Fillable DSA 2020/21 Claim for reimbursement of costs through (Student Loans Company)

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DSA 2020/21 Claim for reimbursement of costs through (Student Loans Company)

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Country of origin: UK
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SFE/DAEX/2021/A
DSA
Claim for reimbursement of costs
through Disabled Students’ Allowances
2020/21
Personal Details
Customer Reference Number Name
University or College
Date of birth (DDMMYYYY)
Address
Course
Postcode
Complete this form to claim any costs you have had to pay in connection with
your studies due to a reason relating to your disability, mental health condition or
specific learning difficulty. For example:
Travel costs.
Books in Braille.
Consumables (batteries, cartridges, paper).
Additional costs of university or college accommodation.
Please note that the above list is not exhaustive. If you require further information
on what you are entitled to claim for, please contact us on 0300 100 0607.
To find out how we’ll use the information you provide go to
www.gov.uk/studentfinance to read our Privacy Notice before completing this
form.
Alternatively, you can request a copy by writing to the Student Loans Company
(SLC) at 100 Bothwell Street, Glasgow, G2 7JD or by calling us on 0300 100 0607.
If we become aware of fraudulent activity we will share the supplier details you
give us with Cifas.
You need to tell your suppliers that you’ve given us their details.
£
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SFE/DAEX/2021
Claim for reimbursement of costs through
2020/21
Disabled Students’ Allowances (DSA)
Please attach receipts or invoices as evidence of your purchases.
Please do not include items which are invoiced directly to us.
Details of your costs
Amount (£)
Name and address of supplier
Total claimed
Declaration
If you cannot sign the form it must be
signed on your behalf by your attorney.
The Power of Attorney letter must
be sent with the application before a
signature from that attorney will be
accepted.
I have incurred the expenses shown
on this form.
I will inform you of any changes that
occur.
Your full name (in BLOCK CAPITALS)
Signed
Today’s date (DDMMYYYY)
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DSA 202021 Claim for reimbursement of costs through (Student Loans Company)

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Completed 29 March 2021

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