1SFE 1213Application [600339]

1SFE/ /1213Application
for Student: [anonimizat]1
2012/
2013
PR1FYou can also apply online at
www.direct.gov.uk/student: [anonimizat]_england
Forename(s)
Surname
Refer to the guidance notes when you see this icon. The notes will give you extra
information to help you complete the form correctly.
You will have to send evidence with your application whenever you see this icon.
Details about the evidence required can also be found in the guidance notes.en
You should complete this form if you are continuingstudy on one of the following courses:
•A full-time or sandwich course of higher education.
•A diploma or degree course in a health related discipline and you are eligible to apply for an
income assessedbursary from the National Health Service (NHS).
•A full-time Initial Teacher Training (ITT) course.
If your course started before1 September 2010:
• A part-time ITT course.
• A flexible ITT course that lasts at least 6 weeks.n
If you are a part-time ITT student: [anonimizat] 1 September 2010 you
need to apply for part-time support using a PTG1 form.
Deadline
It is very important we receive this form with all the appropriate evidence by 29 June 2012.
This means you can be confident you will receive your first payment at the start of term.
If the deadline passes, we'll always do our best to process your application as soon as
possible, however your full entitlement may not be available at the start of term.
This form should be returned within 9 months of the start of your academic year, otherwise
you may lose your full entitlement to student: [anonimizat].

2section1 finance available
All students can apply for the following student: [anonimizat]: n
• Maintenance Loan
• Tuition Fee Loan
• Parents' Learning Allowance
• Adult Dependants' Grant• Travel Grant
• Disabled Students' Allowances
• Childcare Grant
Tick
SFE/PR1F/1213If you started your course in academic year
2006/07 or after (not including gap year
students who started in 2006/07) you can
also apply for: n
• Maintenance Grant
• Special Support Grant
• Bursaries and ScholarshipsIf you started your course in academic year
2005/06 or before (this would include gap year
students who started in 2006/07) you can also
apply for: n
• Grant for Tuition Fees
• Higher Education 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 2012/13' or by visiting our
website
www.direct.gov.uk/student: [anonimizat] 5 easy steps
Depending on your circumstances you may not need to complete all of the steps.
Step1For all students
•Complete sections 2-4.
•You do notneed to complete section 4 if you are onlyapplying for a Tuition Fee Loan.
•If you are applying for a loan you need to tell us how much you want by completing
the loan request section on page 9.
!If you onlywant to apply for a Tuition Fee Loan or a reduced rate of Maintenance Loan you
can go to Step 5.
Step2For students who want student: [anonimizat]
•Complete sections 5 and 6.
•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 what
evidence needs to be provided can be found in the notes. ne
Step3For students who have dependants
•Complete section 7.
•You should complete this section if you have any children or adult dependants and
want to apply for financial help in relation to them.
!If you are a single independent student go directly to Step 5.

3section1 finance availablecontinued
SFE/PR1F/1213Tick TickStep4For students who want student finance based on household income
•Complete section 8.
•Depending on your answers in section 8 you may need to ask your parent(s) or partner
to provide details about their income in section 9 so we can work out what your full
entitlement to student finance will be.
Step5For all students
•Make sure that you have signed the Student Declaration on pages 15 and 16.
If you asked someone to complete section 9, make sure that they have signed their
declaration(s) on page 25.
Other student finance available
Childcare Grant n
If you want to apply for the Childcare Grant
you need to complete this form first then
complete a Childcare Grant (CCG1)
application form.
Please send me a CCG1application form: Disabled Students’ Allowances (DSAs) n
If you want to apply for DSAs you need to
complete this form first then complete a
Disabled Students’ Allowances application
form.
Please send me a DSA application form:
Childcare Grant and DSA application forms can also be downloaded from
www.direct.gov.uk/studentfinance or requested by calling us on 0845 300 5090.
What if I have further questions?
If you have further questions you can:
• visit www.direct.gov.uk/studentfinance
• refer to 'A guide to financial support for higher education students 2012/13' which can be
downloaded from www.direct.gov.uk/studentfinance
• call us on 0845 300 5090
Where do I send my form?
Return this form to: Student Finance England, PO Box 210, Darlington, DL1 9HJ.
Please remember to pay the correct postage.

