Curret Year Icome Assessmet Form Academic Year 2015/16 Persoal details Perso 1 Your Customer Referece Number Your Customer Referece Number Name Name Date of birth Address / / Date of birth / / Address Postcode Postcode If you wat to provide your fiacial details separately, you ca dowload aother copy of this form at www.gov.uk/studetfiace Before you complete this form For the studet to be assessed based o your estimated icome for the tax year 2015-16, we eed to be able to compare your estimated icome with your actual icome for the tax year 2013-14. Have you give us your fiacial details for the 2013-14 tax year? If you must give us fiacial details. You ca dowload a form to give your details at www.gov.uk/studetfiace Perso 1 If you re awarded a curret year icome assessmet, we ll use your fialised 2015-16 household icome to work out how much the studet ca get if they apply for fudig based o household icome i the 2016/17 academic year. If your icome will fall by a further 15% i 2016/17, you ca apply for a further curret year icome assessmet. How do I complete this form? Start by completig Sectio A ad the work your way through the form. Depedig o your circumstaces you may ot eed to complete every sectio. Do t forget to sig the Declaratio at the ed. Sectio A tax credits ad icome support Sectio B your fiacial iformatio Sectio C other icome Sectio D icome deductios tes to help you complete some of the questios withi the form ca be foud every time you see. SFE/CYI/1516/A 1
After I have set you my completed form, do I eed to do aythig else?, but ot just ow. After tax year 2015-16 has eded, we will cotact you ad ask you to cofirm, with evidece, your actual earigs for that tax year. These evidece items will be the same documets that you sed to, or receive from, HM Reveue & Customs. For example, a P60, SA200 or Self Assessed Tax Retur. If your actual icome is differet from your estimates we may adjust the amout of studet fiace awarded. If we have paid the studet(s) too much we may have to recover studet fiace from them. Sectio A Tax credits ad icome support Does your tax year ed o 5 April 2016? Perso 1 If o, whe does it ed? / / / /! If your tax year eds o a date other tha 5 April 2016, please provide us with iformatio for your tax year that will ed durig the academic year 2015/16. Q2 Did you receive Workig Tax Credits or Child Tax Credits? Perso 1 Will you receive Icome Support? Sectio B Your fiacial iformatio How to aswer the questios i this sectio: If you aswer to ay of these questios you will eed to provide the total amout of gross icome you expect to receive for that icome type. The total amout should iclude all earigs coverig the full tax year. For example, if you were made redudat part-way through the year, you eed to iclude earigs from 6 April 2015 up to the date of your redudacy ad ay icome you expect to receive from the up to 5 April 2016. For pesio paymet questios, please oly tell us the amout of the pesio you expect to receive from the first moth you receive it util the ed of the tax year. You do t eed to tell us the full aual amout. If you aswer to ay questio, this meas you are tellig us that you do ot expect to receive ay icome from that particular icome type. Do you expect to receive ay icome from salary, wages, taxable state beefits or from occupatioal or private pesios? a Total expected icome from salary / wages Perso 1 b Total expected icome from taxable state beefits c Total expected icome from occupatioal pesio(s) d Total expected icome from private pesio(s) SFE/CYI/1516 2
Sectio B Your fiacial iformatio - cotiued Q2 If you are i receipt of taxable state beefits, oly iclude the followig beefits i your total i : Bereavemet Allowace Idustrial Death Beefit Carer s Allowace Jobseekers Allowace Cotributio based Employmet ad Support Statutory Adoptio Pay Allowace Statutory Materity Pay Graduated retiremet beefit Statutory Paterity Pay Icapacity Beefit (oly iclude the amout Statutory Sick Pay received after 28 weeks of icapacity) Widowed Paret s Allowace Do you expect to receive ay icome from a State Retiremet Pesio? Perso 1 a Total expected o-lump sum amout b Total expected lump sum amout Do you expect to receive ay icome from savigs ad ivestmets? a Total expected UK iterest from UK baks, buildig societies ad uit trusts b Total expected icome from other savigs ad ivestmets c Total icome from UK ivestmets ad divideds d Total icome from foreig ivestmet ad divideds Gross UK iterest (before tax has bee deducted) You must iclude iterest you receive o bak, buildig society ad other savigs accouts uless it is specifically o-taxable, for example, a o-taxable Idividual Savigs Accout (ISA) etc. Q4 Do you expect to receive ay icome from taxable beefits i kid? Total expected icome from taxable beefits i kid Taxable beefits i kid are other beefits that you are etitled to, but do ot form part of your salary. For example, a fuel allowace or compay car. Ay other icome Q5 Do you expect to receive ay other icome durig the 2015-16 tax year that you have t yet told us about? - Go to Sectio C - Go to Sectio C - Go to Sectio D - Go to Sectio D SFE/CYI/1516 3
Sectio C Other icome Do you expect to receive ay icome from self-employmet? Perso 1 a Total taxable profit from busiesses b Total taxable profit from parterships Q2 Do you expect to receive ay icome as a Miister of religio? Total expected icome amout (mius expeses that would ot ormally show o a P60 or P11D) Do you expect to receive ay icome from lump sums or from other taxable icome sources? Total expected icome from lump sums or other taxable icome sources. For example, moey received as compesatio or from redudacy. You must iclude the full amout of your redudacy paymet, eve if you do t expect to pay tax o it. Q4 Do you expect to receive ay icome from property lettigs? Total expected icome from property lettigs Q5 Do you expect to receive ay icome from UK trusts? Total expected icome from UK trusts. For example, paymets from settlor-iterested trusts ad icome from UK estates. Q6 Do you expect to receive ay foreig icome? Total expected foreig icome Q7 Do you expect to receive ay icome from a overseas pesio? Total expected icome from a overseas pesio Q8 Do you expect to receive ay other overseas icome ad gais? Total expected other overseas icome ad gais SFE/CYI/1516 4
Sectio D Icome deductio Perso 1 Do you expect to pay ay private pesio cotributios? Total expected private pesio cotributios Q2 Do you expect to pay ay Additioal Volutary Cotributios (AVCs)? Total expected AVCs Do you expect to have ay allowable expeses o which you will claim tax relief? Total expected allowable expeses o which you will claim tax relief Declaratio Make sure you sig the declaratio i ik. Digital sigatures wo t be accepted. Our Data Protectio Statemet sets out who will use the iformatio provided o this form ad what they will use it for. Before sigig this form please read our statemet olie at www.gov.uk/studetfiace If you caot sig the form it must be siged o your behalf by your Power of Attorey. The Power of Attorey letter must be set with the applicatio before a sigature from that Power of Attorey will be accepted. This applicatio for fiacial support may be delayed uless you sig ad date this declaratio. I cofirm that to the best of my kowledge ad belief, the iformatio I have provided is true ad complete. If it is ot I uderstad the studet(s) I am supportig may have their fiacial support withdraw ad I could be prosecuted. I agree to supply ay further iformatio i relatio to the applicat s applicatio for fiacial support that the Studet Loas Compay (SLC) may ask for ad agree to tell them immediately if my circumstaces chage i ay way that might affect this applicatio for fiacial support. Perso 1 Your full ame (i block CAPitAls) Your full ame (i block CAPitAls) Your sigature Your sigature r r DAY MONTH YEAR DAY MONTH YEAR today s date today s date SFE/CYI/1516 5