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Page 1
For Official Use Only
/
Financial Questionnaire
READ THESE INSTRUCTIONS BEFORE COMPLETING THE QUESTIONNAIRE
The statement on Page 2 outlines the requirement for you to provide personal information about yourself, your partner (if applicable)
and your family, and for investigations to be made to verify these details against national criminal and security records. Credit
reference checks and investigations into your financial circumstances will also be carried out.
You are being asked to provide a
clear, complete
and
accurate
picture of your current and recent financial situation.This must reflect
the situation of anyone who shares financial responsibility with you. After completing the questionnaire, you must sign the declaration
on the last page to that effect.
In order to fill in this form, you will need to look at your financial papers (such as bank and credit card statements, payslips and
mortgage details), which you may be required to produce as part of the vetting process.
a. Surname
c. Full Forename(s):
1. Your Details
b. Title (Mr/Mrs/Ms/Miss/Dr/Prof/Rev):
d. Date of Birth:
e. Staff or Service Number
(if applicable)
:
f. National Insurance
Number:
g. Please specify your employment type:
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Page 1
How to complete this form
The information you provide will be scanned electronically so please ensure you only write inside the white boxed areas. Do not mark
or strike through any other areas of the form. If completing by hand please write in
BLACK INK
using
BLOCK LETTERS
. Keep each
character within the boxes on the form and leave one space between names/words. If an answer will not fit in the space provided,
please enter your answer on the continuation sheet at the back of this form, giving the number of the question you are referring to. If
you make a mistake, please do not correct it but delete it by filling in the relevant box as in the example below. Please do not use
correcting fluid.
Ensure you answer ALL the questions. You can use the abbreviation NA (Not Applicable). NA - If a question does not apply to you,
write
NA
in the
first two boxes only
of the relevant question.
Not Known
- If you do not know the answer, or you cannot provide the
information needed, write
NK
in the
first two boxes only
of the relevant question. Please provide an explanation why the information
is unknown to you in the appropriate boxes.
Unanswered questions or Not Known replies may cause delay to the processing of
this questionnaire.
Surname (now):
/ /
Day
Month
Year
RN
Army RAF MOD Civilian Other Civil
Servant
Other
Contractor
Police Officer /
Civilian Staff
Other
Civil Nuclear
Employee
Civil Nuclear
Contractor
NSV003 (Revised 04/2010)
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SMITH
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Page 2
STATEMENT OF HMG PERSONNEL SECURITY AND NATIONAL SECURITY VETTING POLICY
Minimum Personnel Security Controls
1. It is HM Government's policy that all areas of government and the
national infrastructure should include in their recruitment processes
certain basic checks. These checks include verification of the applicant's
identity, employment history, their right to work in the UK and, if
appropriate, checks of any unspent criminal records. Within government
these controls are described in the Baseline Personnel Security
Standard. In addition, the Centre for the Protection of National
Infrastructure (CPNI) produces a range of relevant guidance on
personnel security and makes similar advice available to the wider
national infrastructure.
National Security Vetting
2. National security vetting comprises a range of additional checks and may
be applied where a risk assessment indicates it is proportionate to do so.
The risk assessment process takes account of the access an individual
may have to sensitive assets (physical, personnel or information) at risk
from a wide range of threats. These threats include: terrorism,
espionage, or other actions that could threaten the United Kingdom. The
requirements of international agreements concerning the protection of
allies' information may also inform such assessments.
3. It is government policy that individuals should not be expected to hold an
existing security clearance in order to apply for posts that require vetting,
except where such posts are short term and need to be filled urgently.
4. There are three different types of national security vetting clearance:
Counter Terrorist Check (CTC), Security Check (SC) and Developed
Vetting (DV). Before any such clearance is undertaken the requirements
of the Baseline Personnel Security Standard must be met. Whilst the
information required and the range and depth of checks undertaken at
each level may vary, they are all intended to allow Government
departments and agencies, the Armed Forces and police forces to
assess whether individuals who are to be employed in sensitive posts or
critical functions might represent a security risk either directly or
indirectly.