section
personal details
Customer Reference Number (if you have one)
Personal details
a Title
Forename(s)Mr Mrs Miss Ms
Surname
Sex Male Female
Date of birthYEAR MONTH DAY2
SFE/PR1F/1213Contact details
b Please give your current home address. If you know it, please also give your term-time
correspondence address. n
Home address
Postcode
Home phone numberTerm-time address
Postcode
Date on which you will move to this address
Mobile phone number
Email addressYEAR MONTH DAY
Marital status
c Please tick one box:
Single
Living with a partner
Married/civil partnershipn
Please give the date of marriage/civil partnership
Separated
Divorced/dissolved civil partnership
Widowed/surviving civil partnerYEAR MONTH DAY
4e
e
e
e

section3about your course and university or college
Yes NoYes No
SFE/PR1F/1213a Full tuition fee amount for the academic year 2012/13
Please remember your tuition fee amount can change each year. If you are unsure about
the tuition fee amount you will be charged, please contact your university or college forclarification.
b Is this the final year of your course?
c Will you be studying at exactly the same university or college and on exactly the
same course that you were in the academic year 2011/12?if ‘Yes’ go to f
If any of your course or university and college details have changed in any way since you
applied for student finance for the previous academic year, you must complete all of the
questions in this section with the new details.£
University/college details
d University/college name and address
Postcode
UCAS personal identification number
UCAS university/college code
UCAS campus code (if applicable)
Course details
e Course name
If you are following a combined studies or modular course, please list all subjects being studied
UCAS course code
Qualification you expect to
gain (e.g. BSc Physics)
Course start date
Course end date
Course length (years)YEAR MONTH
YEAR MONTH
5

section3about your course and university or college
continued
SFE/PR1F/1213Year of courseFoundation
First year
Second yearThird year
Fourth year
Other (give details)
If the course is franchised to another university/college, give the address of the other
university/college
Postcode
fWhich of the following is your course? Tick one box only.
6
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)
Flexible postgraduate ITT
Part-time undergraduate ITT
Part-time ITT
(excluding first degrees)Do you have a disability which prevents you
from attending your university/college in person?
You must provide evidence that clearly shows you
are unable to attend university or college in person
for a reason which relates to your disability. eYes Non
Other course types (if you started your course before 1st September 2010) n
Answer both questions
Number of weeks you will be studying
full-time in academic year 2012/13.
Number of weeks you will be on full-time
teaching practice in academic year2012/13.
You must provide a letter from your u
niversi
eeks
eachin
3.ty or
you will
g
ecollege confirming the number of w
be on full-time study and full-time t
practice during academic year 2012/1

SFE/PR1F/1213Term 1 Living with parent(s) Elsewhere or own home
Term 2 Living with parent(s) Elsewhere or own home Term 3 Living with parent(s) Elsewhere or own home
Term 1 University or college Study abroad Placement in the UK or abroad
Term 2 University or college Study abroad Placement in the UK or abroad
Term 3 University or college Study abroad Placement in the UK or abroad
Abroad
UK
Don’t know
Postcode Yes No
7section3about your course and university or college
continued
g Are you eligible to apply for any bursary or award, excluding a social work
bursary, for the academic year 2012/13 from any of the following?
• National Health Service (NHS)
• Department of Health (DoH)
• Scottish Government Health Directorate Bursary
(Scottish Healthcare Allowance) n
If ‘Yes’, is this bursary or award income assessed or non-income assessed?
Income assessed Non-income assessedYes No
Term details
h Where will you live during the academic year 2012/13?
i Where will you spend most of your time studying in the academic year 2012/13?
if you have ticked ‘University or college’ and/or
‘Study abroad’ for all 3 terms go to section 4
j Where will your placement be?
If your placement is abroad, have you
been accepted onto the ERASMUS
exchange scheme? if ‘Yes’ go to section 4
Placement name and address, if known

