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2021/22 Applying for student nance based on household (Student Loans Company)

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2021/22
Applying for student nance
based on household income form
To nd out how we’ll use the information you provide go to www.gov.uk/studentfinance to read our
Privacy Notice before completing this form.
About this form
Who should complete this form?
Complete this form if you want to change your
student nance application to be based on your
household income.
Where you see this icon it means we need you to
give supporting evidence. Details of the evidence
needed will be shown where the icon appears.
If you leave any question blank we won’t be able
to process your application. If a question doesn’t
apply to you, enter ‘None’ or ‘N/A’ as the answer.
What sections should you complete?
All students need to complete sections 1, 2 & 4 and
read, sign and date the declaration.
Complete section 3 if you are a full-time student
and want to apply for a Parents’ Learning
Allowance, Childcare Grant and/or Adult
Dependants’ Grant.
Your application to have your student nance
based on your household income, or an application
for a Parents’ Learning Allowance, Childcare
Grant and/or Adult Dependants’ Grant must be
received within 9 months from the start of your
academic year.
Section 1
Your personal details
1.1 Customer Reference Number
1.2 Personal details
Title
Mr
Mrs Miss Ms
Forename(s)
Surname
Date of birth (DDMMYYYY)
facebook.com/SFEngland
twitter.com/sf_england
SFE/NMTtoMT/2122/A
£
g
£
£
Section 2
Student nancial questions
Unearned income
2.1 Estimate the total taxable unearned income,
before deductions, that you expect to
receive in academic year 2021/22.
What is the source of this income?
What is taxable unearned income?
Taxable unearned income is any income you receive from the following sources:
• Bank or building society gross interest
• Property, lettings or rent
• Dividends or investments
•
Trusts or sponsorships
• Any other payment received for attendin
the course
Don’t include any:
• Earnings from full or part-time work
• Maintenance Loan or grant payments you
may receive
• Payments you r eceive from parents under
a covenant
•
Teacher Training Bursaries
•
Higher Education Bursaries (for care leavers)
•
Bounties paid by the armed services to
reservists or disablement or invalidity pensions
•
ISAs
Payments from an employer
2.2 Will you be employed during the
academic year?
No
Yes
if no go to 2.5
2.3 Will your employer be releasing you to
attend your course this academic year?
No
Yes
If ‘Yes’ how much will your employer pay
you for time spent attending the course
during this period?
2.4 During this academic year, will you or
your employer pay any money into a
pension fund on your behalf?
No
Yes
If ‘Yes’ how much during this period?
2
SFE/NMTtoMT/2122
£
£
Section 2
Student nancial questions
Dependent Children
2.5 Will you have any children who will be wholly
or mainly nancially dependent on you during
the academic year?
No
if no go to 2.7
Yes
2.6 Give details of the dependent children
When stating the child’s income, include
their income form all sources after income
tax and National Insurance contributions in
tax year 2019-20.
Do include any income the child gets from:
• working
• interest earned on savings
• investments
• any maintenance payments
Don’t include income from:
• Child Benet
•
• Government Child Trust
Child 1 full name
Relationship to you
Date of birth (DDMMYYYY)
Who do they live with?
Income from all sources after income tax and
social security
You must provide
• copies of birth certicates; and
• evidence of Child Tax Credits and/or Child
Benets for each child named.
Child 2 full name
Relationship to you
Date of birth (DDMMYYYY)
Who do they live with?
Income from all sources after income tax and
social security
If you have more than two dependent children, give details for each additional child
on the additional notes at the end of this form.
Additional Financial Support
2.7 Are you a full-time student that wants
to apply for any of the following:
• Parents’ Learning Allowance
• Childcare Grant
• Adult Dependants’ Grant?
No
if no go to section 4
Yes
if yes go to section 3
Child Tax Credit or the child element of
Universal Credit
SFE/NMTtoMT/2122
3
Section 3
Parents’ Learning Allowance, Childcare
Grant and Adult Dependants’ Grant
Only complete this section if you are a full-time student.
For more information on Dependants’ Grants go to www.gov.uk/studentfinance
3.1 Are you under 25, living with a partner and
applying for Childcare Grant or Parents’
Learning Allowance?
No
if no go to 3.3
Yes
3.2 Give the total estimated income after
income tax and National Insurance
deductions in this academic year for:
You
£
Your partner
£
How much of this will be Child Tax Credit or
the child element of Universal Credit for this
academic year?
You
£
Your partner
£
3.3 Do you want to apply for Childcare Grant?
No
if no go to 3.6
Yes
3.4 During the academic year, do you or your
partner expect to receive:
• the childcar e element of Working Tax
Credit or Universal Credit; or
• T ax-Free Childcare from HM Revenue and
Customs (HMRC); or
• Childcar e Allowance from the National
Health Service (NHS) as part of a student
nance package?
No
Yes –
