financial assessment form

8/14/2019 Financial Assessment Form

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www.direct.gov.uk/studentfinance

This form is also available on our website at

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SFE/PFF1/1011PFF1

Financial Assessment Form

2010/11For parents and partners providing

financial details for the first time


2/18SFE/PFF1/10112

H o w d o I c o m p l e t e t h i s f o r m ?

You need to provide details in all 4 sections of this form:

section 1 - personal details

section 2 - data sharing and you

section 3 - your financial information for tax year 2008-09

section 4 - your dependents

Please refer to the Support Notes at the back of this form each time you see this icon.

Whenever you see this icon you must provide evidence to support the students application.

Further information about the evidence required can be found in the Support Notes.

W h o s h o u l d c o m p l e t e t h i s f o r m ?

Complete this form if you are:

The students natural or adoptive parent.

The students step-parent.

The husband, wife, civil partner or cohabiting partner of one of the students parents.

The students husband, wife or civil partner.

The students partner, if the student is over 25 and you live with them as though you are marriedor in a civil partnership.

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Please remember to pay the correct postage.

What i f I have fu r the r ques t ions?

If you have further questions you can:

visit our website at www.direct.gov.uk/studentfinance

Call us on 0845 300 50 90

W h e r e d o I s e n d m y f o r m ?

Return this form to us at Student Finance England, PO Box 210, Darlington, DL1 9HJ.


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Male Female

SFE/PFF1/1011 3

section 1 personal de ta i l sa Students details

Customer Reference Number/ALIAS ID:

Forename(s):

Surname:

Date of birth:

b Your details

Customer Reference Number:

Forename(s):

Surname:

Sex:

Please complete this section with the details exactlyas they appear on your birth certificate or passport.

Date of birth:

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

Relationship to student:

Contact telephone number:

Email address:

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section 2 da ta sh a r i n g an d yo u

Person 1

You are now ready to provideyour financial information.

- -

This year it may be possible to share the details that you give us with other Governmentbodies, allowing us to gain the most accurate financial information possible. This can only bedone if you have a valid National Insurance (NI) Number. n

Please provide your NI Number below: If you do not have a NI Number because youreceive non-UK taxable income, pleaseprovide the equivalent financial informationin pounds sterling and provide theappropriate financial evidence.

go to Section 3

You are now ready to provideyour financial information.

go to Section 3

I have a NI Number I do not have a NI NumberTick Tick


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section 3 your financial information for tax year 2008-09

Yes No

Yes No

Please give financial details for the tax year from 6 April 2008 to 5 April 2009.

Answer every question in this section, providing income details where applicable.

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

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

Q2 Did you receive Income Support?

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How to answer questions 3 - 14

If you answer Yes to any of these questions you will need to provide the total amount ofincome you received for that income type.

If you need help to calculate the total income you should refer to the guidance notes.

Where any amount is entered, evidence for that amount must be provided.

If you answer No to a question, this means you are telling us that you did not receive anyincome from that particular income type.

Q3 Did you receive any income from salary, wages, occupationalpensions or taxable state benefits?

Total income received:

Q4 Did you receive any income from Self-employment?Combined total income showing on your SA103 and/or

SA200 forms:

Total income showing on your SA104 form:

Q5 Did you receive any income from a State RetirementPension?

Total non lump sum amount received:

Total lump sum amount received:

Yes No

Yes No

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Yes No

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Q13 Did you receive any income from an Overseas Pension?

Total income from an Overseas Pension:

Q14 Did you receive any other overseas income and gains?

Total income from other overseas income and gains:

Yes No

Yes No

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Obligations

Q15 Did you pay any private pension contributions?Total private pension contributions you paid:

Yes No

Q16 Did you pay any Additional Voluntary Contributions (AVCs)?

Total Additional Voluntary Contributions you paid:

Yes No

Q17 Did you have any allowable expenses on which you claimedtax relief?