4
SFE/PR1F/1213 8section3about your course and university or college
continued
l 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
and young 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. n
section
your UK bank or building
society account details
UK bank/building society 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 your
Maintenance Loan, Bursary (if applicable) or any grant payments being delayed.n
Sort code
Account number
Building society roll number (if applicable)

SFE/PR1F/1213loan request section
If you are applying for a Maintenance Loan, a Tuition Fee Loan or both, please complete this
section to tell us how much you want to apply for.
££
9Tick
TickNational Insurance Number n
Maintenance Loan n
Amount of Maintenance Loan
you would like to apply for: Maximum available to you
If you wish to apply for less than the maximum
available to you, please state the amount.
Tuition Fee Loan n
You can apply for up to a maximum of £3,465 depending on your circumstances. You should find
out how much your university or college is charging before you apply for a Tuition Fee Loan.
Amount of Tuition Fee Loan
you would like to apply for: Maximum available to you
If you wish to apply for less than the maximum
available to you, please state the amount.
Contact details
Please give the names and addresses of two contacts. The contacts you give should live at
different addresses and will only be contacted if, for example, you move address and do
not inform us. You must inform your contacts that you are providing us with their details.
Contact 1
Forename(s)
Surname
Relationship to you
Address
Postcode
Country
Phone numberContact 2
Forename(s)
Surname
Relationship to you
Address
Postcode
Country
Phone number

10 SFE/PR1F/1213Yes Nosection5dependent and
independent students
Yes No
Yes NoThis section determines whether you are a dependent or an independent student. This
is important as it establishes whose income we need to take into account from yourhousehold before we calculate your entitlement.
a1Will you be 25 or over on the first day of the academic year?
if 'Yes', you are an independent student, go to section 6
a2Have you been married or in a civil partnership at any time before the first
day of the academic year?
if 'Yes', you are an independent student, go to section 6
a3Will you have the care of a person under the age of 18 on thefirst day of the academic year?
en
if 'Yes', you may be considered an independent student go to section 6
If you have previously been considered independent because you have supported yourselffinancially for a total of 3 years or more prior to the start of the first academic year of your
course, you will continue to be considered independent. if this applies to you go to section 6
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 with
them.
You are irreconcilably estranged from (have no contact with) your parents and this will
not change.
At any point from the age of 16 to the start of your course, you have not been under the
legal 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.Your parents are living outside the European Union and the assessment of their financial
circumstances would place them in jeopardy.
Your parents are living outside the European Union and it would not be reasonably
practicable or possible for them to send you money.nn
If you have ticked any of the boxes above, you will be contacted for evidence and
subject to this, you may be considered independent.
if you have ticked any of the boxes above go to section 6

£
£ £ Yes No
Yes Nosection6 student financial questions
11 SFE/PR1F/1213(DD MM YYYY)If you leave any questions blank we will not be able to process your application.
If a question does not apply to you, please enter ‘None’ or ‘N/A’ as the answer.
Unearned income
a 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 2012/13.n
What is the source of this income?
Payments from an employer
b Will your employer be releasing you to attend your course for the academic year 2012/13?if ‘No’ go to d
If ‘Yes’, how much will your employer pay you for time spent attending your course during this period?
n
c During the academic year 2012/13, will you or your employer pay any money into a pension fund on your behalf?
If ‘Yes’, how much during this period?
Dependent children
d Give details of any children who will be wholly or mainly financially dependent on you during the academic year 2012/13.When stating the child’s income, include their income from all sources after income tax and social security contributions.
Child’s full name Date of birth
e Relationship
to youWho will
they live with?Child’s income
n

