Special Consideration Application Form for
Corporate and Professional Qualifications
Before completing this form you should read the Special Consideration Policy for Corporate and Professional Qualifications policy. If you
have any queries please call us on +44 (0)1227 818609 or email support@libf.ac.uk. You must return the completed form together with
the supporting evidence within 5 working days of first notifying us. Please note that incomplete application forms may not be accepted
.
The London Institute of Banking & Finance is a registered charity, incorporated by Royal Charter.
YOUR DETAILS
LIBF number ____________________________________________________________________________________________________________________________________
SECTION 1 CONTACT DETAILS
YOUR DETAILS
Qualification name: ___________________________________________________________________________________________________
Assessment name: ___________________________________________________________________________________________________
Assessment date: ___________________________________________________________________________________________________
Does this application relate to an incident at the assessment venue?
n
Yes
n
No
Was the invigilator informed about your concern(s)?
n
Yes
n
No
Does this application relate to health / personal circumstances
n
Yes
n
No
Please provide full details about the circumstances that led to this application, including dates and times relevant to your studies.
Continue on a separate sheet if necessary.
SECTION 2 SPECIAL CONSIDERATION APPLICATION
MS05/18
Please submit your completed application form together with your supporting evidence either by email to support@libf.ac.uk or post to:
Student Support Services
The London Institute of Banking & Finance
4 – 9 Burgate Lane
Canterbury
Kent CT1 2XJ
United Kingdom
YOUR DETAILS
INTERNAL USE ONLY: PROGRAMME MANAGER COMMENT
YOUR DETAILS
Please confirm what evidence you are providing to support your claim. You should only send photocopies or scans as we are unable to
return original documents. If evidence is to follow please explain why:
Medical appointment / Health certificate
Death Certificate
Letter (on headed paper) of support / explanation from a Line Manager / HR at place of employment.
Letter from GP / Medical practitioner, relevant to the circumstances of your application.
Other (please state):_______________________________________________________
If your application is successful what would be your preferred outcome?
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
SECTION 3 : EVIDENCE
We will use and protect your personal data in accordance with current data protection legislation to evaluate your claim. Further details,
including your rights, the disclosure of data to third parties, storage, retention and how to amend your personal data, can be found
within our Privacy Notice (www.libf.ac.uk/privacy).
YOUR PERSONAL DATA
n
I declare that the information contained in this form is true and accurate, consent to the processing and use of personal data as
outlined in the Privacy Notice and accept our terms and conditions.
n
I confirm that by completing and submitting this form and associated evidence, I give consent to the processing and secure storing of
the evidence provided.
Signed______________________________________________________________________ Date ________________________________
Please note that all unsigned forms will be returned and will result in a delay in the processing of your enquiry
DECLARATION
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