under which anyloan(s) will be made I agree that I will be obligedto pay any charges and penalties which mayapply under the Teaching and Higher EducationAct 1998 and the Regulations made under thatAct, as amended from time to time or successorlegislation and/or Regulations.

m I understand that the Student Loans Companywill check my National Insurance Number andpersonal details, with the Department for Workand Pensions (DWP). If I do not know myNational Insurance Number, or if the number Iprovide cannot be authenticated, DWP will traceand give my number to the lender.

n If I have broken the terms of this contract Iagree that the lender may share informationheld about me and my account with any person,including the government or a governmentagency of another country, who may assist inestablishing my whereabouts and/or in takingaction to recover outstanding loan amounts.

Disabled Students’ Allowances (DSAs)• I understand that any equipment I receive

through DSAs must be used for my course ofstudy and my LA is not responsible for payingany repair costs.

• I understand that if I do not tell my LA about anychange in my circumstances which may effectmy entitlement, I may have to return anyequipment I have already received in the yearthrough a DSA.

Childcare Grant• I understand that if I do not take up my childcare,

or if I change to a childcare provider who is notregistered or approved, I will have to pay backany overpayment.

• I understand that if I do not provide the evidenceof childcare costs within the timescales set, Imight lose my entitlement. Also if my paymentsto my childcare provider are different from theestimates I provide, I understand that furtherpayment will increase or decrease accordingly, or if no further Childcare Grant payments aredue to be paid to me, I may be liable to repay any difference.

• I confirm that neither I nor my husband, wife, civilpartner or cohabiting partner have chosen toreceive support for childcare from the childcareelement of the Working Tax Credit and I agree totell my LA immediately if I or my husband, wife,civil partner or cohabiting partner does receivethis support.

Customer Reference Number

Bursary and scholarship data sharing consent will not affect your entitlement to anyother financial support available. If you started your course in academic year 2006/07 orafter you may be eligible for a non-repayable bursary or scholarship. In order for youruniversity or college to determine and pay any bursary or scholarship to which you may beentitled, we will share some of your personal, financial and course details as well asinformation about your eligibility for student finance with them. Most universities and collegeswill not pay bursaries and scholarships if you do not give consent.

If you do not wish your details to be shared for this purpose, please tick this box.

section

11financial details for the tax year 2011-12 for parents and partners

Quick start guideSection 11 is divided into 5 parts, this guide gives you a quick summary of each part.

Part ATell us your name and address and some other personal information.

Parts B and CAnswer every question, providing income amounts and financial evidence for the tax year2011-12 where appropriate.

Part DAnswer every question, telling us about any income deductions you had, providing financialevidence for the tax year 2011-12 where appropriate.

What happens if my household income has dropped since tax year 2011-12? If your household income has dropped by 15% since tax year 2011-12 you can apply for a ‘CurrentYear Income Assessment’.

This means we would use your expected income for tax year 2013-14 instead of your actual incomefrom tax year 2011-12 when calculating the student’s entitlement. However, there must be at least a15% drop in the overall household income (not just your own income) between these two tax yearsfor us to do this and we will ask for evidence of your 2013-14 income at the end of that tax year.

What details do I need to provide in this section?If you are the parent, parent's partner or partner of a student you need to tell us some personal detailsand what your financial income was the tax year 2011-12. You must tell us your 2011-12 incomedetails as we cannot accept amounts from any other tax year. We need your income amounts so wecan work out what the student(s) you are supporting are entitled to.

Part EIf you have any children who are financially dependent on you, tell us about them here.

25SFW/PN1F/1314

section

11continuedfinancial details for the tax year 2011-12 for parents and partners

/ / / /

You do not have to disclose your financial information to the student.If you would like to provide it separately, you can download an Assessment of Financial Circumstancesform 2013/14 from www.studentfinancewales.co.uk and return it to us.Alternatively, you can have the form sent to you by ticking this box:

Part A – Your personal detailsPerson 1Your Customer Reference Number (If you have one)

Relationship to the student

Title

Forename(s)

Surname

Date of birth

Place of birth (name of town or village exactly as it appears on your birth certificate or passport)

Home address

PostcodeHome telephone number

Email address

Person 2Your Customer Reference Number (If you have one)

Relationship to the student

Title

Forename(s)

Surname

Date of birth

Place of birth(name of town or village exactly as it appearson your birth certificate or passport)

Home address

PostcodeHome telephone number

Email address

Tick TickPerson 1Send me a separate form

Person 2Send me a separate form

SFW/PN1F/131426

section

11continuedfinancial details for the tax year

2011-12 for parents and partners

Yes No Yes No

Person 1 Person 2

Yes No Yes No

Part B – Your financial information for the tax year 2011-12Instructions • Please give financial details for the tax year from 6 April 2011 to 5 April 2012.

