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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.

PLEASE READ THE STATEMENT BEFORE FILLING IN THIS QUESTIONNAIRE.

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

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

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

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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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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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

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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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

h. Have you ever remortgaged to consolidate your personal debts?

Yes

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:

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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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

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

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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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

Details:

£ £

Current

annual

salary (gross)

Usual

annual

bonus (gross)

Annual

car allowance (gross)

Monthly

net salary (including average bonus and any

allowances)

Monthly

income from state benefits (e.g. Child Benefit,

Family Credit)

Monthly

net income from pensions and annuities

Monthly

net income from savings and investments

averaged)

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

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

Details:

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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

Yes No

Yes

Yes No

Yes

11. Household Monthly Outgoings

To enable us to assess the household outgoings, please provide an accurate account of all

household expenditure.

MONTHLY COST

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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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

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

Yes No

Yes

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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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

Yes No

Yes

Yes No

Yes

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

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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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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