Please submit your completed application form together with your supporting evidence either by email to email@example.com or post to:
Student Support Services
The London Institute of Banking & Finance
4 – 9 Burgate Lane
Kent CT1 2XJ
INTERNAL USE ONLY: PROGRAMME MANAGER COMMENT
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
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
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.
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