• Answer ‘Yes’ or ‘No’ to every question, if you answer ‘Yes’ please provide the income amount.

• Where you tell us an amount, you must provide evidence to support it.

• If you answer ‘No’ to a question, this means you are telling us that you did not receive any income from that particular income type in tax year 2011-12.

• If you need help with any questions you should refer to the guidance notes each time you see this icon.

Please note that if you leave any questions blank we will not be able to processthis application.

Q1 Did you receive Working Tax Credits or Child Tax Credits?

Q2 Did you receive Income Support?

Q3 Did you receive any income from salary, wages, taxablestate benefits or from occupational or private pensions?

Total income from salary / wages

Total income from taxable state benefits

Total income from occupational pension(s)

Total income from private pension(s)

Yes No Yes No

£ £

£ £

£ £

£ £

Financial evidence required – Please provide financial evidence for each individual amountentered above. The following table summarises the evidence you need to send to support theamounts you have given.

Income type Tax year 2011-12 evidence items you can send

Salary, taxable state benefits,occupational / private pension(s)

Original P60

Wages and occupational pension(s) Original Month 12 wageslip or Week 53 wageslip

Taxable state benefits – if you were unemployedfor the full 2011-12 tax year

Original P60U

a

b

c

d

27SFW/PN1F/1314

!

Yes No Yes No

Person 1 Person 2Q5 Did you receive any income from savings and

investments?

a Total interest from UK banks, building societies andunit trusts

b Total income from UK life insurance gains, securitiesand partnerships

c Total income from UK investments and dividends

d Total income from foreign investment and dividends

Financial evidence required – Please provide financial evidence for the amount(s) enteredabove. The table at the top of page 29 summarises the financial evidence you need to send.

section


Yes No Yes No

Person 1 Person 2Q4 Did you receive any income from a state retirement pension?

a Total non-lump sum amount received

b Total lump sum amount received

£ £

Financial evidence required – Please provide financial evidence for the amount(s) enteredabove. The following table summarises the financial evidence you need to send.


Your pension payments Confirmation from the Department of Work andPensionsOriginal P60Original BR735Confirmation from the Benefits Agency

Your pension payments if you were Self Assessed and completed an online tax return

A copy of your full finalised online tax return

Your pension payments if you were Self Assessed and completed a short paper tax return

A copy of your full finalised SA200 form

Your pension payments if you were Self Assessed and completed a full paper tax return


£ £

£ £

£ £

£ £

£ £

SFW/PN1F/131428


Interest from UK banks, building societies andunit trusts

Bank / building society statementsCopies of dividendsHalf yearly statements

Income from savings and investments if you wereSelf Assessed and completed an online tax return


Income from savings and investments if you wereSelf Assessed and completed a short paper taxreturn


Income from savings and investments if you wereSelf Assessed and completed a full paper taxreturn

A copy of your full finalised:SA100 and SA101 forms; plus your SA104F or SA104S form (where applicable); orSA106 form

Q7 Did you receive any other income during the 2011-12 tax year that you haven’t yet told us about?

Person 1 Yes

No

Go to Part C

Go to Part D

Person 2 Yes

No

Go to Part C

Go to Part D

section



Financial evidence required – Please provide financial evidence for the amount entered above.The following table summarises the financial evidence you need to send.


Taxable benefits in kind if your salary was £8,500or more

Original P11D

Taxable benefits in kind if your salary was lessthan £8,500

Original P9D

Yes No Yes No

Person 1 Person 2

Q6 Did you receive any taxable benefits in kind?

Total income received £ £

29SFW/PN1F/1314

section


Part C – Other income

Instructions• Complete Part C in the same way you completed Part B giving financial details for the tax year

from 6 April 2011 to 5 April 2012.

