英国签证网络在线填写表格
英国签证申请表
姓名（中文）：
曾用名：
性别：
本人手机：
出生地：
出生年月日：
婚姻状况：已婚□ 未婚□ 分居□ 离婚□ 丧偶□ 其它□
英国目的：旅游 □ 探亲/访友 □ 商务 □ 其他 □
计划去英国开始和结束日期：
本次有没有同行人员：有□ 没有□ 与您的关系：家人□（父母□ 配偶□ 子女□ 其他□）朋友□ 同事□ 其他□
若不和配偶住在一起，配偶现居住地址：
子女姓名：
出生日期：
居住地址：
子女姓名：
出生日期：
居住地址：
父亲名字：
出生日期：
母亲名字：
出生日期：
父母国籍：
工作单位及其他信息
现职业状况：雇员□ 自雇□ 退休□ 学生□ 无业□ 其它
单位/学校名称：
固定英文：
单位/学校地址：
邮编：
单位/学校电话：
传真：
税后月薪：
在英
亲友
姓名
关系
在英国详细地址
电话
邮箱
现居住详细地址：
邮编：
在以上住址居住了多少年：
是否为房主：是□ 不是□
是否与配偶居住在一起：是□不是□
配偶手机号：
如无请提供其他紧急联系人手机号：
护照及家庭信息
护照号码：
出生地点：
签发地点：
现用的是否第一本护照：是□ 不是□
配偶姓名：
出生日期：
是否与配偶居住在一起：是□ 不是□
您每月生具体数额：
本次在英国期间预计支出的费用，请说明预算数额：
费用由谁支付：
近10年是否获得英国签证？
近10年去过几次英国？
如去过英国，告知具体出入境时间，具体到年月日：
英国签证个人资料表(学生适用)
英国签证个人资料表（学生适用）一、个人情况1、姓名：_________________________2、姓名拼音：_______________________________3、曾用名：________________________4、曾用名拼音：_____________________________5、身份证号：_____________________________________________6、性别：___________7、出生日期：________年_______月_______日8、出生地：___________省__________市9、现住址：_____________________________________________________________________10、邮编：________________，11、在此地址居住了________年12、家庭电话：_______________________ 13、手机号：_________________________14、电子邮件：__________________________________________________________________15、通讯地址是否与现住址一致？□是□否→请写明：_____________________________________，邮编：________________ 16、你的健康状况是否良好？□是□否→病史：___________________________________二、护签情况（无论是因公护照、因私护照均要填写。
如果空间不够，请另附纸写明）1、护照号码：________________________2、护照签发地：_________省________市3、签发机关：____________________4、护照签发日期：________年_______月_______日5、护照有效期至：________年_______月_______日（此次回国后至少6个月以上有效）6、此护照是否是你的第一本护照？□是□否→请列出过去10年中曾持有的所有护照信息①护照号：______________，□注销□遗失②护照号：______________，□注销□遗失7、你是否曾经拥有其他国籍或其他国家的护照？□否□是→国家：_______________，护照号：___________________8、过去10年中，你曾经去过的所有国家或地区：①抵达日期：______年____月____日，抵达城市：___________，停留天数：_______天目的：____________________________________________________________________②抵达日期：______年____月____日，抵达城市：___________，停留天数：_______天目的：____________________________________________________________________ 9、你是否曾经被任何国家拒签或者拒绝入境？□否□是→时间：________年，拒签国家：__________________，拒签号：______________原因：________________________________________________________________________10、你是否申请过英国签证？□否□是→①上次获得签证的时间：______年____月____日②签证号码：_______________________③是否申请过续签？□否□是→时间：________年______月______日原因：__________________________________________ 结果：□获得签证□被拒绝④是否有英国的国家保险号？□否□是→号码：_________，获得原因：__________11、过去10年中，你是否去过英国？□否□是→①抵达日期：______年____月____日，抵达城市：__________，停留天数：_______天目的：______________________________________________________________________②抵达日期：______年____月____日，抵达城市：__________，停留天数：_______天目的：_____________________________________________________________________ 12、你是否有亲属或朋友在英国？□否□是→姓名：____________，与你的关系：_____________，你是否打算去拜访他们？□否□是三、学习情况（列出你目前就读的学校）学校名称：___________________________________________ □初中□高中□大学学校地址：________省________市_______________________________________________ 学校邮编：___________ 就读时间：______年____月____日至______年____月____日四、家庭情况（如有直系兄弟姐妹，请另附纸写明）1、父亲姓名：_____________________ 姓名拼音：_______________________________出生日期：______年_____月_____日手机：___________ 邮箱：__________________ 地址：__________________________________________________ 邮编：_____________ 2、母亲姓名：_____________________ 姓名拼音：_______________________________出生日期：______年_____月_____日手机：___________ 邮箱：__________________ 地址：__________________________________________________ 邮编：_____________本人声明以上资料全部属实，如有不实愿承担一切后果。
英国签证信息表
英国签证信息表说明：（1）该表信息将用于申请赴英签证，请务必填写准确、完整（不适用的问题可以不填）。
（2）遇到‘是’、‘否’选项，可删除未选选项，保留选定选项。
例，您是否去过英国？否（如没去过）。