section7Parents' Learning Allowance, Adult
Dependants' Grant and Childcare Grant
12Only complete this section if you are applying for Parents' Learning Allowance, Adult
Dependants' Grant or Childcare Grant.
a Are you a lone parent?
Your partner £ You £ Your partner £ You £ Yes No
Husband, wife or partner Other adult dependant
£ Other adult dependant £ Husband, wife or partner
£ Husband, wife or partner£ Other adult dependant£ Husband, wife or partner£ Other adult dependant£ Husband, wife or partner£ Other adult dependant
£ Husband, wife or partner
£ Other adult dependant £ Husband, wife or partner£ Other adult dependant £ Husband, wife or partner£ Other adult dependant £ Husband, wife or partner£ Other adult dependant
£ Other adult dependant £ Husband, wife or partnerYes Noif ‘Yes’ go to d
b Are you under 25, living with a partner and applying for
Childcare Grant or Parents’ Learning Allowance?if ‘No’ go to d
SFE/PR1F/1213c Give the total estimated income after income tax and National Insurance deductions in the academic year 2012/13 for:
How much of this will be Child Tax Credit for the academic year 2012/13?
d If you are a lone parent and are notclaiming Adult Dependants' Grant go to f
Give an estimate of your husband's, wife's, partner's or other adult dependant's income for
the academic year 2012/13.
Income from earnings
after deductions
Adoption Agency payments
Any disability pension or benefit
Child Benefit
Guardian’s Allowance
Fostering or Boarding Out
payments n
Residence Order Allowance
Child Tax Credit
Working Tax Credit

section7Parents' Learning Allowance, Adult
Dependants' Grant and Childcare Grantcontinued
13Husband, wife or partner Other adult dependant
All other income after deductions
If other, what is it?
If applying for Adult Dependants' Grant, please indicate who the adult dependant is:
Your Your Your partner (if Other adult
husband wife you are 25 or over) dependant £ Husband, wife or partner£ Other adult 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. e
f Answer this question if you are applying for 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. nType £ Type £ Type £ Type £
Yes No
SFE/PR1F/1213

section8 about your family
14 SFE/PR1F/1213If you are a dependent student, go to question a.
Mother Father Both N/A or
Single
Living with a partner
Married/civil partnership
Separated
Divorced/dissolved civil partnership
Widowed/surviving civil partner
Yes NoIf you are an independent student with a partner, go to the Student Declaration on
pages 15 and 16 and then pass this form to your partner to complete section 9.
If you are a single independent student, go to the Student Declaration on pages
15 and 16.
a With which parent do you normally live, or have more contact with?
What we mean by 'parent', for the purposes of working out your household income, can
change depending on when you started in higher education. n
b What is the marital status of this parent?
c Have your parents divorced, separated
or been in a civil partnership which has
been dissolved, since
1 September 2011? e
Now please read and sign the Student
Declaration on pages 15 and 16 and then
pass this form to the person(s) who you
have indicated in 'question a' to complete
section 9.Now please read and sign the Student
Declaration on pages 15 and 16 and
then pass this form to the person(s)
who you have indicated in 'question a'
to complete section 9.