Total allowable expenses on which you claimed tax relief:

Yes No

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D at a P r o t e c t io n Ac t 1 9 9 8The Student Loans Company (SLC) is a Data Controller under the Data Protection Act 1998.

We hold information for the purposes specified in our notification to the Information Commissionerincluding determining eligibility for student finance, assessing the maximum amount of financialsupport available, payment of student finance and the detection and prevention of fraud, and mayuse this information for any of these. The Secretary of State for Business, Innovation and Skills is a

joint Data Controller for your information.If false or inaccurate information is provided and fraud is identified, details may be passed to fraudprevention agencies to prevent fraud and money laundering.

We may share the information you have given us with other organisations including the Departmentfor Business, Innovation and Skills, other Government bodies and with the university or college forthese purposes. We may also get information about you from other organisations. If so, it will onlybe for the purposes described and as the law permits us to do.

For more detailed information about with whom we share your information and for what purpose,go to www.direct.gov.uk/studentfinance-dataprotection.

Dec la ra t ionThis 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 given on this formis true and complete and I understand that if I have given SLC false information, or have not giventhem complete information, I may be prosecuted and financial support withdrawn.

I agree to supply any further information in relation to the applicants application for financialsupport that SLC may ask for and agree to tell them immediately if my circumstances change inany way that might affect this application for financial support.

Your decision about bursary and scholarship data sharing consent will not affect the

student's entitlement to any other financial support available.In order for a university or college to determine and pay any bursary or scholarship towhich the student(s) you are supporting may be entitled, we will share some of your personal andfinancial details with them.

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

Date:

Your full name: (in BLOCK CAPITALS)

Your signature:

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S u p p o r t N o t e s

Notes n

Income Type Amount () Where to find amount Evidence

Total salary or wages for theyear:

Income from taxable statebenefits:

Occupational Pension:

Tips and other payments noton P60:

Directors salary or wages:

P60 Pay and incomedetails box

P60 - Pay and incomedetails box


SA102 E1 Box 3


Please send any of thefollowing:

Month 12 Wageslip

Original P60

Original P60U

Week 53 Wageslip

Total income received: Write this total figure on the application.

section 2 da ta sh a r i n g an d yo uAny information that we receive about you is kept securely and held strictly under the provisions of

the Data Protection Act.If you fail to provide your National Insurance (NI) Number on the application form but it is shown

on any evidence you provide us in support of an application, we may use this information and shareit with HM Revenue and Customs in order to obtain accurate financial information about you.

section 3 your financial information for tax year 2008-09Please give evidence for the tax year 2008-09. Normally, this is the year ending 5 April 2009, but maydiffer if your employer or business has a tax year which does not end in April.

For any income paid in a foreign currency, please state the equivalent in pounds sterling.

What if my income is less in tax year 2010-11 than it was in tax year 2008-09?

If the total income for your household (before tax) for the tax year 2010-11 will be at least 15% lessthan it was in tax year 2008-09, still complete this section.

From April 2010, it may be possible for the financial assessment to be calculated using the expected

total income for your household in the tax year 2010-11 - a 'current year income assessment'. If you are completing this form before April 2010, please give brief details of the expected

reduction in income on a separate piece of paper and enclose it with this form. We will thencontact you for further information when we can fully assess your household's financialcircumstances.

If you are completing this form after April 2010, you can download a 'Current Year IncomeAssessment' form from www.direct.gov.uk/studentfinance and return it with this application orcontact us on 0845 300 50 90 to have one sent to you.

Please note that a 'current year income assessment' cannot be carried out unless you alsoprovide your financial details for the 2008-09 tax year.!

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Bereavement Allowance Carer's Allowance Contribution based Employment and Support

Allowance. Graduated retirement benefit Incapacity Benefit. Only include the amount

received after 28 weeks of incapacity.