申请人信息姓名：姓名拼音：曾用名：曾用名拼音：性别：婚姻状况：出生日期：年月日出生地（省份、城市）：国籍：其他国籍：护照信息护照号码：护照签发地（省份、城市）：护照签发机构：护照签发日期：年月日护照到期日期：年月日这是你的第一本护照吗？是□ 否□10年以内的旧护照信息旧护照（1）护照号：护照签发地（省份、城市）：护照签发机构：护照签发日期：年月日护照到期日期：年月日护照存放地点：旧护照（2）护照号：护照签发地：（省份、城市）：护照签发机构：护照签发日期：年月日护照到期日期：年月日护照存放地点：旧护照（3）护照签发地：（城市）：护照签发机构：护照签发日期：年月日护照到期日期：年月日护照存放地点：（如有其他旧护照，请按照以上格式接在后面补充下去）联系信息申请人实际居住地址（城市、街、楼栋、门牌号）：邮编：已在该地址居住时间：年月家庭电话：移动电话：E-mail：家庭信息（须填写完整）母亲姓名：出生日期：年月日出生地（省份、城市）：国籍：父亲姓名：出生日期：年月日出生地（省份、城市）：国籍：配偶姓名：国籍：出生日期：年月日现在是否和您居住在一起？是□ 否□此次是否和您一起去英国？是□ 否□您有几个孩子：孩子1信息姓名：出生日期：年月日出生地：护照号：现在是否和您居住在一起：是□ 否□此次是否和您一起去英国：是□ 否□孩子2信息姓名：出生日期：年月日护照号：现在是否和您居住在一起：是□否□此次是否和您一起去英国：是□ 否□孩子3信息姓名：出生日期：年月日出生地：护照号：现在是否和您居住在一起：是□ 否□此次是否和您一起去英国：是□ 否□（如有其他孩子信息，请按照以上格式接在后面补充下去）工作情况（教师填写）申请人现在职业：现在工作单位名称（请填写中、英文）：就职开始日期：年月日单位地址（城市、街、楼栋、门牌号）：邮编：单位联系电话：单位联系E-mail：您是否曾在以下类型的机构工作过：--武装部队：是□ 否□--政府（中央或地方）：是□ 否□--司法：是□ 否□--媒体：是□ 否□--民政：是□ 否□--公安（或私人保安公司）是□ 否□收入和开支情况每月税后总收入：RMB您是否有其他收入来源，包括从朋友或家人处？是□ 否□您的存款、财产、股票或其他收入情况--存款：RMB--房产：RMB--股票：RMB--其他：RMB您每月支付给家人或亲属的费用：RMB您每月的生活开支：RMB您此次旅行可用的费用：您此次赴英国的费用由谁负担：负担多少：您在英国期间的个人消费将有多少：以往签证和旅行情况过去10年内您是否去过英国？是□ 否□过去10年内您是否去过其他国家（除英国外）？是□ 否□--国家名称：您是否曾经被拒签过？是□ 否□--拒签国家：过去10年内您是否获得过英国签证？是□ 否□--目的：--签证受理号码：--签证签发日期：年月日--签证截止日期：年月日过去10年内您是否被拒绝过进入英国？是□ 否□您是否曾经被任何国家驱逐出境过？是□ 否□过去10年内您是否曾经在英国境内的Home Office递交过申请？是□ 否□您有英国国家保险号码吗？是□ 否□您在国外是否有过不良记录？是□ 否□您在国内是否有过不良记录？是□ 否□其他信息您希望在英国工作吗？否您希望在英国学习吗？否您是否有家属或朋友在英国？是□ 否□姓名1：国籍：住址：电话：和您的关系：姓名2：国籍：住址：电话：和您的关系：姓名3：国籍：住址：电话：和您的关系：。
英国访问学者签证在线申请表填写说明
英国签证在线申请表填写说明（访问学者）根据英国签证中心最新规定（英国签证中心为英国边境总署所管理，是您递交申请及支持文件、录入生物辩识数据如指纹的场所），开始对所有在中国的签证实行在线申请。
其中，包含在线填写申请表格和在线预约送签时间。
请您仔细阅读附件中的《英国商务签证材料》，在填表之前确保您手中的信息完整。
具体流程如下：1. 在线填写申请表格网址：网页如下：请点击网页右下角的按钮“Apply for a UK visa now”开始申请。
如果填写完申请后，需要再次登录您的申请，请直接点击以上页面左侧的第三项“Existing Applications Login here”。
2. 开始填写表格注意：- 请用英文大写字母填写表格- 确保您的电脑连接有打印设备，以便完成后直接打印出申请表格- 打印好申请表格后，请在表格第一页右侧贴上申请人照片- 请在打印好的申请表格第2页和末页，由申请人本人签名和填写日期- 关于表格的解释说明详见第2页至15页- 关于在线预约的说明详见第16页第一页：申请安全问题开始在线申请之前，请填写以下必要的安全问题。
（请记住您所填写的信息，以便保存之后再次登录使用）Enter your E-mail address 填写您的邮箱地址请填写：您的邮箱地址（用于再次登录申请和发送GWF号码）Confirm your E-mail address 确认您的邮箱地址Entre a password for your application/appointment 设定您的登录密码（密码至少为8-12个字符）Confirm your password 确认您的登录密码Enter a password reminder word 填写密码找回关键词完整填写之后请点击Next（下一页）第二页：关于签证申请信息Current location 选择申请人所在国家Where would you like to lodge your application? 您将在哪里递交申请？请选择：请按照您所属于的送签领区选择签证中心（请参看《英国商务签证资料清单》上关于领区的划分。
英国签证申请表
姓 名
曾用名
婚姻状况
职 务
目前住址
何时开始居住在此地址？
家庭电话
手机
单位名称（中英文）
单位地址
邮编
单位电话
传真
电子邮件
进入此单位时间
年月日
职务
月收入
元/月
最终目的地城市名称及访问目的
去程到达英国及离开时间
去程转机机场名
航班号
回程到达英国及离开时间
回程转机机场名
航班号
此次行程费用由谁支付
大概花费
家庭成员(如已过世请至少提供姓名，出生年月日及出生地)
称谓
姓名
出生年月日/ 出生地
现住址
配偶
年月日/
父亲
年月日/
母亲
年月日/
பைடு நூலகம்子女
年月日/
子女
年月日/
其 他 情 况
是否有旧护照
是 □ 否 □ 如有请提供,没有请说明去向
是否被拒签过? 是□ 否□
如有被拒签情况请提供细节（申请国家，何种类型，时间）：
曾到过的国家,签发日期及停留时间
是否有同行人？如有请提供姓名、出生年月日及其国籍
本人声明:
1、本人所提供的资料以及所填写的内容完全属实，提供任何虚假材料都有可能导致我的签证被拒签，以及影响以后我再次申请签证；
2、本人清楚递交领事馆的资料包括公证书、银行存款证明书等原件均不予退还。
日期： 年 月 日 申请人签名：（亲笔）
英国签证网络在线填写表格
Appendix 1 FLR(O)Request for Fee Exemption from applicant who is destitute seeking to apply for leave to remain on the basis of Article 8 right to respect for family or private life under Appendix FM or paragraph 276ADEYou should only complete this form if you are seeking a fee exemption because you are destitute and so are unable to pay the fee for your leave to remain application form FLR(O). Definition of destitutionYou will only be considered to be destitute if:a) You do not have adequate accommodation or any means of obtaining it (whether ornot your other essential living needs are met); orb) You have adequate accommodation or the means of obtaining it, but cannot meetyour other essential living needs.Please ensure that you also complete and submit Form FLR (O) 04/2013.If you wish to use a representative to assist you in completing this form, they should be registered with the Law Society or the Office of the Immigration Services Commissioner (OISC). You can also refer to the Immigration Enquiry Bureau (IEB) on 0870 606 7766 or consult our website at: .You should only complete this form if:∙You are applying for leave to remain in the UK on the basis of family or private life under ECHR Article 8 using form FLR(O); and∙You are destitute, and