Checks
5. Individuals subject to national security vetting (including UK nationals
taking up sensitive posts in international organisations) will be asked to
provide via questionnaire personal information about themselves,
partners, family members and other associates. It may be checked, and
retained for future checks, against:
• Relevant personnel records held by the employing department or
company
• Criminal records (both spent and unspent as defined by the
Rehabilitation of Offenders Act 1974)
• Information held by the Security Service.
• Credit reference agency records
6. The process may also take account of:
• Financial circumstances generally
• Third party character references
• Any medical considerations that could give rise to security concerns
7. Interviews with the vetting subject and referees may be carried out to
establish good character and to verify information that has been
provided.
Decision Making
8. National security vetting decisions may only be taken by Government
departments, agencies, the Armed Forces or police forces. All the
available information is taken into account to reach a reasoned decision
on an individual's suitability to hold a security clearance.
9. Security clearances may be refused or withdrawn where:
• There are security concerns related to an individual's involvement or
connection with activities, organisations or individuals associated with
the threats described in this Statement (or any similar new threats
that emerge);
• Personal circumstances, current or past conduct indicate that an
individual may be susceptible to pressure or improper influence;
• Instances of dishonesty or lack of integrity cast doubt upon an
individual's reliability;
• Other behaviours or circumstances indicate unreliability.
10. Wherever possible existing employees will have an opportunity to
discuss, comment on and challenge any adverse information that
arises. However in certain circumstances it may not be possible to
share such information as this could compromise national security, the
public interest or third party confidentiality.
Avenues of Appeal
11. Existing employees who are subject to national security vetting and
either refused a security clearance or whose clearance is withdrawn
may appeal against such decisions. All departments and agencies that
carry out national security vetting must provide for an internal appeal
process. Where individuals remain dissatisfied they may appeal to
the Security Vetting Appeals Panel, an independent body.
12. The Panel will consider the case, review the information and invite the
appellant and the organisation to make representations. The Panel will
make recommendations to the Head of Department or organisation in
the light of its findings as to whether the decision should stand or be
reviewed. The Panel may also comment on the security vetting
procedures and adequacy of the internal appeal arrangements.
13. There are no national security vetting appeal routes for applicants for
employment who are refused a security clearance. Separate
arrangements exist for applicants, employees and contractors of the
security and intelligence agencies, who may complain to the
Investigatory Powers Tribunal. Any individual may apply to an
Employment Tribunal if they feel that they have been discriminated
against in any part of the recruitment process.
Ongoing Personnel Security Management
14. The national security vetting process provides an assessment of the
vetting subject at the time the process is carried out but active ongoing
personnel security management is required to ensure that a security
clearance maintains its currency. As a minimum this will involve active
consideration of the vetting subject's continuing conduct in respect of
security matters; it will also require checks to be repeated at regular
intervals.
Please note that any information provided will be treated in strict confidence. In cases where a potential risk is identified, and a decision
taken to 'manage the situation' rather than refuse security clearance, those tasked with managing that risk will need the appropriate
information in order to do this effectively.
Failure to disclose relevant circumstances or information is likely in itself to be regarded as evidence of unreliability and will
be taken into account when assessing your suitability for security clearance. It is therefore in your own interests to be honest
and open in the information you provide in this questionnaire.
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Page 3
2. Your Properties
a. How many properties do you own, or partly own, in the UK or overseas?
b. Details of your properties:
Date of Purchase
/ /
Day
Month
Year
Purchase price
£
Property 1
What type of mortgage?
Term of mortgage (in months):
£
Current market valuation
Mortgaged?
Address Line 1:
Address Line 2:
Town:
Postcode:
Country:
County/Region:
If you own more than 2 properties, please provide details on the continuation pages.
c. Total of property market valuations, including those on continuation pages (if any)
£
Date of Purchase
/ /
Day Month Year
Purchase price
£
Property 2
What type of mortgage?
£
Current market valuation
Mortgaged?
Address Line 1:
Address Line 2:
Town:
Postcode:
Country:
County/Region:
Yes
No
Yes
No
Repayment Interest Only Flexible Other
Repayment
Interest Only
Flexible
Other
a. How much do you (and your partner) have in savings accounts, premium bonds and
invested in shares, funds, etc.?