Student Declaration n
15 SFE/PR1F/1213Before signing and returning your completed
form, you should read the Data ProtectionStatement in the accompanying notes.
This declaration covers all of the student finance
available to students for academic year 2012/13.
By signing this declaration you are confirming
that you have read the specific terms andconditions about loans, Childcare Grant andDisabled Students' Allowances because they will
affect you if you apply for them at any time inacademic year 2012/13. If you don’t apply forthese in academic year 2012/13 their specificterms and conditions will not affect you.
Your application for financial support may be
delayed unless you sign and date thisdeclaration.n
General Declaration
•I confirm that to the best of my knowledge and
belief, the information I have provided is true andcomplete. If it is not I understand I might be
refused financial support, or prosecuted and my
financial support withdrawn.
• I agree to give the Student Loans Company
(SLC) any information they require to process myapplication and agree to tell them immediately ifmy circumstances change in any way that might
affect 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 an
overpayment of financial support, I am obligated
to repay this in full.
Loan Contract
aI confirm I have read and understood ‘Student
loans: A guide to terms and conditions’ availableonline at
www.direct.gov.uk/studentfinance
bI acknowledge and agree that any loan(s) made
to me by the Secretary of State for Business,Innovation and Skills, ‘the lender’ (which includes
any persons exercising functions on behalf of the
Secretary of State pursuant to section 23(4) of
the Teaching and Higher Education Act 1998 as
amended from time to time or successorlegislation, ‘the Act’) will be on the terms set out
in these declarations and in Regulations which
are made under section 22 of the Act as
amended from time to time.cI undertake to repay the lender any loan(s) madeto me, together with all and any interest,penalties and charges which apply.
dI agree that any loan(s) made to me as a
consequence of the acceptance of my applicationby the lender is a/are contract(s) between meand the lender which binds me from the paymentto me of the first loan advance and that the
repayment of any such loan(s), together with alland any interest, penalties and charges whichapply, will be due by me to the lender as a debt.
eI agree that I shall be obliged to make repaymentof my loan(s), together with all and any interest,penalties and charges which apply, to suchaddress as shall be notified to me in writing andthat any services in respect of my loan(s) may be
provided at such address or other address(es) asthe lender may from time to time determine andthat the service of providing the loan is providedat the lender’s principal address.
fI agree that any action for repayment and/or inrespect of or in connection with my loan(s) and/orall and any interest, penalties and charges whichapply, will be brought before the ordinary civilcourts and shall be governed by the generalrules of civil procedure.
gI agree that my request for a loan, the loan andthe contract between me and the lender shall begoverned by the law of the place of my homeaddress as stated in this application form (or, ifmy address is outside the United Kingdom,English law).
hI irrevocably agree that the courts of the part ofthe United Kingdom in which my home addressstated in this application form is situated (or theEnglish, Scottish and Northern Ireland courtswhere my address is outside the UnitedKingdom) shall have non-exclusive jurisdiction tohear any action or proceedings arising out of orin 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 me inany other court of competent jurisdiction.
iI agree that from the date I submit this form untilthe date when my loan(s), together with all andany interest, penalties and charges which apply,is fully repaid I will notify the lender of anychanges in the personal details (includingNational Insurance Number) and contact details Ihave provided as required in accordance with theregulations referred to in paragraph b.

