POINTS BASED SYSTEM FORM (VAF9 JUNE 2012) APPENDIX 3: TIER 1 (ENTREPRENEUR) SELF- ASSESSMENT

This form is for use outside the UK only. This form is provided free of charge.

For official use only

READ THIS FIRST

This form must be completed in blue or black ink. Only complete after you have obtained your points score from the electronic Self-Assessment Points Calculator (www.ukba.homeoffice.gov.uk/pointscalculator ). Please follow the guidance notes carefully and complete all questions as indicated. Please ensure you submit all relevant, original documents as indicated in the sections. It is better to explain why you do not have a document than to submit a false document. Your application will be automatically refused, and you may be banned from coming to the UK for 10 years if you use a false document, lie or withhold relevant information. You may also be banned if you have breached immigration laws in the UK Please ensure you also complete the main Personal Details form.

Part 1

About you

1.1 Given name(s)

1.2 Family name

1.3 Occupation (this is your current or most recent job)

Attributes:

You need to score a total of 75 points from Parts 2 5. You can score 25 points from either Part 2 or Part 3 (not from both). You should refer to the Immigration Rules and Tier 1 (Entrepreneur) Policy Guidance.

Part 2

Access to no less than 200,000 [25 points available]

Yes Yes No No

2.1 Do you have access to funds amounting to no less than 200,000? Put a cross (x) in the relevant box 2.1 Are you relying on third party funding for any of the 200,000? Put a cross (x) in the relevant box

Part 3

Access to no less than 50,000

3.1 Do you have access to funds amounting to no less than 50,000 from: Put a cross (x) in the relevant box one of more FSA registered Venture Capitalist firms regulated by the Financial Services Authority Give the name of the Venture Capitalist firm (s) together with the registration number for this activity with the FSA

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one or more registered UK entrepreneurial seed funding competition endorsed by the UKTI Give the name of the seed funding competition (listed as endorsed on the UKTI website)

one or more UK Government Departments, made available for specific purpose of establishing or expanding a UK Business Give the name of the UK Government Department

Part 4

Money is held in one or more regulated financial institutions [25 points available]
Yes No

4.1 Are the funds held in one or more regulated financial institutions? Put a cross (x) in the relevant box

Part 5

Money is disposable in the United Kingdom [25 points available]

Yes No

5.1 Are the funds disposable in the United Kingdom? Put a cross (x) in the relevant box

Part 6
6.1 Will you be part of an entrepreneurial team? Put a cross (x) in the relevant box Please provide details of the other member of the entrepreneurial team Name Yes No

Nationality

Date of Birth

D D
Passport Number

M M

Y Y Y Y

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Table of evidence listing each piece of evidence provided

All documents must be original. For each source of funds on which you are relying to claim points you must provide a letter from the financial institution holding the funds showing: That the money is available to you; and That the institution is regulated by the home regulator; and That the money is disposable in the UK. If you are part of an entrepreneurial team, both your names must be shown If third party funding is used, you must provide a letter from every third party granting permission for you to have access to the money and a letter of confirmation from a legal representative or legal representatives confirming that the signatures are valid (2 pieces of evidence). If the third party is a Venture Capitalist firm, a seed funding competition or a UK Government Department, the letter must confirm the award and the amount of money in the award. If you are part of an entrepreneurial team sharing funds, both of you must have equal access to funds and each document must show both names. You must complete the following table to confirm the specified documents provided with this application to demonstrate each source of funds. One line is completed (line 0) as an example only. Source No Letter from financial institution holding the money, confirming the amount of money, that the institution is regulated by the home regulator and that the money is transferable to the UK.
Letter from third party granting permission to use the money, if applicable. Legal representatives letter confirming validity of permissions if third party money is used. Letter from the FSA registered Venture Capitalist firm; seed funding competition; or UK Government Department; or combination of these totalling 50,000 of funds
state if venture Capitalist, Seed funding or Govt Dept

Amount of money in UK Pounds Sterling in this institution

Name of institution 0 1 2 3 4 5 6 7 8 9 10

Bank of Somewhere

YES

YES

X0,000

Totals

Number of pieces of evidence: >>>>>

>>>>>>>

>>>>>>>

>>>>>>>

Total amount of money claimed

Please note: Applicants should ensure that they are familiar with the requirements for further leave to remain in this category. They should note that the requirements may be revised and such revisions my apply to migrants who already hold leave to remain in the category.
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Part 7