Industrial Death Benefit Jobseekers Allowance Statutory Adoption Pay Statutory Maternity Pay Statutory Paternity Pay Statutory Sick Pay Widowed Parent's Allowance

Q3 Income from salary, wages, occupational pensions or taxable state benefitsBenefits

Only include income received for the following benefits:


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Q7 Income from savings and investments

Total income showing on your SA100 and SA200 documents or on your bank statements/letters ifyou are non Self Assessed (SA).


Dividends from UK companies:

Dividends from unit trusts andopen ended investmentcompanies:

Foreign dividends (up to 300):

UK bank, building society, unittrust etc. interest/amount whichhas been taxed already (grossedup) + untaxed UK interest(amounts that have not beentaxed at all):

UK interest, dividends and otherinvestment income companydividends (excluding tax credit):

SA100 TR3 Box 3(Grossed Up)

SA100 TR3 Box 4(Grossed Up)

SA100 TR3 Box 5

SA100 TR3 box 1(grossed up) + SA100TR3 Box 2 or SA200box 5.1 (grossed) +SA200 box 5.2

SA200 Box 5.3


Self Assessed Tax Return

Statements

Copies of DividendStatements

Half Yearly Certificates

Total savings and investmentincome showing on your SA100and SA200 documents:

Write this total figure on the application.

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Q6 Minister of religion


Total taxable income minusexpenses not included in your P60

or P11D: Write thistotal figureon theapplication.

SA102M Box 4 + Box 8+ Box 10 minus (Box

26 + Box 35)

Please send your:


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Total income showing on your SA104 document


Total untaxed savings incometaxable at 20%:

Taxed Income taxable at 10%:

Taxed Income taxable at 20%:

Taxed Interest:

SA104F Box 33

SA104F Box 69

SA104F Box 72

SA104S Box 26



Statements



Total savings and investment

income showing on your SA104document:


Total income showing on your SA104 documentIncome Type Amount () Where to find amount Evidence

Foreign investment income:

Dividend income (foreign) other:

Dividends from foreigncompanies:

SA106 F3 Box 4

SA106 F3 Box 11

SA106 F3 Box 6(grossed up)



Statements



Total savings and investmentincome showing on your SA106document:


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Q7 Income from savings and investments



Stock dividends:

Non-qualifying distributions andclose company loans written offor released:

Interest from gilt edged and otherUK securities gross amountbefore tax:

UK life insurance policy etc. gainson where no tax was treated aspaid:

UK life insurance policy etc. gainsfrom voided ISA's:

Life insurance gains - UK lifeInsurance policy etc. gains onwhich tax was treated as paid:

SA101 Ai1 Box 12

(Grossed Up)SA101 Ai1 Box 13

SA101 Ai1 Box 3

SA101 Ai1 Box 6

SA101 Ai1 Box 8

SA101 Ai1 box 4

Please send any of the

following: Self Assessed Tax Return

Statements



Total savings and investmentincome showing on your SA101document:


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Q8 Income from taxable benefits in kind


Total cash equivalent of fuel forall cars/ vans made available:

Private medical treatment orinsurance:

Vouchers and credit cards:

Mileage allowance and passengerpayments:

Assets transferred or placed atemployees disposal (cars, property,goods or other assets):

Assets placed at employeesdisposal:

Living accommodation:

Payments made on behalf ofemployee:

Cash equivalent of loans after

deducting any interest paid by theborrower:

Qualifying relocation expensespayments and benefits:

Services supplied:

Other items (includingsubscriptions and professionalfees):

Expenses payments made to, oron behalf of, the employee:

Total cash equivalent of allcars/vans made available:

P11D Box 10 (SectionF & G)

P11D Box 11

P11D Box 12 (Section C)

P11D Box 12 (Section E)

P11D Box 13 (Section A)

P11D Box 13 (Section L)

P11D Box 14 (Section D)

P11D Box 15 (Section B)

P11D Box 15 (Section H)

P11D Box 15 (Section J)

P11D Box 15 (Section K)

P11D Box 15 (Section M)

P11D Box 16 (Section N)

P11D Box 9 (SectionF & G)