YEAR MONTH DAYrjIn the event that I leave the United Kingdom to
reside outside the United Kingdom or that for any
other reason I am outside the UK tax system, I
undertake to inform the lender in accordance with
the regulations referred to in paragraph b and Iundertake to provide the lender with my new andany subsequent contact details until my loan,together with all and any interest, penalties and
charges which apply, is fully repaid.
kI agree to take all future action requested by the
lender and provide the lender with all information
required to ensure repayment, in accordance
with the regulations referred to in paragraph b.
lIf I breach any of the terms under which any
loan(s) will be made I agree that I will be obligedto pay any charges and penalties which may
apply under the Teaching and Higher Education
Act 1998 and the regulations made under that
Act, as amended from time to time or successor
legislation and/or regulations.
mI understand that the Student Loans Company(SLC) will check my National Insurance Number
and personal details with the Department forWork and Pensions (DWP). If I do not know my
National Insurance Number, or if the number Iprovide cannot be authenticated, DWP will trace
and give my number to the lender.
nIf I have broken the terms of this contract I agree
that the lender may share information held about
me and my account with any person, including
the government or a government agency ofanother country, who may assist in establishingmy whereabouts and/or in taking action torecover outstanding loan amounts.
o I understand that if I received any loan(s) prior to
1 September 2012 and have started a newcourse on or after 1 September 2012 in relationto which I have obtained any additional loan(s),
then I agree to the repayment terms set out in
this paragraph. If I make a payment towards a
loan I obtained before 1 September 2012 and Ihave already repaid this loan in full, then SLC
shall be entitled to deduct any such overpayment
from the outstanding loan(s) I obtained on orafter 1 September 2012.
Disabled Students’ Allowances (DSAs)
• I understand that any equipment I receive
through DSAs must be used for my course of
study and SLC is not responsible for paying anyrepair costs.
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 evidence
of childcare costs within the timescales set, I
might lose my entitlement. Also if my payments
to my childcare provider are different from theestimates I provide, I understand that further
payment will increase or decrease accordingly, or
if no further Childcare Grant payments are due to
be paid to me, I may be liable to repay any
difference.
• I confirm that neither I nor my husband, wife, civil
partner or cohabiting partner have chosen toreceive support for childcare from the childcare
element of the Working Tax Credit and I agree to
tell SLC immediately if I or my husband, wife,
civil partner or cohabiting partner does receive
this support.
16 SFE/PR1F/1213Customer Reference Number
Your full name
(in BLOCK CAPITALS)
Your signature Date
Your decision about bursary and scholarship data sharing consent will not affect your
entitlement to any other financial support available.
If you started your course in academic year 2006/07 or after, you may be eligible for a bursary
or scholarship. In order for your university or college to determine and pay any non-repayable
bursary or scholarship to which you may be entitled, we will need to share some of your
personal, financial and course details as well as information about your eligibility for student
finance with them. Most universities and colleges will not pay bursaries and scholarships if
you do not give consent. n
If you do not wish your details to be shared for this purpose, please tick this box.
!The relevant person(s) you indicated in section 8 must complete section 9, as well as the declaration(s) on page 25. Please pass this form to them now.
If you are a single independent student please now go to page 27 to finalise
your application.

17section9financial details for the tax year 2010-11
for parents and partners
What details do I need to provide in this section?
In this section of the form you need to tell us some personal details and what your financial
income was for the tax year 2010-11. You must tell us your 2010-11 income details as we
cannot accept amounts from any other tax year. We need your income amounts so we can
work out what the student(s) you are supporting are entitled to.
Quick start guide
Section 9 is divided into 6 parts, this guide gives you a quick summary of each part.
Part A
Tell us your name and address and some other personal information.
Part B
Tell us your National Insurance Number.
Parts C and D
Answer every question, providing financial information for the tax year 2010-11.
Part E
Answer every question, telling us about any income deductions you had during the tax
year 2010-11 where appropriate.
Part F
If you have any children who are financially dependent on you, tell us about them here.
SFE/PR1F/1213What happens if my household income has dropped since tax year
2010-11? n
If your household income has dropped by 15% since tax year 2010-11 you can apply for a
‘Current Year Income Assessment’.
This means we would use your expected income for tax year 2012-13 instead of your actualincome from tax year 2010-11 when calculating the student’s entitlement. However, theremust be at least a 15% drop in the overall household income (not just your own income)
between these two tax years for us to do this and we will ask for evidence of your 2012-13
income at the end of that tax year.

18 SFE/PR1F/1213section9continuedfinancial details for the tax year 2010-11
for parents and partners
/ / / /Part A – Your personal details
Person 1
Your 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
Postcode
Home telephone number
Email addressPerson 2
Your 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
Postcode
Home telephone number
Email address
Tick TickYou do not have to disclose your financial information to the student.
If you would like to provide it separately, you can call us on 0845 300 5090 to request a form or
alternatively, you can have the form sent to you by ticking this box:
Person 1
Send me a separate formPerson 2Send me a separate form