so are unable to pay the fee for your leave to remain application form FLR(O).You must complete every section of this form.The decision on whether you qualify for a fee exemption will be made on the basis of the information you provide in this form and the evidence submitted with it. It is up to you to provide sufficient information and evidence to show that you are destitute.12You should not complete this form if you applying for leave to remain in the UK on the basis of family or private life under ECHR Article 8 using form FLR(O) and are not destitute. In that situation you should use form FLR(O) and not submit this Appendix 1.You will need to provide full documentary evidence along with this fee exemptionapplication to demonstrate your financial circumstances. The nature of this evidence may vary according to your individual circumstances, but some examples of relevant documents you may wish to include are stated below. Documents should be on letter headed paper from an official source. Letters from charities should show the registered charity number. Copies of bank and savings documents should be certified by the bank/financial institution. Please tick the boxes below to show which documents you are enclosing:Savings account statementsTenancy agreement or documents relating to your mortgage Utility and other relevant billsLetter confirming employment (the person writing should state their position in the company and contact details)Pay slips P60P45Letters from a charity or Local Authority confirming you are in receipt of support Letters from any friends or family who are providing you with support Letters confirming you or your spouse/partner are in receipt of public fundsOther documents –please specify what they are.If you are including other documents please give details in the box below:This isnot an application for leave to remain on the basis of Article 8 family or private life grounds. It is an assessment as to whether we consider you to be destitute in order towaive the application fee for Form FLR(O). If you are seeking a fee exemption you should submit your FLR(O) form and Appendix 1 request for fee exemption form at the same time. The FLR(O) may require you to submit additional documentary evidence.If you are granted a fee exemption, this does not guarantee that your application for leave to remain will be successful.If you decide not to continue with your application, you must contact us immediately. Section 1 - Biometric residence permits (BRP)If you qualify for a fee exemption because you are destitute, we will contact you and provide you with information about enrolling your biometric data without having to pay a fee. Failure to provide your biometric data will result in your application being rejected.If you do not qualify for a fee exemption your application will be rejected. If you wish to apply for leave to remain on the basis of your family or private life you will need to re-submit your FLR(O) form, with the relevant fee.Section 2 – Your personal details3Section 3 – DependantsPlease complete this section for children under the age of 18 years living with you in the UK4If you have more than 3 dependants please provide details on a separate sheet of paper.5REASONS WHY YOU ARE DESTITUTE:Note: You should demonstrate in your answers to questions 4.1 to 7.4 below, whether you have adequate accommodation or the means of obtaining it, and if you have adequate accommodation, whether you cannot meet your other essential living needs. If you have been without support from a third party for some time you will be expected to explain how you have supported yourself during this period and provide evidence.Please answer all the questions below. If you do not fully complete the form we may reject your application.Section 4 – Your current accommodation circumstances4.1 What address can we contact you at?House/Flat NumberStreet NameTown or CityCountyPost CodeNo4.3 If yes, when did you move into your current address?If no, where are you currently living? Please provide the full address unless you are homeless.House/Flat NumberStreet NameTown or CityCountyPost Code4.4 Please provide details of any previous UK addresses:House/Flat NumberStreet NameTown or CityCountyPost CodeContinue on a separate page if necessary.674.5 Have you been asked to leave the accommodation in which you are currently living?No4.6 If Yes, please provide details of why this is:4.7 Do you own or rent your home? Please specify:Own homeRent home4.8 If you do not own or rent your home who presently provides you with accommodation?FriendRelativeRefugeLocal AuthorityCharitable organisationOtherIf you have stated “other” please give details in the box below: 4.9 Who do you live with and what is their relationship to you?If Yes, specify how much you pay, and how regularly you pay this (weekly/monthly):84.11 Does anyone support you financially or by providing your essential living needs such as food? If so, who?4.12 Are they able to continue supporting you? If not, please explain why in the box at Section 8.4.13 Are you homeless tonight?4.14If Yes, please explain why:4.15 If yes, on what date will you become street homeless? (day/month/year)Section 5 – Your financial detailsPlease note we require evidence of your finances, including bank statements, building society savings books or other formal documentation in support of your application for a Fee Exemption. If you are being supported by a friend or relative, we require written evidence in the form of a letter confirming this, with formal documentation showing th at person’s financial resources. If you are beingsupported by a charity or other organisation, including a Local Authority, we also require formal documentation to evidence this. Please provide full details of exactly what the support entails, why you are eligible for such support and when the support began.95.3 Do you have any of the following material assets(You must tick any or all of the assets you have)∙ Cash savings∙ Property in the UK∙ Property outside of the UK∙ Land in the UK∙ Land outside the UK∙ Valuable jewellery∙ TV, DVD player, electrical goods∙ Car or vehicle5.5 What is the value of all/each of the above assets?Please specify the relevant currency:5.6 Please indicate any other material assets.5.7 Do you have any of the following monetary assets?∙ Cash held in the UK or overseas∙ Savings/investments in the UK or overseas105.8 Please provide name of bank or building society/other in which the asset is held and the name of the country where these assets are:5.9 What is the value of your savings or investments?Please specify the relevant currency:5.11 Please list any other monetary assets:Section 6 – Public Funds6.1 Do you receive any of the following public funds?You must declare any or all of the following you receive:∙ Attendance allowance ∙ Carer ’s allowance ∙ Child benefit ∙ Child tax credit∙ Contribution-based Jobseeker’s Allowance∙ Contribution-based Employment and Support Allowance ∙ Council tax benefit∙ Disability living allowance ∙ Housing benefit∙ Housing and Homelessness assistance ∙ Incapacity Benefit∙ Income based job seekers allowance∙ Income related employment support allowance ∙ Income support11∙Personal independence payment ∙Pension credit ∙Severe disablement allowance ∙Social fund payment ∙State pension credit ∙ Working tax creditIf Yes, please state for each public fund you are receiving:Section 7 – Spouse/partner financial detailsIf Yes, please provide details of the nature of their employment and their salary, including what income they receive in each