3. Savings and Other Assets
Description of
savings/investments:
c. What is the valuation of your (and your partner's) vehicles?
£
£
Description of
vehicles:
d. What is the valuation of your (and your partner's) other assets, e.g. jewellery, antiques,
timeshares?
£
Description of
other assets:
Term of mortgage (in months):
b. Do you save:
Regularly?
Occasionally?
Hardly ever?
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Page 4
e. Have you ever received a lump sum worth more than £5,000? (e.g. redundancy, pension
commutation, inheritance, gift, winnings)
Yes No
Details:
TOTAL OF ALL ASSETS (add Total from c in Section 2 and amounts from a, c and d
given in this section)
£
a. How many mortgages and secured loans are linked to your properties?
4. Mortgages
d. Do you have any other mortgages or secured loans in addition to those declared above?
If 'yes', please give details on the continuation pages.
Yes No
g. Have you ever adjusted the payment terms of your mortgages, e.g. payment holiday?
Yes
No
h. Have you ever remortgaged to consolidate your personal debts?
Yes
No
If you answer 'yes' to Question 4f, g or h, please give details on the continuation pages.
e. Total of mortgage / loan balances outstanding (including any listed on the continuation
pages):
£
f. Have you ever taken a further mortgage advance(s) for any purpose?
Yes No
2nd.1st.
b. Mortgage / loan lenders of property 1:
Date of 1st mortgage / loan:
/
Year
Month
Initial amount:
£
Balance outstanding:
£
2
nd
.
1
st
.
c. Mortgage / loan lenders of property 2:
Date of 1st mortgage / loan:
/
YearMonth
Initial amount:
£
Balance outstanding:
£
£
Balance outstanding now:
c. Total of loan balances outstanding (including any listed on the continuation pages)
£
a. How many loan agreements (including student loans but not secured loans listed at Q4) are outstanding?
5. Loans
b. Please give details below. Use the continuation pages if necessary.
Lender 1:
Purpose:
/
Year
Month
Date taken out:
£
Amount:
Repayment:
£
£
Balance outstanding now:
Lender 2:
Purpose:
/
Year
Month
Date taken out:
£
Amount
:
Repayment:
£
Date of 2nd mortgage / loan:
/
YearMonth
Initial amount:
£
Balance outstanding:
£
Date of 2nd mortgage / loan:
/
Year
Month
Initial amount:
£
Balance outstanding:
£
Expiry Date:
/
Year
Month
Expiry Date:
/
Year
Month
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Page 5
Issuer:
Credit limit:
Issuer:
Credit limit:
Issuer:
Credit limit:
Issuer:
Credit limit:
a. How many credit, store and charge card accounts do you (and your partner) have?
6. Credit Cards
b. Please give details below.
c. Total of balances outstanding (including any listed on the continuation page)
£
d. Do you transfer balances between credit cards, e.g. 0% interest deals?
Yes
No
a. How many current accounts were
overdrawn
in the previous month?
b. Please give details below. Use the continuation pages if necessary.
7. Current Accounts - Overdrafts
c. Total of overdrafts (including any listed on the continuation page)
£
d. In the last 5 years, how many times have you exceeded your overdraft limit(s)?
TOTAL OF ALL LIABILITIES (add 4e, 5c, 6c, 7c)
£
Type:
£££
Avg monthly payment:
Balance outstanding:
Type:
£
£
£
Avg monthly payment: Balance outstanding:
Type:
£££
Avg monthly payment:
Balance outstanding:
£
£
Branch:Bank:
Max. O/D last month:
Overdraft limit:
Type:
£
Avg monthly payment:
Balance outstanding:
££
£
£
Branch:
Bank:
Max. O/D last month:
Overdraft limit:
8. General Circumstances
a. Are you living with someone?
b. If you are living with someone, do they share a financial responsibility with you or make a
contribution to your financial situation?
If you answered 'yes', it will be necessary to explore the impact
of this person's contribution on your financial situation. Please include the requested information in the
relevant sections of this form.
Yes
No
Yes No
Details:
c. For whom do you have a financial responsibility, other than yourself (e.g. partner, children, parent)?