19 SFE/PR1F/1213section9continuedfinancial details for the tax year 2010-11
for parents and partners
Yes No Yes NoPerson 1 Person 2
Yes No Yes NoPart B – Data sharing and you
–
–We will share and check the details you give us with HM Revenue & Customs, allowing us
to gain the most accurate information possible. This can only be done if you have a validNational Insurance (NI) Number.
n
I have an NI Number
Please provide your NI Number below:Tick Tick
Person1
Person 2
You are now ready to provide
your financial information.go to Part CI do not have an NI Number
If you do not have a NI Number because youreceive non-UK taxable income, please providethe equivalent financial information in pounds
sterling.
You are now ready to provide
your financial information.go to Part C
Part C – Your financial information
Instructions
• Please give financial details for the tax year from 6 April 2010 to 5 April 2011.
• Answer ‘Yes’ or ‘No’ to every question, if you answer 'Yes' please provide the income amount.
• 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 2010-11.
• If you need help with any questions you should refer to the guidance notes each time you see
this icon.
• If any questions are left blank we will not be able to process this application.n
n
!fYou do not need to send us any evidence. However, you should keep all of your 2010-11
inancial evidence as we may ask for it at a later date to verify the details you have provided.
Q1 Did you receive Working Tax Credits or Child Tax
Credits?
Q2 Did you receive Income Support?

20 SFE/PR1F/1213Yes No Yes NoPerson 1 Person 2section9continuedfinancial details for the tax year 2010-11
for parents and partners
Yes No Yes NoPerson 1 Person 2
£ £
£ £
£ £
£ £
£ £
£ £Q3 Did you receive any income from salary, wages,
taxable state benefits or from occupational orprivate pensions?
aTotal income from salary/wages nYes No Yes No
£ £
£ £
£ £
£ £bTotal income from taxable state benefits
cTotal income from occupational pension(s)
dTotal income from private pension(s)Person 1 Person 2
n
Q4Did you receive any income from a state retirement
pension? n
aTotal non-lump sum amount received
bTotal lump sum amount received
Q5Did you receive any income from savings and
investments? n
aTotal interest from UK banks, building societies and
unit trusts
bTotal income from UK life insurance gains, securities
and partnerships
cTotal income from UK investments and dividends
dTotal income from foreign investment and dividends

21 SFE/PR1F/1213Yes
No Yes
No section9continuedfinancial details for the tax year 2010-11
for parents and partners
Yes No Yes NoPerson 1 Person 2
Q6Did you receive any taxable benefits in kind? n
Total income received£ £
Yes No Yes NoPerson 1 Person 2
£ £
£ £
Yes No Yes No
£ £Q7Did you receive any other income during the 2010-11 tax year that you haven’t yet told us about?
Person 1Go to Part D
Go to Part EPerson 2Go to Part D
Go to Part E
Part D – Other income
Instructions
• Complete Part D in the same way you completed Part C giving financial details for the tax year
from 6 April 2010 to 5 April 2011.
•If you need help with any questions you should refer to the guidance notes each time you see
this 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.n
Q1Did you receive any income from self-employment? n
aTotal taxable profit from businesses
bTotal taxable profit from partnerships
Q2Did you receive any income as a Minister of religion? n
Total taxable income minus expenses that are not
included on your P60 or P11D

Yes No Yes NoPerson 1 Person 2
£ £
Yes No Yes No
£ £
Yes No Yes No
£ £section9continuedfinancial details for the tax year 2010-11
for parents and partners
Yes No Yes NoQ3Did you receive any other taxable income or lump
sums?n
Total income received£ £
Yes No Yes No Q4Did you receive any income from property lettings? n
Total income received£ £
Yes No Yes No Q5Did you receive any income from UK trusts? n
Total income received£ £
22 SFE/PR1F/1213Q6Did you receive any foreign income? n
Total income received
Q7Did you receive any income from an overseas
pension? n
Total income received
Q8Did you receive any other overseas income
and gains? n
Total income received