relevant period (weekly/monthly/annual)Employment:Salary:If Yes, please provide details and value of assets:Please specify the relevant currency:12If Yes, please provide details and value of savings or investments:Please specify the relevant currency:NoIf Yes, please state for each public fund your spouse/partner is receiving:Please continue on a separate sheet if necessary.Section 8 – Additional InformationPlease provide any additional information that you feel we should take into account in determining whether you should be exempt from paying a fee for the FLR(O)DeclarationI can confirm that I have included all the necessary information and evidence that supports this application for a Fee Exemption.I am aware that it is an offence under the Immigration Act 1971, as amended bythe Immigration and Asylum Act 1999 and the Nationality, Immigration and Asylum Act 2002, to make to a person acting in execution of any of those Acts a statement or representation which I know to be false or do not believe to be true, or to obtain or to seek to obtain leave to remain in the United Kingdom by means which include deception.I confirm that I have provided full and complete details of my financial situation and that of my spouse/partner, and confirm that the information provided is accurate and truthful. I will notify the Home Office if my circumstances change whilst my application is being considered.I understand that all information provided by me to the Home Office will be treated in confidence; that it may be disclosed to other government departments, agencies, local authorities, the police, foreign governments and other bodies for immigration purposes or to enable them to perform their functions; and if such bodies provide the Home Office with any information about me, which may be relevant for immigration purposes, it may be used in reaching a decision following this application.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 can be obtained from the Home Office website at:.I have completed Section 9 of FLR(O) which gives consent for the Home Office to request verification checks of the documents I have supplied to show that I am destitute in order to make an application on Form FLR(O) without paying a fee.Signature:Print Name:Date:Checklist:Have you fully completed this form?Have you enclosed full documentary evidence required by this form?Have you also enclosed a fully completed FLR (O) 04/2013 form? (If not, or if youhave enclosed the wrong form, your application will be rejected.)14。
英国签证信息采集表
何时？ ；何地？ ；哪种签证? ；是否获得签证？□是，□否
是否到过英国？□否，□是：何时？ ，逗留了多久？ 。
是否在军队服役？□否，□是：服役期间？ 军种？ 职务和军衔？
是否在公检法、中央或地方政府、媒体工作过？□否，□是：工作期间？ 单位名称？ 职务？
过去十年曾进入的所有国家（可另附纸）
家庭地址
邮编： 在此地已居住多久：
工作单位
在此单位开始工作的时间： 年 月 日
单位地址
工作电话
工作传真
单位邮编
家庭电话
家庭传真
移动电话
个人电子邮箱地址
单位电子邮箱地址
月收入
每月收入中的多少钱供家庭成员和孩子使用
你每月生活花费多少钱
是否有其他的收入来源？包括朋友和家人
如有，请提供详细信息和金额：
是否有存款、房产或其他收入，如股票或分红
英国签证信息采集表（不要空项，没有的信息请填写“无”）
姓 名
曾用名
性别
□男 □女
婚姻状况
姓名拼音
访问目的
（详细）
访问时间和停留天数
年 月 日- 年 月 日，共 天
现国籍和曾经国籍
出生地
省 市
出生日期
年 月 日
身份证号
护照号码
签发日
年 月 日
有效期
年 月 日
签发地
省 市
签发机关
是否是您的第一本护照
如不是，请提供以前的护
国家
签证类型
停留时间
家庭成员表
申请人姓名
关系
姓名
婚姻状况
出生年月日、地点
现住地址
现在职业
英国签证申请个人信息表
自雇（个体）学生退休无业
具体职务
年收入（RMB
工作状况
受雇
税后月收入
（RMB
具体职务
工作职责（一两句话， 简要说明即可）
单位名称（中文）
进入单位时间
单位名称（英文）
单位地址
单位邮编
单位电话
是否有另外的收入？
退休金 生活津贴 由子女 给予赡养费生活费等 投资（可多 选）
左边所选项目的年收入总额为：
如有，请提供拒签时间、地点、签证类型及原因
是否由配偶或家庭成员供养？是否
若有，请说明你们的关系，以及每个月获得的收入总额：
你是否有其他信息要补充？
备注：1、填写上述内容要完整、字迹清晰
2、电话号码前请注明区号
3、必须本人签名
本人声明：以上所填内容完全属实，否则本人接受被取消申请资格并由本人承担因此 造成的所有风险和损失！
RMB
储蓄
我没有另外的收入或积蓄
计划出行日期：
日 月 年
离开英国日
期：
日 月 年
访冋央国主要目的：旅游（包括探亲访友）商务活动其他
简要描述一下你的出行计划（包含你将访问的对象、拜访的地点及你将要进行的活动如观光、购物 等）：
是否有同行人员，如果有请注明同行人的姓名、关系、出生日期、护照号和是否持有英国签证： 名字：
英国签证申请个人信息表
每个申请人单独填写一张
姓名
曾用名
性别
婚姻状况
出生日期
出生地（省， 市
护照号
签发地（省 市）
签发日至到期日
是否有旧护照？填写旧 护照号
旧护照签发地
旧护照的签发日至到期 日
身份证号
现居住地址