Details:
d. What major financial changes to your budget do you anticipate in the next 12 months? (e.g. salary increase, partner returning
to work, endowment policy maturing or reduction in hours, partner ceasing work, moving house and increasing mortgage etc)
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Page 6
9. Household Monthly Income
To enable us to assess the household income - please provide
a clear picture of all sources of earned and unearned income.
SELF OTHER PERSON
£
£
j. Total individual
monthly
incomes
k. Total joint monthly income
£
If a fuller explanation of your income would be helpful to us, please provide the details below.
Details:
l. Has all income been declared for tax purposes (e.g. rental income)?
Yes No
e. Have you been the victim of "identity theft" or credit card fraud? If 'yes', please give details.
Yes
No
Details:
£ £
£ £
£
£
£ £
£ £
£
£
£
£
£ £
£ £
a.
Current
annual
salary (gross)
b.
Usual
annual
bonus (gross)
c.
Annual
car allowance (gross)
d.
Monthly
net salary (including average bonus and any
allowances)
e.
Monthly
income from state benefits (e.g. Child Benefit,
Family Credit)
f.
Monthly
net income from pensions and annuities
g.
Monthly
net income from savings and investments
averaged)
h.
Monthly
income from rented properties
i. Monthly maintenance received
10. Accommodation Charges
b. If 'yes', how much (per month)?
£
c. What other costs are you liable for (e.g. service charge, agent's fees, etc.)?
a. Do you pay rent for any property?
Yes
No
d. Do you share rent and utility costs with other tenants?
Yes No
e. Do you receive accommodation free of charge? If 'yes', please give details below.
Yes
No
Details:
Details:
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Page 7
Sought a reduction in monthly repayments with a lender?
Ever consolidated debt onto a new financial arrangement?
Had a default or termination notice issued to you by a bank or creditor?
12. Financial History / Arrangements
a. Have you and/or your partner in the last 10 years:
Had a credit or store card application declined?
Had a personal loan application declined?
Number of
Times
Most Recent
Year
Arranged a debt management plan (formal or informal)?
Consulted a debt management company or advisory service, e.g. CAB?
Had a credit or store card withdrawn?
Yes
No
Yes
No
Yes
No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
11. Household Monthly Outgoings
a.
£
To enable us to assess the household outgoings, please provide an accurate account of all
household expenditure.
MONTHLY COST
£
£
£
£
£
£
£
£
£
£
£
£
£
£
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
Details:
Total of outgoings:
Mortgage / Rent / Board / Lodging
Service charge / ground rent / management fees
Council Tax
Housekeeping (i.e. food and household necessities)
Motoring costs (including tax, insurance, petrol & maintenance) / commuting and travel costs
Utility bills (gas, electricity, oil, water bills, telephones and mobile phones)
Loan repayments
Sky / Cable / TV licence / Internet access
Maintenance payment for children
Nursery fees / school fees / parental contribution to student costs
Pensions / insurance (all - excluding car insurance)
Holidays (average per month of annual costs)
Entertainment (including sports and gym club memberships, trips out, etc.)
Other regular commitments (please detail below)
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Page 8
Been subject to a county court judgement?
Been subject to an attachment of earnings order?
Had repossession proceedings commenced against you?
Been investigated by HMRC or DWP?
b. Have you and/or your partner ever applied for an Individual Voluntary
Arrangement (IVA), or (in Scotland only) a Protected Trust Deed, or a
Debt Relief Order?
c. Have you and/or your partner ever been declared bankrupt?
d. Do you have any financial interests that may conflict with your duties
as a Civil Servant, member of HM Forces, or as a Government
contractor?
(e.g. your partner runs a company, which tenders for
contracts that you are responsible for placing)
e. Are there any details or explanations that would help us to
understand your financial position better?
If you answered 'yes' to any question, please provide full details on the continuation pages.
13. Financial Obligations
a. Do you have any form of financial obligation in excess of £1000 that has not been disclosed
elsewhere on this form?
If 'yes', please advise details on the continuation pages.
Yes
No
Yes
No
b. Have you ever lent or given anyone (including family members) more than £1000 ?
If 'yes', please
advise details on the continuation pages, including any plans for repayment.
c. If you answered 'yes' to Questions 8a and 8b - does the other person have debts in their sole
name in excess of £5000, to your knowledge?
