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Culture Documents
Application Form PDF
Application Form PDF
April 2013
Tier 4 Student
This printed application is for informational purposes only.
Please do not send a copy of this application by post, as your official application is submitted online to the UK
Visas and Immigration.
Customise application
Lead applicant
Personal details
Title Mr
Gender Male
Nationality Indonesia
Address
County Lanarkshire
Postcode G4 0PF
Correspondence address
Reference numbers
Tell us about the reference numbers that have been assigned to you
Have you ever had any UK Visas and Immigration reference numbers Yes
assigned to you?
Can you provide a current passport or travel document with your Yes
application?
Nationality Indonesia
Have you ever had any other passport or travel document that you have Yes
used to travel to the UK?
Can you provide a previous passport or travel document with your Yes
application?
Nationality Indonesia
Previous addresses
Please give details of your previous addresses in Northern Ireland and the dates you lived there
Have you lived at any other address in the UK within the past 5 years? Yes
County Lanarkshire
Postcode G1 2TD
Personal history
Personal history
Have you been convicted of any criminal offence in the UK or any other No
country?
Do you have any civil judgments against you or any civil penalty under the No
UK Immigration Acts?
Have you ever been charged or indicted in any country with a criminal No
offence for which you have not yet been tried in court?
In either peace or war time have you ever been involved in, or suspected No
of involvement in, war crimes, crimes against humanity, or genocide?
Have you ever been involved in, supported or encouraged terrorist No
activities in any country?
Have you ever been a member of, or given support to, an organisation No
which has been concerned in terrorism?
Have you, by any means or medium, expressed views that justify or glorify No
terrorist violence or that may encourage others to commit terrorist or
other serious criminal acts?
What is your current immigration status in the UK? None of the above
Entry clearance/visa
Did you have a visa/entry clearance when you last applied to come to the Yes
UK?
What is the reference number for that visa /entry clearance (this can be 007065823
found in your passport/travel document)?
Port (including airports) at which you entered the United Kingdom Glasgow
Have you ever stayed in the United Kingdom beyond your period of leave? No
Have you ever knowingly used deception when seeking leave to enter or No
remain, entered the United Kingdom illegally or worked in the United
Kingdom without immigration permission to do so (contrary to your
conditions of stay)?
Have you ever been refused entry clearance, leave to enter or leave to No
remain in the UK?
Have you ever been removed, required to leave or deported from the UK? No
Outstanding applications
Outstanding appeals
Public funds
Public funds
T4 course details
T4 sponsor details
Sponsor's address
County Lanarkshire
Postcode G4 0BA
T4 course details
What is the level of qualification you will be awarded when you NQF7 / SCQF11
successfully complete your course?
Is the address of your primary site of study the same as your Tier 4 Yes
sponsor's address?
T4 UCAS details
How can you demonstrate your English language ability? My CAS confirms I speak, listen, read and write in
English to B2 level
Maintenance (funds)
Maintenance (funds)
How much are your course fees as stated on your Confirmation of 10000
Acceptance of Studies (CAS), in pounds sterling?
Have you or your parent(s)/legal guardian(s) already paid any of your Yes
course fees?
What evidence are you providing with your application that this amount Information on the CAS
has been paid?
Do you have current leave as a Tier 4 Student, as a Student or as a Yes
Postgraduate Doctor or Dentist?
Have you, during your current period of Tier 4 leave: Started and completed the course of study for
which your current leave was granted?
How long was the course you completed, or if you are still studying, how Less than 6 months
much of your current course have you completed to date?
Where are you intending to study? Outer London or anywhere else in the United
Kingdom
Have you or your parent(s)/legal guardian(s) already paid any money to No
your sponsor for accommodation?
T4 general attributes
T4 general attributes
What is the level of the course you are applying for? NQF7 / SCQF11
Supporting documents
Current passport or travel document. This document is mandatory, if it is not submitted this Yes
application may be rejected as invalid.
Evidence of Identity - this document is mandatory, if it is not submitted this application may be rejected as invalid.
Evidence of your finances - if there is any maintenance left to pay, one or more of the following documents must be submitted.
Documents used to obtain your CAS – if your sponsor listed one or more of the following documents on your CAS, each of these
documents must be submitted.
Declaration
I need £17380.00 to cover my maintenance (monthly living costs and course fees for the first Yes
year of my course, or for the length of my course if less than one year). I certify that:
• I have paid £3500.00 to my sponsor for my maintenance and, where required, I am providing
specified evidence of this with my application.
• I have £13880.00 available to me in the manner specified in the Immigration Rules for my
remaining maintenance and, where required, I am providing specified evidence of this with my
application.
• All the money I am using is available to me in the manner specified in the Immigration Rules
and is for my living costs in the UK and will remain so available unless used to pay for living costs
in the UK or my course fees.
• When I am providing evidence of cash funds, this money has been held for a consecutive 28
day period ending no more than 31 days before this application.
Declaration
The information I have given in my application is complete and is true to the best of my
knowledge and belief.
The photographs I have submitted with my application are a true likeness of me.
The documents I have submitted in support of my application are complete and correct to the
I agree to co-operate with UK Visas and Immigration officials, or any other person charged by
the Secretary of State for the Home Office, with conducting pre-issue and post-issue checks in
relation to my application.
I am aware that the rules and requirements governing applications may change in the future
and that I should not assume the current rules and requirements will continue to apply.
Please read the following statements and confirm that you agree by placing a tick in the box
below.
• I confirm that I have read and that I understand and agree the above declarations.
• I confirm that the information I have given in this application is complete and is true to the best
of my knowledge and belief.
• I agree to the use of the data provided in this application in accordance with the UK Visas and
Immigration’s Information Charter.
• I understand that my details may in certain circumstances be passed to fraud prevention
agencies to prevent and detect fraud and money laundering. I also understand that such
agencies may provide the Home Office with information about me. Further details explaining
when information may be passed to or from fraud prevention agencies and how that
information may be used can be obtained from the Home Office website: