Household Income
Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT
t / 0300 555 0505 w / www.saas.gov.uk
Household income for the tax year ending 5 April 2019
Who should fill in this form?
The parents, step parents, parent’s partner, legal guardians or husband, wife, civil partner or partner of the student
must fill in this form as a formal declaration of their income for the tax year ending 5 April 2019. If you received
state benefits, you must fill in Sections A to F. If you did not receive state benefits, you should only fill in Sections
A to D.
When you send us the form, you must also send us copies of documents as proof of the income you declared for
example, P60, self-assessment or tax credit award/annual review. Please note that if you have already sent us this
proof, you do not need to send it again.
If you are not sure how to fill in the form or which documents to send us, please contact us on 0300 555 0505.
Section A Student details
Name
Date of birth
SAAS reference number
Section B Your details: parents, step parents, parent’s partner, legal guardians / husband, wife, civil
partner or partner
Person 1
Person 2
If you are the student’s parent, step-parent or legal guardian and you are the only person named above, please tell us
why in the box below. For example, ‘single parent’.
Reason for one person’s details
If you have not already done so, you must send us a copy of one of the documents listed below as proof that you live
as a single person:
Your 2020-2021 tax credit award or
tax credit annual review for tax year
ending 5 April 2020.
A letter from the Jobcentre or Department for Work and Pensions which
clearly states you receive benefits as a lone parent. This must be on headed
paper and dated within the last three months.
Your council tax notice for 2020-2021
that shows a 25% discount.
A letter from your council or housing association that shows you have
been given the tenancy as a lone parent or are receiving housing benefit as a
lone parent. This must be on headed paper and dated within the last three
months.
Your most recent Universal Credit
statement that shows you receive a
standard allowance as a single person.
A letter from a professional person who can confirm you live as a single
parent. This must be on headed paper and dated within the last three
months.
A professional person can be a doctor, nurse, lawyer, solicitor, notary public,
teacher, counsellor, police officer, family mediation worker, social worker,
nursery teacher, student adviser or minister of religion.
Household Income
Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT
t / 0300 555 0505 w / www.saas.gov.uk
Section D Declaration Person 1 and 2 must sign this
SAAS will use the information you have given us in this form for the purpose of processing this claim. Further information on how we
collect, hold and process your information can be found at https://www.saas.gov.uk/_forms/third_party_privacy. We have a duty to
appropriately manage public funds and we will use the information provided on this form for the prevention, detection, investigation
and reporting of crime, including Fraud. We will share this information with other bodies for these purposes.
As far as I know, the details above are complete and accurate.
I agree to give you any further information you may ask for.
I agree to tell you immediately if my circumstances change in any way that might affect this application for support.
I understand that the information I have provided will be used for the prevention detection, investigation and reporting of
crime and I understand SAAS will share this information with other bodies for these purposes.
Person 1
signature
Date
Person 2
signature
Date
If you received state benefits, you must now fill in Sections E and F on page three. If you did not receive state
benefits, you do not need to fill in or send us page four.
Section C - Your total income for the tax year ending 5 April 2019
If you received state benefits (excluding any form of state pension or working tax credit), please tick the box
below and fill in Section E and F on page three. Don’t forget to declare any non-benefit income on this page and
sign the declaration below.
Person 1
Person 2
Type of income
Person 1
Person 2
PAYE income declare your income before tax, as shown on your P60.
NONE
NONE
Self-employment, property or land declare your net profit (taxable
profit after expenses but before tax/taxable allowance has been deducted)
from year ending between 6 April 2018 and 5 April 2019.
NONE
NONE
Working Tax Credit. You should not declare Child Tax Credit or the
childcare element of Working Tax Credit.
NONE
NONE
Pension declare your income before tax from private pensions,
employers pensions and any form of state pension (including pension
credit).
NONE
NONE
Dividends, bonds, trusts, bank/building society accounts or
investment income declare the amount you received before tax.
NONE
NONE
Maintenance you receive for either yourself or a student in further/higher
education (this includes the student named in Section A).
NONE
NONE
Other income if you received a type of income that is not listed on this
page or on page three, declare the type of income and how much you
received.
NONE
NONE
If you pay maintenance for a child in further/higher education (not the
student named in Section A), enter their name, date of birth and how
much you pay.
NONE
NONE
If you declared no income above and received no state benefits, please
enter a reason for this. For example, stay-at-home parent or unemployed
and not entitled to benefits.
REASON
FOR £0
INCOME
REASON
FOR £0
INCOME
Household Income
Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT
t / 0300 555 0505 w / www.saas.gov.uk
Section E Benefits we take into account. If you received one or more of the benefits in the list below,
please declare your total income from each benefit for the tax year ending 5 April 2019. If the benefit you
receive is not listed here, go to Section F.
Benefit type
Person 1 Amount
Person 2 Amount
Bereavement Allowance
NONE
NONE
Carer’s Allowance
NONE
NONE
Employment and Support Allowance
NONE
NONE
Incapacity Benefit
NONE
NONE
Income Support
NONE
NONE
Industrial Death Benefit
NONE
NONE
Industrial Injuries Disablement Benefit
NONE
NONE
Invalid Care Allowance
NONE
NONE
Invalidity Benefit
NONE
NONE
Jobseekers Allowance
NONE
NONE
Maternity Allowance
NONE
NONE
Severe Disablement Allowance
NONE
NONE
Statutory Sick Pay
NONE
NONE
Statutory Maternity Pay
NONE
NONE
Universal Credit (excluding child and housing element)
NONE
NONE
Widowed Parent’s Allowance
NONE
NONE
Section F Benefits we don’t take into account. If you received one or more of the benefits in the list
below, please tick the box beside the benefits you received. You don’t need to declare how much you
received.
Benefit type
Person 1
Person 2
Adoption allowance
Attendance allowance
Bereavement payment
Christmas bonus
Child Benefit
Child Tax Credit
If you
If you
Child’s Special Allowance
received
received
Clothing Allowance
any of
any of
Council Tax Reduction
these
these
Constant Attendance Allowance
benefits,
benefits,
Disability Living Allowance
please
please
Guardian’s Allowance
tick the
tick the
Housing Benefit
relevant
relevant
Winter fuel payment
box
box
Social fund payment
Mobility supplement
Personal Independence Payment
Scottish Welfare fund
Universal Credit child and housing cost elements
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