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Appendix 1 FLR(O)Request for Fee Exemption from applicant who is destitute seeking to apply for leave to remain on the basis of Article 8 right to respect for family or private life under Appendix FM or paragraph 276ADEYou should only complete this form if you are seeking a fee exemption because you are destitute and so are unable to pay the fee for your leave to remain application form FLR(O). Definition of destitutionYou will only be considered to be destitute if:a) You do not have adequate accommodation or any means of obtaining it (whether ornot your other essential living needs are met); orb) You have adequate accommodation or the means of obtaining it, but cannot meetyour other essential living needs.Please ensure that you also complete and submit Form FLR (O) 04/2013.If you wish to use a representative to assist you in completing this form, they should be registered with the Law Society or the Office of the Immigration Services Commissioner (OISC). You can also refer to the Immigration Enquiry Bureau (IEB) on 0870 606 7766 or consult our website at: .You should only complete this form if:∙You are applying for leave to remain in the UK on the basis of family or private life under ECHR Article 8 using form FLR(O); and∙You are destitute, and so are unable to pay the fee for your leave to remain application form FLR(O).You must complete every section of this form.The decision on whether you qualify for a fee exemption will be made on the basis of the information you provide in this form and the evidence submitted with it. It is up to you to provide sufficient information and evidence to show that you are destitute.12You should not complete this form if you applying for leave to remain in the UK on the basis of family or private life under ECHR Article 8 using form FLR(O) and are not destitute. In that situation you should use form FLR(O) and not submit this Appendix 1.You will need to provide full documentary evidence along with this fee exemptionapplication to demonstrate your financial circumstances. The nature of this evidence may vary according to your individual circumstances, but some examples of relevant documents you may wish to include are stated below. Documents should be on letter headed paper from an official source. Letters from charities should show the registered charity number. Copies of bank and savings documents should be certified by the bank/financial institution. Please tick the boxes below to show which documents you are enclosing:Savings account statementsTenancy agreement or documents relating to your mortgage Utility and other relevant billsLetter confirming employment (the person writing should state their position in the company and contact details)Pay slips P60P45Letters from a charity or Local Authority confirming you are in receipt of support Letters from any friends or family who are providing you with support Letters confirming you or your spouse/partner are in receipt of public fundsOther documents –please specify what they are.If you are including other documents please give details in the box below:This isnot an application for leave to remain on the basis of Article 8 family or private life grounds. It is an assessment as to whether we consider you to be destitute in order towaive the application fee for Form FLR(O). If you are seeking a fee exemption you should submit your FLR(O) form and Appendix 1 request for fee exemption form at the same time. The FLR(O) may require you to submit additional documentary evidence.If you are granted a fee exemption, this does not guarantee that your application for leave to remain will be successful.If you decide not to continue with your application, you must contact us immediately. Section 1 - Biometric residence permits (BRP)If you qualify for a fee