If 'yes', please provide details below.
Yes
No
Yes
No
Yes
No
Yes No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Number of
Times
Most Recent
Year
If you are a self-employed contractor, please go to Section 14. Otherwise, please go to the Declaration on Page 11.
Details:
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Page 9
14. SELF-EMPLOYED CONTRACTORS - ADDITIONAL INFORMATION SHEET
a. Are you being employed through an agency for the contracted work?
b. Are you self employed and submit invoices in your personal/trading name?
c. Are your invoices submitted by a company, of which you are the primary director or shareholder?
d. If 'Yes', please provide the following information:
Company Name:
e. Are your annual returns to Companies House up to date?
f. Are your annual accounts registered at Companies House up to date?
g. Are payments of VAT, tax and social security paid up to date, by their due date?
If you have answered 'No' to
Q14e, f or g, please provide
an explanation here
k. Have you ever been involved with a company that has undertaken a voluntary liquidation or
creditors winding up?
Yes
No
Yes
No
Yes No
Yes
No
Yes No
Yes
No
Yes
No
Yes
No
Full Name:
Yes No
l. Have you ever been disqualified from being a company director?
m. Has the company been investigated by HMRC or DWP?
Company Number:
Accounting Date:
/ /
Day Month Year
j. Has the company been subject to a county court judgement?
Yes
No
If you have answered 'Yes' to
Q14h, i or j, please provide
an explanation here
DETAILS OF INCOME
n. Please provide details of your personal (and your partner's) income from the company, including the amount of any
dividends received and frequency of payments, for the previous and current accounting periods.
If you have answered 'Yes' to
Q14k, l or m, please provide
an explanation here
Details:
N.B. Copies of company accounts may be requested to support your description or provide clarity.
i. Have the directors been fined for non-filing of documents at any time?
Yes No
h. Has a late filing penalty been imposed on the company at any time?
Yes No
Now please complete the declaration on Page 11
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Page 10
Continuation of Answers
Question
Number
IMPORTANT: When providing additional information please write the Question Number against each answer and provide all
the information requested in the original question.
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Page 11
Declaration
I declare that I have read and understood the statement of HM Government's policy on vetting on page 2 of this questionnaire.
I understand that in accordance with this policy the personal information that I have provided on this form about myself, my partner
(if applicable) and my family will be submitted for checking against national criminal and security records
I understand that a check against credit reference agency records and investigations into my financial circumstances will also be
carried out. I understand, too, that the information provided may be subject to ongoing checks where they are necessary and
proportionate.
I declare that the information I have given is true and complete to the best of my knowledge and belief, and I understand that any
false statement or deliberate omission in the information I have given in this questionnaire may disqualify me from employment
(including employment in connection with Crown contracts if applicable) or make me liable to disciplinary action, which may include
dismissal.
I undertake to notify any material changes in the information I have given above (e.g. change of partner, address or financial
circumstances), including any future criminal convictions, to the Personnel or Security branch concerned.
Important: Data Protection Act 1998. This questionnaire asks you to supply "personal" and "sensitive personal"data as defined by
the Data Protection Act 1998. You will be supplying this data to the appropriate vetting authority where it will be processed
exclusively for the purpose of security vetting, , in accordance with HM Government's vetting policy, save that, in the highly unlikely
event that data supplied by you discloses or suggests that:
i. a criminal offence has occurred or is likely to occur or,
ii. staff may be at risk of danger e.g. if you have been diagnosed with a serious mental condition as potentially endangering
yourself or others
then the vetting authority may pass on that information alone to the appropriate person(s). Subject to this, the vetting authority will
protect the information which you provide and will ensure that it is not passed to anyone who is not authorised to see it.
By signing the declaration on this page, you are explicitly consenting for the data you provide in this questionnaire to be
processed in the manner described above.
If you have any concerns about any of the questions we ask, or what we will do with the information you provide, which are not
answered by the guidance notes please contact the person who issued this form for further information.
Note:
Please review the form
BEFORE SIGNING
to ensure that all questions have been fully answered.
Date:
Signed:
/ /
Day Month Year
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