P11D P9D

Self Assessed TaxReturn

Total income from benefits inkind:


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Q9 Income from other taxable income and lump sums


Other taxable income beforeexpenses and tax taken off

(Casual earnings, freelanceincome, business receipts whereyour business has ceased):

Foreign earnings not taxable inthe UK:

Taxable lump sums, excludingredundancy and compensation forloss of job:

Lump sums or benefits receivedfrom an employer financedretirements benefit scheme:

Redundancy and other lump sumsand compensation payments:

Other income (Short return):

SA101 TR3 Box 15

SA101 Ai2 Box 12

SA101 Ai2 Box 3

SA101 Ai2 Box 4

SA101 Ai2 Box 5

SA200 Box 7.1

Please send your:


Total income from other taxableincome and lump sums:


Q10 Income from property lettings

Income Type Name Amount () Where to find amount Evidence

Income from foreign property orland:

Income from UK property:

SA106 Box 25

SA200 Box 6.3SA105 Box 36



Copy of Rent Book

Total income from propertylettings:


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Q13 Income from an Overseas Pension


Total amount of unauthorisedpayment from a pension scheme,subject to surcharge:

Taxable short service refund ofcontribution (overseas pensionschemes only):

Taxable lump sum death benefitpayment (overseas pensions only):

Value of pension benefits inexcess of your available lifetimeallowance, taken by you as alump sum:

Amount of unauthorised paymentfrom a pension scheme, notsubject to surcharge:

Total income from OverseasPensions:

SA101 Ai4 Box 10

SA101 Ai4 Box 12

SA101 Ai4 Box 13

SA101 Ai4 Box 5

SA101 Ai4 Box 9

Please send your:



Q14 Other overseas income and gains


Amount of omissions (exemptionsunder transfer of foreign assets):

Write thistotal figureon theapplication.

SA106 F6 Box 46 Please send your:


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S u p p o r t N o t e s

Section 4 - y o u r d e p e n d a n t s

Academic Yea rYou should provide the child dependants income for the academic year. The academic year isdetermined by when the student begins their study.

Student's study begins between Academic Year

1 August 2010 and 31 December 2010 inclusive 1 September 2010 to 31 August 2011

1 January 2011 and 31 March 2011 inclusive 1 January 2011 to 31 December 2011

1 April 2011 and 30 June 2011 inclusive 1 April 2011 to 31 March 2012

1 July 2011 and 31 July 2011 inclusive 1 July 2011 to 30 June 2012

a The child dependants income is required to assess the eligibility for the deductions in the

calculation of household income for each child that is wholly or mainly financially dependent onthe student, the student's husband, wife or partner or the student's parents or step-parents. Youcan find out more information about how household information is calculated in the booklet'Higher education student finance - How you are assessed and paid'.

Please do not include income from sources such as the Government Child Trust, State ChildBenefit or minimal sums of money from other sources when entering a child dependant's income.

Dec la ra t i on

If you cannot sign this form, it must be signed on your behalf by your Power of Attorney. The Power

of Attorney letter must be sent with this form before a signature from that Power of Attorney willbe accepted.

Change of circumstances

You must notify the SLC about any change in your circumstances, which may affect the student'sentitlement to financial support.

The most common change of circumstances would be if:

your household income changes; or your marital status changes.

Information about data sharing for bursary and scholarship purposesUniversities and colleges will be offering financial awards such as bursaries or scholarships to theirstudents. To help them administer these awards (i.e. to determine eligibility and entitlement to, andif relevant pay, a bursary or scholarship - "bursary administration purposes") they will ask theSecretary of State or Student Loans Company for access to information you provide in connectionwith any application for student finance for academic year 10/11 (whether on this form or at a laterdate).

We will share the relevant information with them, unless you indicate that you do not wish us to doso by ticking the box on the declaration. If you do not give consent for us to share this information,the payment of any bursary or scholarship to which the student(s) you are supporting may be

entitled will be delayed.

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financial assessment form

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