• If you need help with any questions you should refer to the guidance notes each time you seethis icon.

The notes contain a breakdown of what we want you to include for each question as well aswhere to find individual amounts on some of the financial documents you might have.

• Where an amount is entered you must provide evidence to support it. A table has been providedat the end of Part C to summarise what financial document(s) you need to send.

Yes No Yes No

Person 1 Person 2

Q1 Did you receive any income from self-employment?

a Total taxable profit from businesses

b Total taxable profit from partnerships

£ £

£ £

Yes No Yes NoQ2 Did you receive any income as a Minister of religion?

Total taxable income minus expenses that are not included on your P60 or P11D. £ £

Yes No Yes NoQ3 Did you receive any other taxable income or lump

sums?


Yes No Yes NoQ4 Did you receive any income from property lettings?


Yes No Yes NoQ5 Did you receive any income from UK trusts?


SFW/PN1F/131430

Yes No Yes No

Person 1 Person 2

Q6 Did you receive any foreign income?


Yes No Yes NoQ7 Did you receive any income from an overseas

pension?

Total income received£ £

Yes No Yes NoQ8 Did you receive any other overseas income

and gains?


Please provide financial evidence for each individual amount you entered in Part C. The followingtable summarises the financial evidence you need to send.

How you submitted your 2011-12 details to HM Revenue & Customs (HMRC)

Document(s) you need to send – tax year2011-12

Online tax return A copy of your full finalised online tax return

Short paper tax return A copy of your full finalised SA200 form

Full paper tax return A copy of each individual form that any amountyou told us about is recorded on. Depending onyour tax circumstances you may need to sendus a copy of your full finalised:

SA100 – Main tax return formSA101 – Additional informationSA102M – Ministers of religionSA103S – Self-employment short versionSA103F – Self-employed full versionSA103L – Lloyds underwritersSA104F – Partnership full versionSA104S – Partnership short versionSA105 – UK PropertySA106 – ForeignSA107 – Trusts

section



Financial evidence you need to send for the tax year 2011-12

31SFW/PN1F/1314

section


Part D – Income deductions

Yes No Yes NoQ1 Did you pay any private pension contributions?

Total amount you paid £ £


Contribution type Tax year 2011-12 evidence items you can send

Your private pension contributions Annual statement from your pension or insurancecompanyOriginal P60Tax CalculationsConfirmation from the Department of Work andPensions of the amount of pension paid

Your private pension contributions if you were Self Assessed

A copy of your full finalised tax return

Person 1 Person 2

Yes No Yes NoQ2 Did you pay any Additional Voluntary Contributions

(AVCs)?

Total amount you paid £ £


Contribution type Tax year 2011-12 evidence items you can send

Your Additional Voluntary Contributions (AVCs) Annual statement from your pension or insurancecompanyOriginal P60Tax CalculationsConfirmation from the Department of Work andPensions

Your Additional Voluntary Contributions (AVCs) ifyou were Self Assessed

A copy of your full finalised tax return

Person 1 Person 2

Instructions• Complete Part D in the same way you completed Part B giving financial details for the tax year

from 6 April 2011 to 5 April 2012.• If you need help with any questions you should refer to the guidance notes each time you see

this icon.• Where you tell us an amount you must provide evidence to support it.

SFW/PN1F/131432

Yes No Yes NoQ3 Did you have any allowable expenses on which

you claimed tax relief?

Total amount on which you claimed tax relief £ £


Expense type Tax year 2011-12 evidence items you can send

Your allowable expenses on which you claimedtax relief

Original Coding Notice (P2)

Your allowable expenses on which you claimedtax relief if you were Self Assessed and completed an online tax return


Your allowable expenses on which you claimedtax relief if you were Self Assessed and completed a short paper tax return


Your allowable expenses on which you claimedtax relief if you were Self Assessed and completed full paper tax return

A copy of your full finalised:SA100SA101 and / orSA102 form

Person 1 Person 2

section



33SFW/PN1F/1314

section


Part E – Your dependantsIdentify any children who will be wholly or mainly financially dependent on you.

Q1 Child dependants not in further or higher education in academic year 2013/14

Include unearned income for all dependants. Only include earned income details for personsaged 16 and over. Do not count casual earnings of persons under 16.