Yes No Yes No
£ £Person 1 Person 2section9continuedfinancial details for the tax year 2010-11
for parents and partners
Part E – Income deductions
Yes No Yes No
£ £Person 1 Person 2
Yes No Yes No
£ £Person 1 Person 2Instructions
• Complete Part E in the same way you completed Part C giving financial details for the tax year
from 6 April 2010 to 5 April 2011.
• If you need help with any questions you should refer to the guidance notes each time you see
this icon. n
23 SFE/PR1F/1213Q1Did you pay any private pension contributions?
Total amount you paid
Q2Did you pay any Additional Voluntary Contributions
(AVCs)?
Total amount you paid
Q3Did you have any allowable expenses on which
you claimed tax relief? n
Total amount on which you claimed tax relief

24 SFE/PR1F/1213section9continuedfinancial details for the tax year 2010-11
for parents and partners
Part F – Your dependants n
Identify any children who will be wholly or mainly financially dependent on you.
Q1Child dependants not in further or higher education in academic year 2012/13
Include unearned income for alldependants. Only include earned income details for persons
aged 16 and over. Do not count casual earnings of persons under 16.n
Full name Date of birth
(DD MM YYYY)Income for the year
Q2Child dependants in further or higher education in academic year 2012/13
Do notinclude the applicant when completing this question.
If the student is your partner, please include any children they named in section 6 of this form if the
children have applied for student finance.
Full name
(DD MM YYYY)Date of birthSchool, college or
university CourseAre they receiving
financial support?
If so, from which
authority or
organisation?

25Declaration for parents and partners n
Before signing, you should read the Data Protection Statement in the notes that
accompany this form. n
This application for financial support may be delayed unless you sign and date thisdeclaration.
• 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 for financial
support that the SLC may ask for and agree to tell them immediately if my circumstances
change in any way that might affect this application for financial support.
Person 1
Your full name (in BLOCK CAPITALS)
Your signature
Date
Your decision about bursary and
scholarship data sharing consent will notaffect the student's entitlement to anyother financial support available.
If a student started their course in academic
year 2006/07 or after they may be eligible fora bursary or scholarship. In order for a
university or college to determine and pay
any bursary or scholarship to which thestudent(s) you are supporting may beentitled, we will share some of your personaland financial details with them.
n
If you do not wish your details to be shared
for this purpose, please tick this box. YEAR MONTH DAYPerson 2
Your full name (in BLOCK CAPITALS)
Your signature
Date
Your decision about bursary andscholarship data sharing consent will notaffect the student's entitlement to anyother financial support available.
If a student started their course in academic
year 2006/07 or after they may be eligible fora bursary or scholarship. In order for a
university or college to determine and pay
any bursary or scholarship to which thestudent(s) you are supporting may beentitled, we will share some of your personaland financial details with them.
n
If you do not wish your details to be shared
for this purpose, please tick this box.
YEAR MONTH DAYr r
!Now pass this form back to the student.
SFE/PR1F/1213Deadline
It is very important we receive this form with all the appropriate evidence by 29 June 2012.
This means you can be confident the student will receive their first payment at the start of term.
Please remember if the deadline passes we will do our best to process this application as soon
as possible, however the full entitlement may not be available at the start of term.

26 SFE/PR1F/1213Additional notes
If you are providing extra information please clearly mark what section and question the
information is about.

27 SFE/PR1F/1213Checklist
Before returning this form, please make sure you have done the following:
•Fully answered all questions that apply to you.
•Enclosed all the documents we have asked for
as evidence where you have seen this icon next
to a question. e
•Signed and dated the relevant declaration(s).
Within 6 weeks of returning your completed application form with all the relevant evidence,
you will be sent a letter showing the amount of financial support you will receive.
Please remember to pay the correct postage.Tick
Tick
Tick
You must return your completed form to the address shown below:
Student Finance England
PO Box 210
Darlington
DL1 9HJ