English Language

You need a minimum standard of English language in order to score 10 points. Without this your application will be refused. You should refer to the Tier 1 (Entrepreneur) Policy Guidance. 7.1 Put a cross (x) in one box to indicate under which category of the English language requirement you are claiming points: National of a majority English speaking country. Go to question 7.2 Degree taught in English. Go to question 7.5 7.2 National of a majority English speaking country (10 points) English language Test. Go to question 7.3 Previous leave granted under the Business Persons category Go to question 7.9

Enter your nationality. This should be the nationality shown in the passport/travel document you wish to use for this programme. Go to Question 7.11 7.3 English language test (10 points). Provide details of the test taken Awarding Body: Title of qualification:

Level of qualification:

Date of Award:

D D
Award reference number:

M M

Y Y Y Y

7.4 Put a cross (x) in the following box to confirm the evidence you have supplied. Go to Question 7.11 7.5 Degree taught in English (10 points) The degree must be equivalent to a UK Bachelors degree or above. See Tier 1 (Entrepreneur) Policy Guidance Country of award >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> State/County/Province (if applicable)

Institution >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Qualification

Year of Award

Y Y Y Y

Start

D D

M M

Y Y Y Y
Grade

End

D D

M M

Y Y Y Y

Field of Study >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

7.6 Put a cross (x) in the relevant box to confirm how you verified you degree was taught in English The points-based calculator shows the degree was taught in English; Go to Question 7.7 7.7 Put a cross (x) in the relevant box to indicate what evidence has been supplied Original degree certificate - Go to Question 7.11 Original academic transcript - Go to Question 7.11

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7.9 What evidence are you providing to show your original entry clearance/leave to remain in the UK? Put a cross (x) in the relevant box Passport Other State which >>>

7.10 If you cannot provide original evidence of your previous entry clearance/leave to remain in the UK please supply as much detail as possible of your original application including the post of issue.

7.11 Put a cross (x) in the box to confirm that you claimed 10 points for your level of English Language >>>>>>>>>>>>>>>

Part 8

Maintenance - Refer to the Tier 1 (Entrepreneur) Policy Guidance

You must have a minimum level of funds to score 10 points for your level of funds. If you do not score 10 points your application will be refused. You must have 3,100 available funds for yourself plus 1,800 for each dependant accompanying you or intending to join you in the United Kingdom within 12 months of your arrival in the United Kingdom. This money must be held in your personal bank account for a consecutive 90 day period before the date of your application and not fall below the required amount at any time during that period. Refer to the Tier 1 (Entrepreneur) Policy Guidance. 8.1 Calculate the amount of funds required for you >>>>>>> and the dependants named in the Personal Details part of this application form and enter the amount here. 8.2 Put a cross (x) in the box to confirm that you have this amount of funds available and that it has been in your personal bank account for a consecutive 90 day period prior to your making this application.

8.3 Put a cross (x) in the relevant boxes to indicate what evidence of these funds has been supplied. All documents must be original. Building society/savings account pass book Letter from a bank or building society confirming funds and that they have been in your bank for a consecutive 90 day period Personal bank or building society statements covering a consecutive 90 day period Letter from a regulated financial institution confirming funds and covering a consecutive 90 day period

8.4 Put a cross (x) in the box to confirm that you have claimed 10 points for your level of funds >>>>>>>>>>>>>>>>>>>>>

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Part 9

Summary Sheet

Please complete the summary sheet below listing the points you have claimed and the documentation provided. You must provide the required evidence as specified in this application form and the Tier 1 (Entrepreneur) Policy Guidance. All documents must be original, unless otherwise stated. Failure to submit required evidence is likely to lead to refusal of the application. Points Scoring Area Access to 200,000 (Part 2) Access to 50,000 (Part 3) Financial institution is regulated (Part 4) Funds are disposable in the UK (Part 5) English language (Part 7) Maintenance (Part 8) Points Claimed Documents Provided (please list)

Total I confirm I have completed the Personal Details separate form and accept the contents of the declaration. Applicants signature Date

D D

M M

Y Y Y Y

YOU MUST SUBMIT A PAPER COPY OF THIS APPENDIX WITH YOUR SUPPORTING DOCUMENTS. ENSURE YOU ALSO COMPLETE THE PERSONAL DETAILS FORM EITHER ON PAPER OR ON LINE. YOU SHOULD SIGN THE DECLARATION AND SUBMIT THIS WITH YOUR OTHER DOCUMENTS

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