exemption because you are destitute, we will contact you and provide you with information about enrolling your biometric data without having to pay a fee. Failure to provide your biometric data will result in your application being rejected.If you do not qualify for a fee exemption your application will be rejected. If you wish to apply for leave to remain on the basis of your family or private life you will need to re-submit your FLR(O) form, with the relevant fee.Section 2 – Your personal details3Section 3 – DependantsPlease complete this section for children under the age of 18 years living with you in the UK4If you have more than 3 dependants please provide details on a separate sheet of paper.5REASONS WHY YOU ARE DESTITUTE:Note: You should demonstrate in your answers to questions 4.1 to 7.4 below, whether you have adequate accommodation or the means of obtaining it, and if you have adequate accommodation, whether you cannot meet your other essential living needs. If you have been without support from a third party for some time you will be expected to explain how you have supported yourself during this period and provide evidence.Please answer all the questions below. If you do not fully complete the form we may reject your application.Section 4 – Your current accommodation circumstances4.1 What address can we contact you at?House/Flat NumberStreet NameTown or CityCountyPost CodeNo4.3 If yes, when did you move into your current address?If no, where are you currently living? Please provide the full address unless you are homeless.House/Flat NumberStreet NameTown or CityCountyPost Code4.4 Please provide details of any previous UK addresses:House/Flat NumberStreet NameTown or CityCountyPost CodeContinue on a separate page if necessary.674.5 Have you been asked to leave the accommodation in which you are currently living?No4.6 If Yes, please provide details of why this is:4.7 Do you own or rent your home? Please specify:Own homeRent home4.8 If you do not own or rent your home who presently provides you with accommodation?FriendRelativeRefugeLocal AuthorityCharitable organisationOtherIf you have stated “other” please give details in the box below: 4.9 Who do you live with and what is their relationship to you?If Yes, specify how much you pay, and how regularly you pay this (weekly/monthly):84.11 Does anyone support you financially or by providing your essential living needs such as food? If so, who?4.12 Are they able to continue supporting you? If not, please explain why in the box at Section 8.4.13 Are you homeless tonight?4.14If Yes, please explain why:4.15 If yes, on what date will you become street homeless? (day/month/year)Section 5 – Your financial detailsPlease note we require evidence of your finances, including bank statements, building society savings books or other formal documentation in support of your application for a Fee Exemption. If you are being supported by a friend or relative, we require written evidence in the form of a letter confirming this, with formal documentation showing th at person’s financial resources. If you are beingsupported by a charity or other organisation, including a Local Authority, we also require formal documentation to evidence this. Please provide full details of exactly what the support entails, why you are eligible for such support and when the support began.95.3 Do you have any of the following material assets(You must tick any or all of the assets you have)∙ Cash savings∙ Property in the UK∙ Property outside of the UK∙ Land in the UK∙ Land outside the UK∙ Valuable jewellery∙ TV, DVD player, electrical goods∙ Car or vehicle5.5 What is the value of all/each of the above assets?Please specify the relevant currency:5.6 Please indicate any other material assets.5.7 Do you have any of the following monetary assets?∙ Cash held in the UK or overseas∙ Savings/investments in the UK or overseas105.8 Please provide name of bank or building society/other in which the asset is held and the name of the country where these assets are:5.9 What is the value of your savings or investments?Please specify the relevant currency:5.11 Please list any other monetary assets:Section 6 – Public Funds6.1 Do you receive any of the following public funds?You must declare any or all of the following you receive:∙ Attendance allowance ∙ Carer ’s allowance ∙ Child benefit ∙ Child tax credit∙ Contribution-based Jobseeker’s Allowance∙ Contribution-based Employment and Support Allowance ∙ Council tax benefit∙ Disability living allowance ∙ Housing benefit∙ Housing and Homelessness assistance ∙ Incapacity Benefit∙ Income based job seekers allowance∙ Income related employment support allowance ∙ Income support11∙Personal independence payment ∙Pension credit ∙Severe disablement allowance ∙Social fund payment ∙State pension credit ∙ Working tax creditIf Yes, please state for each public fund you are receiving:Section 7 – Spouse/partner financial detailsIf Yes, please provide details of the nature of their employment and their salary, including what income they receive in each relevant period (weekly/monthly/annual)Employment:Salary:If Yes, please provide details and value of assets:Please specify the relevant currency:12If Yes, please provide details and value of savings or investments:Please specify the relevant currency:NoIf Yes, please state for each public fund your spouse/partner is receiving:Please continue on a separate sheet if necessary.Section 8 – Additional InformationPlease provide any additional information that you feel we should take into account in determining whether you should be exempt from paying a fee for the FLR(O)DeclarationI can confirm that I have included all the necessary information and evidence that supports this application for a Fee Exemption.I am aware that it is an offence under the Immigration Act 1971, as amended bythe Immigration and Asylum Act 1999 and the Nationality, Immigration and Asylum Act 2002, to make to a person acting in execution of any of those Acts a statement or representation which I know to be false or do not believe to be true, or to obtain or to seek to obtain leave to remain in the United Kingdom by means which include deception.I confirm that I have provided full and complete details of my financial situation and that of my spouse/partner, and confirm that the information provided is accurate and truthful. I will notify the Home Office if my circumstances change whilst my application is being considered.I understand that all information provided by me to the Home Office will be treated in confidence; that it may be disclosed to other government departments, agencies, local authorities, the police, foreign governments and other bodies for immigration purposes or to enable them to perform their functions; and if such bodies provide the Home Office with any information about me, which may be relevant for immigration purposes, it may be used in reaching a decision following this application.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 can be obtained from the Home Office website at:.I have completed Section 9 of FLR(O) which gives consent for the Home Office to request verification checks of the documents I have supplied to show that I am destitute in order to make an application on Form FLR(O) without paying a fee.Signature:Print Name:Date:Checklist:Have you fully completed this form?Have you enclosed full documentary evidence required by this form?Have you also enclosed a fully completed FLR (O) 04/2013 form? (If not, or if youhave enclosed the wrong form, your application will be rejected.)14。