Cofirmatio of Household Fiacial Commitmets f Depedats Grats - Academic Year 2014/15 Studet details Customer Referece Number the studet fiace experts Feame(s) Surame About this fm Complete this fm to tell us about your actual household fiacial commitmets betwee 1 ad 31 ch. Sectio 1 - your actual household fiacial commitmets Complete the table below to tell us the mothly amouts f each of your household fiacial commitmets. Oly iclude fiacial commitmets that were already beig paid befe the start of the academic year of your first year of study. You should ot iclude paymets you started makig after this. F example, if you started your first year of study o 10 ad you took out a life isurace policy o 3 you should ot iclude the paymets towards that policy. Do t iclude utility bills as a fiacial commitmet, f example, TV licece, mobile phoe bills, gas bills, electric bills etc. Mtgage Ret Coucil Tax Mtgage Edowmets Mtgage Isurace Cotiued o page 2 SFE/CofDG/1415 1
SFE/CofDG/1415 2 Sectio 1 - your actual household fiacial commitmets (cotiued) Cotets Isurace Life Isurace Medical Isurace Home Improvemet Loa Obligaty Child Maiteace Vehicle Isurace Vehicle Loa Buildigs Isurace
Sectio 2 - evidece of your household fiacial commitmets You eed to sed evidece to cofirm how much you paid f each household commitmet f the whole of the period required. You eed to sed evidece of every paymet made durig this period. If this is the first time you re sedig evidece of a fiacial commitmet, it must also show that the commitmet was i place befe the start of the academic year of your first year of study.! You should oly sed photocopies of evidece because ay evidece will be securely destroyed oce we ve checked it. the boxes below to tell us what evidece you re sedig f each household fiacial commitmet. Household fiacial commitmet type Mtgage Ret Photocopied evidece I m sedig f period 1 to 31 ch Statemet from mtgage provider. Letter from ladld cofirmig paymets If also i receipt of housig beefit please supply the followig clearly showig each received amout Coucil tax Please ote: we do t accept coucil tax bills as they do t cofirm paymets Mtgage edowmets Mtgage isurace Buildigs isurace Cotets isurace Life isurace Medical isurace Letter from local authity cofirmig paymets Letter from coucil cofirmig paymets Letter from edowmet provider cofirmig paymets Letter from isurace provider cofirmig paymets Letter from buildigs isurace provider cofirmig paymets Letter from cotets isurace provider cofirmig paymets Letter from life isurace provider cofirmig paymets Letter from medical isurace provider cofirmig paymets Cotiued o page 4 SFE/CofDG/1415 3
Sectio 2 - evidece of your household fiacial commitmets (cotiued) Household fiacial commitmet type Home improvemet loa Obligaty child maiteace Vehicle isurace Vehicle loa please specify ay other ogoig fiacial obligatios you have submitted to be cosidered Photocopied evidece I m sedig f period 1 to 31 ch Letter from loa provider cofirmig paymets Bak statemets (if paymet descriptio is Child Suppt Agecy the o supptig documet required); A siged letter from whoever the child is livig with advisig the amout of child maiteace paid to them; Pay slips f the whole of the time period required if paymet is goig direct from wages. It must state o the pay slips that paymet is to Child Suppt Agecy. Letter from vehicle isurace provider cofirmig paymets Loa letter from loa provider cofirmig paymets Proof of paymets; Receipts. If you re sedig bak statemets as evidece you should clearly mark each paymet to show which household fiacial commitmet it was f. Do t use a highlighter as we may ot be able to process your evidece. laratio I cofirm that to the best of my kowledge ad belief, the ifmatio I have provided is true ad complete. If it is ot I uderstad I may ot receive fiacial suppt, ay suppt I have had may be withdraw ad I could be prosecuted. I agree that i the evet of receivig a overpaymet of fiacial suppt, I am obligated to repay this overpaymet i full. Your full ame (i BLOCK CAPITALS) Your sigature X Today s date / / 4 SFE/CofDG/1415
Checklist Befe you retur this fm please make sure that: You ve told us about all your household fiacial commitmet amouts f the period 1 to 31 ch. You ve icluded all the evidece that you ve ticked to say you will be sedig. Make sure your evidece covers the whole period from 1 to 31 ch. Remember - do t sed igial fiacial documets as evidece. You ve siged ad dated the declaratio. You must retur your completed fm ad evidece to: Studet Fiace Eglad Fialisatio Departmet PO Box 311 Darligto DL1 9NZ Remember to pay the crect postage.! If you do t complete ad retur this fm alog with the appropriate evidece your etitlemet to Depedats Grats will be reviewed ad you may have to pay back ay grat that you ve already received. SFE/CofDG/1415 5