you can’t currently apply for Childcare
Grant.
You can only apply for Childcare Grant
if you stop claiming support from any of
these sources.
3.5 Give details of the children you need
Childcare Grant for during this academic
year
Child 1
Forename(s)
Surname
Date of birth
(DDMMYYYY)
Child 2
Forename(s)
Surname
Date of birth
(DDMMYYYY)
If you need more space for additional children, give the details above on the
additional notes at the back of this form.
4
Section 3
Parents’ Learning Allowance, Childcare
Grant and Adult Dependants’ Grant
3.6 Are you applying for Adult
Dependants’ Grant?
No
if no go to section 4
Yes
3.7
Who is your adult dependant?
Your husband
Your wife
Your civil partner
Your partner (if you are 25 or over)
go to section 4
Other adult dependant
3.8 Will your other adult dependant’s
income be more than £3,796 for this
academic year?
No
Yes
Applying for an Adult Dependants’ Grant
You will not be able to apply for Adult Dependants’ Grant if your other adult dependant’s income is
more than £3,796 in this academic year.
3.9
Give your other adult dependants’ income
for the 2019-20 tax year.
Income
All salary/wages and self-employed income
(include income from property)
£
All pension income
(including private, occupational and state)
£
If you receive a lump sum pension, only declare the amount
you received that you paid tax on.
All gross taxable income from interest,
investments and dividends
£
Taxable state benets
£
All other taxable income (include
redundancy payments even if you don’t
expect to pay tax on them)
£
Deductions
Private pension contributions and Additional
Voluntary Contributions (AVCs)
£
Allowable expenses on which tax relief
was claimed
£
5
Section 4
About your family
Your parent(s) or partner may have received a separate form asking them to provide details
about their income. This must also be completed and returned to us.
4.1 Are you an independent student?
To be an independent student usually you
would meet one of the following criteria:
• You are 25 or over
• You have care of a child under 18
• You are married/in a civil partnership
• Y ou have supported yourself for 3 or
more years
• You are an orphan
• Y ou have no contact with your parents,
and this will not change
• It is impossible/impractical to contact
your parents, or sending you money
would place them in jeopardy
No
Yes
if yes go to the declaration
page on page 7
4.2 Which parent do you normally live, or
have the most contact with?
The following family members count for
the purposes of income assessment:
• Y our natural or adoptive parents
(if both of them live with you)
• Y our parent and their partner (if they
have one)
Mother
Father
Both
Neither
if Both or Neither go to the
declaration page on page 7
4.3 What is the marital status of this parent?
Ask your parent to send evidence of
their marital status if they are separated,
divorced or have had their civil
partnership dissolved.
They must send a copy of their:
• Decree absolute
• Dissolution order
• A letter from their solicitor conrming
their status
Single
Living with partner
Married/civil partnership
Separated
Divorced/dissolved civil partnership
Widowed/surviving civil partner
Now read, sign and date the declaration on the next page
6
Declaration
• I can conrm that to the best of my knowledge and belief, the information I have provided is true and
complete. If it is not I understand I may not receive nancial support, and support I have had may be
withdrawn and I could be prosecuted.
• I agree that in the event of receiving an overpayment of nancial support, I am obligated to repay this
in full.
Childcare Grant
• I understand and agree that in order to receive Childcare Grant, my personal details and my children’s
details will be shared to a contracted third party who will be handling the administration of Childcare
Grants on behalf of SLC.
• I understand that if I do not inform SLC of any change of circumstances that affect the amount of
Childcare Grant I am entitled to, I will have to pay back any overpayment.
• I conrm that neither I nor my husband, wife, civil partner or cohabiting partner have chosen to receive
support for childcare from the childcare element of: (i) the Working Tax Credit; (ii), the Universal Credit;
(iii) Tax-Free Childcare; and/or (iv) the NHS Childcare Allowance; and I agree to tell SLC immediately
if I or my husband, wife, civil partner or cohabiting partner does receive this support. I understand
that SLC reserves the right to share my personal data with HMRC to check whether I am in receipt of
childcare support from HMRC.
Your full name (in BLOCK CAPITALS)
Your signature
Today’s date (DDMMYYYY)
Next steps
1
Return the completed form to:
Student Finance England
PO Box 210
Darlington
DL1 9HJ
Make sure you pay the correct postage
2
Your parent(s) or partner may have received a separate form asking them to provide
details about their income. This must also be completed and returned to us.
7
Additional notes
If you’re providing extra information clearly mark what section and question the information is about.
8
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202122 Applying for student nance based on household (Student Loans Company)

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Completed 14 September 2021

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