Immigration History Declaration Form

Thank you for your application. Please note:

• We strongly advise you to read the Home Office’s guide for the Student Route visa.
• Please ensure you check your emails regularly, and UCAS TRACK if you have applied via UCAS.
• Please do not pay a study deposit to CCCU until you are requested to do so in MyRecord.

PART A: Please complete (print or type):

Your Name:

Your Student ID Number:

PART B: Please provide the following information in full so that we can process your application.

1) Have you ever studied in the UK before?

□ YES □ NO

2) If you answered YES to Question 1, were you in the UK on a visa during your studies?

□ YES □ NO

If you answered YES to either of the questions above, please list the UK institutions you studied at, along
with the requested details. If you need more space, please use the back of this page. This form will not be
accepted if this information is missing.

Name of Institution
Dates of Course Title and Did you Visa Details (type,
Study Level of Study complete the start & end dates)
(from/to) (as written on your qualification? If you studied on a Tier
previous CAS – 4, Student Route Visa
RQF or QCF level) or a different visa type,
please list it here

Canterbury Christ Church University Registered Company No: 4793659

North Holmes Road, Canterbury, Kent, CT1 1QU Tel +44 A Company limited by guarantee
(0)1227 922000 Registered Charity No: 1098136
www.canterbury.ac.uk
Professor Rama Thirunamachandran - Vice Chancellor
 3) Have you ever had a visa in order to visit, work or live in the UK
previously?

□ YES □ NO

If you answered YES to the question above, you need to list any visas you have had for the UK, along with
the details listed below. If you need more space, please use the back of this page. This form will not be
accepted if this information is missing.

Type of Visa / Visa Start and End Dates Notes

Type of Leave to Remain (Start & Expiry)

4) Have you ever had a visa application to the UK or another country refused?

□ YES □ NO

5) Have you ever had entry clearance, leave to enter, or any variation of leave to enter or remain in the
UK refused?

□ YES □ NO

If you answered YES to questions 4 and/or 5, please provide details here. Remember: you need to attach a
copy of your visa refusal letter(s) when you submit this form. This form will not be accepted if this information
is missing.

Date of Type of Visa / Country Reason for Refusal

Refusal Type of Leave

6) Have you ever been deported from a country or stayed in a country longer than allowed by your
visa?

□ YES □ NO

If yes, please provide details below:

Canterbury Christ Church University Registered Company No: 4793659

North Holmes Road, Canterbury, Kent, CT1 1QU Tel +44 A Company limited by guarantee
(0)1227 922000 Registered Charity No: 1098136
www.canterbury.ac.uk
Professor Rama Thirunamachandran - Vice Chancellor
 7) Did you use an agent or other intermediary to apply to study at the university? If so, please name
the agent below:

8) Do you have any active or pending and/or unspent criminal charges or convictions in the UK or any
other country?

□ YES □ NO

9) How will you fund your studies?

□ Self-Funded
□ Parents / Legal Guardian
□ Parents have provided funds which are already in your own account
□ Sponsorship (Canterbury Christ Church University)
□ Sponsorship (other sponsor)
□ Loan or other financial assistance

10) Will you be applying for your new visa with dependents? If yes, please state the number of
dependents and who they are (e.g. husband/wife/partner, child/ren):

□ YES – How many dependents and who they are: __________________________________

□ NO

11) Where will you make your visa application?

□ My country of residence (please specify: _____________________________ )

□ Another country (please specify: _______________________________ )

Please upload scanned copies of the following documents into MyRecord. We cannot proceed without
receiving all relevant documents.

• Your passport photo page

• Any previous UK visa(s) and BRP card(s)
• Any previous visa refusals (for the UK or any other country)
• Immigration History Declaration Form
• Student Route Visa Agreement

Canterbury Christ Church University Registered Company No: 4793659

North Holmes Road, Canterbury, Kent, CT1 1QU Tel +44 A Company limited by guarantee
(0)1227 922000 Registered Charity No: 1098136
www.canterbury.ac.uk
Professor Rama Thirunamachandran - Vice Chancellor
By signing this document, you confirm that:

All the information I have given on this form is true and accurate.

I understand that the originals of any copied documents I provide will be checked at Registration.

I understand that giving inaccurate or false information or submitting fraudulent documentation will affect my
ability to register or remain on a programme of study within the University.

I also understand that the University may require further information/documentation to assess my
immigration history.

By signing the below declaration, I authorise Canterbury Christ Church University to make enquiries
regarding my immigration status to the Home Office.

Signed: …………………………………….……. Date: ………………………………………….

Print name: …………………………………….…….

Please upload this completed form to MyRecord or return it to: Compliance Department, Canterbury
Christ Church University: ukvi.compliance@canterbury.ac.uk

Canterbury Christ Church University Registered Company No: 4793659

North Holmes Road, Canterbury, Kent, CT1 1QU Tel +44 A Company limited by guarantee
(0)1227 922000 Registered Charity No: 1098136
www.canterbury.ac.uk
Professor Rama Thirunamachandran - Vice Chancellor