Income for the yearDate of birthFull name

(DD MM YYYY)

Q2 Child dependants in further or higher education in academic year 2013/14

Do not include the applicant when completing this question.

If the student is your partner, please include any children they named in section 8 of this form ifthe children have applied for student finance.

School, college oruniversity

Date of birthFull name Course

(DD MM YYYY)

Are they receivingfinancial support? Ifso, from whichauthority ororganisation?

SFW/PN1F/131434

Declaration for parents and partners

Before signing, you should read the Data Protection statement in the notes that accompanythis form.

This application for financial support may be delayed unless you sign and date this declaration.• I confirm that to the best of my knowledge and belief, the information I have provided

is true and complete. If it is not I understand I might be prosecuted and financial support withdrawn.

• I agree to supply any further information in relation to the applicant’s application forfinancial support that the LA may ask for and agree to tell them immediately if mycircumstances change in any way that might affect this application for financial support.

SFW/PN1F/1314 35

Person 1

Your decision about bursary andscholarship data sharing consent will notaffect the student’s entitlement to anyother financial support available.In order for a university or college todetermine and pay any bursary orscholarship to which the student(s) you aresupporting may be entitled, we will sharesome of your personal and financial detailswith them.


Your full name (in BLOCK CAPITALS)

Your signature

Date

YEARMONTHDAY

Person 2

Your decision about bursary andscholarship data sharing consent will notaffect the student’s entitlement to anyother financial support available.In order for a university or college todetermine and pay any bursary orscholarship to which the student(s) you aresupporting may be entitled, we will sharesome of your personal and financial detailswith them.


Your full name (in BLOCK CAPITALS)

Your signature

Date

YEARMONTHDAY

! Now pass this form back to the student.

DeadlineTo make sure the student receives their first payment at the start of term, this form must bereturned with all of the evidence we need by 19 April 2013.We will do our best to process the application as soon as possible, however if the deadlinedate has passed, the first payment may not be ready for the start of term.

36 SFW/PN1F/1314

The following questions are voluntary – you do not have to answer them. Whether or not youanswer will not affect our assessment of your entitlement to financial support. If you answerboth questions a and b, the information will be used to help the Welsh Ministers develop theirpolicies in the future. Your local authority will also use your answer to question b to improvetheir ability to deliver suitable and accessible educational services that meet the varied needsof their communities in the future.

a Your parents’ education (this includes your natural parents, your adoptive parents, your step-parents, partners of your parents, and your guardians).Do any of your parents (as defined above) have any higher education qualifications, for example degrees and diplomas or certificates of higher education? Yes No Don’t know

b How would you describe your ethnic origin?

White: British (Welsh) British (English)

British (Scottish) British (Other)

Irish Any other white background

Black or Black British: African Caribbean Any other black background

Mixed: White and black Caribbean White and black African

White and Asian Any other mixed background

Chinese or other ethnic group: Chinese Any other

Asian or Asian British: Indian Pakistani Bangladeshi

Any other Asian Background

Voluntary questions

SFW/PN1F/1314 37

Additional notesIf you are providing extra information please clearly mark what section and question theinformation is about.

You must return your completed form to your LA at the address shown below, on the covering letter sent with this form or by going online towww.studentfinancewales.co.uk and then selecting ‘Find my Local Authority’.

Tick

ChecklistBefore returning this form, please make sure you have done the following:

• Fully answered all questions that apply to you.

• Enclosed all evidence items. Any original evidence will be returned to youas soon as possible.

• Completed the Loan Request section if you are applying for a MaintenanceLoan, Tuition Fee Loan or both.

• Asked your parent(s) or partner to complete section 11 if you are applyingfor student finance based on your household income.

• Signed and dated the relevant declaration(s).

If you have followed all the instructions provided in the checklist you will be sent a lettershowing the amount of financial support you will receive within 6 weeks.

Please remember to pay the correct postage.

Tick

Tick

Tick

Tick

Address of your Local Authority

38 SFW/PN1F/1314

Documents

Application for Student Finance 2013/14...Student Finance 2013/14 2 SFW/PN1F/1314 1section finance available You can apply for the following student finance by completing this form: