Asylum Support Application Form (ASF1)

Destitution Message

Under the terms of the Immigration and Asylum Act 1999, the Secretary of State may
provide, or arrange for the provision of support for asylum seekers, dependants of
asylum seekers or failed asylum seekers who appear to be destitute or are likely to
become destitute within a 14-day period.

An applicant is deemed destitute if:

“They and their dependants do not have adequate accommodation or any means of
obtaining it, even if other essential living needs are met, or they and their dependants
have adequate accommodation or the means of obtaining it but cannot meet essential
living needs.”

As an applicant, you should note that:

1. You must complete all fields that are relevant to your application;

2. Failure to disclose all necessary information or to provide false information about

yourself or any dependant may lead to information being passed to the police or
other agencies for investigation;

3. Failure to supply the required information may result in your application for
support being refused.

☐ I have read and understood the destitution message

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Section 1. Tell us any reference numbers which may help us to identify
Reference you.
numbers

Give details of any Home Office Reference

current Home
Office reference
numbers Port Reference

Asylum Support Reference

Any other relevant

reference numbers
(i.e. NHS)

Type of support
Section 95: ☐ (you must complete parts 1 – 18)
What type of
support are you Section 4 ☐ ( (you must complete parts 1 – 26)
applying for?

What type of section Accommodation and subsistence ☐

95 support are you
applying for? Accommodation only ☐

Subsistence only ☐

Section 2. Personal Tell us details about yourself.

details

Name
Title: Mr ☐ Mrs ☐ Miss ☐ Ms. ☐ Dr ☐

Family Name:

Given Names;

About other
names you use
now

Do you currently
use any other
Yes ☐ No ☐
name?

Page 2 of 32 ASF1_ V4.0

Details of other name Title: Mr ☐ Mrs ☐ Miss ☐ Ms. ☐ Dr ☐

Family Name:

Given Names:

Gender Male ☐ Female ☐

Date of birth
(dd-mm-yyyy) Day Month Year

Nationality

What is your first

language?

Do you speak English? Yes ☐ No ☐

Can you read English? Yes ☐ No ☐

Relationship status ☐ Married ☐ Single

☐ divorced ☐ Civil Partnership
☐ Separated ☐ Widowed
☐ Partner ☐ Same Sex Partner
☐ Dissolved partnership ☐ Surviving Civil Partner
How many
dependants, in the UK,
are to be included in
this application for
support

Do you have any

dependants that are
not on your asylum
application that you Yes ☐ No ☐
wish to claim support
for?

Page 3 of 32 ASF1_ V4.0

Why are you
requesting support for
this person?

Section 3.
Passport details
Do you have a
current passport or Yes ☐ No ☐
travel document?

Where is this
document?

Do you have any other

passports or travel
documents? Yes ☐ No ☐
Your Passport
details
Document number

Country of Issue

Date of Issue
and expiry

Issuing Authority

Section 4. Other Tell us if you hold another nationality

nationalities you
hold now
Do you have any
other nationality? Yes ☐ No ☐

Other nationality

Other nationalities
you have held in the
past:

Have you had any Yes ☐ No ☐

other nationalities
in the past?

Page 4 of 32 ASF1_ V4.0

Previous nationality.
When did you have
this nationality?
Section 5. Your
current
circumstances
Are you, or will you be,
without Yes ☐ No ☐
accommodation or the
means to meet your
essential living needs
within 14 days?

If “Yes” when will this Day Month Year

be from?

Section 6. Address
and contact details
in the UK

Do you have a
current address? Yes ☐ No ☐ (If no, provide a phone number where we can contact you)

Address House Number or Name

Street Name

Town or City

County

Postcode
Home
telephone
number

Mobile
telephone
number

E- mail address.

Your address:
Tell us where we can write to you:
Is your current
address also your
correspondence Yes ☐ No ☐ (if No fill in the correspondence address)
address?

Page 5 of 32 ASF1_ V4.0

House number or name
Address

Street Name

Town or City

County

Postcode

Who currently ☐ Home Office ☐ Friend

provides you with ☐ Relative ☐ Rented
accommodation? ☐ Partner ☐ Charity
Street Homeless Other?

Tell us who you

currently live with?
(please include their
name and any contact
details you have for
them)

Do you pay towards Yes ☐ No ☐

the cost of your
accommodation?

Amount per month

How are these

payments made and
how is this funded?

Evidence of the rent amount, and how

If you are claiming for much you pay towards it.
subsistence only Entitlement to reside in the property
support, you must Council tax bill
provide the following Utility bill (Gas, Water, Electric)
evidence. Bank statements for partner / other
dependants
Proof of who is paying the rent

Have you been asked Yes ☐ No ☐

to leave this
accommodation?
If yes, state when you
are expected to leave

Page 6 of 32 ASF1_ V4.0

and explain why you
can no longer be
accommodated there.

From To
When did you live at
this address?

Any previous address Yes ☐ No ☐

history?

Provide the address

and dates you lived at
each place.

Section 7. Legal Provide us with the details of your legal representative

representative
Do you have a legal
representative? Yes ☐ No ☐

Who pays for your

representative?

Name of the
representative’s
organisation

Title: Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Dr ☐

Name of
representative Family Name:

Given Names:

Contact telephone
number

Fax number

E mail address

Page 7 of 32 ASF1_ V4.0

Address of your House Number or Name
representative
Street Name

Town or City

County

Postcode

Section 8. Support Tell us more about all the support you or your dependants have
received from your friends and or relatives.

Have you or your

dependants received Yes ☐ No ☐
any support from
friends or relatives
since arriving in the
UK?

If yes, you must

provide details of the
support and why it
stopped or cannot
continue.

Title: ☐ Mr ☐ Mrs ☐ ☐ Miss ☐ Ms ☐ Dr

Who provided the

support? Family Name:

Given Names:

Relationship to you:

House Number
or Name:

Address Street Name:

Town or City:

County:

Postcode:

Page 8 of 32 ASF1_ V4.0

Contact
telephone
number
Fax number

E- mail address

Have you or your Yes ☐ No ☐

dependants received
any support from any
other friend or relative
since arriving in the
UK?

If yes, you must

provide details of the
support provided and
why it stopped or
cannot continue.

Title: ☐ Mr ☐ Mrs ☐ ☐ Miss ☐ Ms ☐ Dr

Who provided the Family Name

support?
Given Names

Relationship
to you

House Number or Name

Street Name

Town or City

County

Postcode

Contact
telephone
number
Fax number

E- mail address

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Any further information
about the support you
have been receiving?

Section 9. Tell us about any employment you have had whilst in the UK
Employment history

Name of your
current employer or
business

Address House Number or Name

Street Name

Town or City

County

Postcode

Start date Day Month Year

Your previous Tell us about any previous employment you have had:
employment (use additional information section if needed)
details:

Name of previous
employer or House Number or Name
business
Street Name
Address
Town or City

County

Postcode

Start date (dd-mm-yyyy)

End date (dd-mm-yyyy)

Page 10 of 32 ASF1_ V4.0

Have you ever had
a National
Insurance Number
Yes ☐ No ☐
(NINO)?
If “Yes” please
provide your
National Insurance
number. Also,
provide P45 and
P60 forms.

Section 10. Visa Tell us about any visa applications you have made to enter the
applications UK in the last 3 years.

Have you ever applied

for a visa to enter the Yes ☐ No ☐
UK?
Tell us about your visa Was the visa granted?
application
If not granted why not?

Date visa issued

Valid from

Valid until

Visa reference number

What financial information and

or assets did you declare to
support your application?
Do you still have access to the
assets you declared to obtain a
visa?
If not, why not?

Section 11A. Tell us about any monetary assets you have access to in the
Monetary assets in UK.
the UK
Do you have any cash Yes ☐ No ☐ Provide details here
funds?
Do you have any bank
and or saving
accounts? Yes ☐ No ☐ Provide details here

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Do you have any Yes ☐ No ☐ Provide details here
credit cards and or
loans?
Do you have a PayPal Yes ☐ No ☐ Provide details here
account?
Do you have a private
Yes ☐ No ☐ Provide details here
and or state pension?

Do you have any Yes ☐ No ☐ Provide details here

Investments?

Currency Value

Currency Value

You must provide Name of bank Account Sort Code Balance of

details of any or organisation Number Account
accounts held
using the table,
and indicate that
you have included,
at least, statements
for the last six
months.

Section 11B. Tell us about any monetary assets you have access to abroad.
Monetary assets
abroad

Do you have any cash Yes ☐ No ☐ Provide details here

funds?

Currency Value

Currency Value

Do you have any bank

and or saving Yes ☐ No ☐ Provide details here
accounts?
Do you have any
credit cards and or Yes ☐ No ☐ Provide details here
Loans?
Do you have a PayPal Yes ☐ No ☐ Provide details here
account?

Page 12 of 32 ASF1_ V4.0

Do you have a private Yes ☐ No ☐ Provide details here
pension?
Do you have any
Investments? Yes ☐ No ☐ Provide details here

You must provide

Name of Account Sort Code Balance of Currency
details of any accounts
bank or Number Account
held using the table
organisation
and indicate that you
have included, at
least, statements for
the last 6 months.

Section 12A. Tell us about the material assets you have in the UK.
Material assets in the
UK
Do you own any land
in the UK? Yes ☐ No ☐
Provide details of the
land that you own Where is it? Estimated value? Can you liquidate or rent it? You must
provide supporting evidence

Do you own any Yes ☐ No ☐

property in the UK?
What is it? Where is it? Estimated value? Can you liquidate or rent it? You
Provide details of the
must provide supporting evidence.
property that you own

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Do you have a car or Yes ☐ No ☐
other vehicle?
Provide details of the
car or other vehicle Yes ☐ No ☐

Registration number

Value
If you have not yet
sold this vehicle,
please provide an
explanation why.

Section 12B. Tell us about the material assets you have outside the UK
Material assets held
abroad
Do you own any land
abroad? Yes ☐ No ☐

Provide details of the Where is it? Estimated value? Can you liquidate or rent it? You must provide
land that you own supporting evidence.

Do you own any

property abroad? Yes ☐ No ☐

Provide details of the Y What is it? Where is it? Estimated value? Can you liquidate or rent it? You
property that you own must provide supporting evidence.

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Section 13. Tell us about any Welfare you receive.
Welfare and
Benefits
Are you in receipt
of any UK welfare Yes ☐ No ☐ Provide details here
or benefits or
support now or
have you been in
the previous 6
months?

Are you (or

Provide details here
someone else) in Yes ☐ No ☐
receipt of any
welfare or benefit
support in relation
to any dependants
on this claim? Or
have been in the
previous 6
months?

Section 14. Tell us about any individual circumstances for you or your
Individual dependants that we should be aware of.
circumstances
Provide details of your ☐ Pregnant ☐ Physical health problems
individual ☐ Learning disabilities ☐ Victim of domestic violence
circumstances ☐ Victim of trafficking ☐Other
☐ Mental health problems ☐No additional reasons

Brief Description

Do you hold
any supporting
documents? Yes ☐ No ☐

Page 15 of 32 ASF1_ V4.0

Are you currently Yes ☐ No ☐
registered with a
doctor in the UK?

Doctors Name

Doctors Address

House Number or Name

Street Name

Town or city

County

Postcode

Telephone

Email

Section 15. Tell us about any accommodation requirements specific to you

Individual or your dependants’ individual needs we should be aware of.
accommodation
requirements
Provide details with
evidence about any
specific
accommodation
requirements you or
your dependants
have?
Section 16. You must complete this section for your 1st dependant. Complete
Dependants a separate Section 16 for each of your dependants. Attach the completed
copies to your application.
Dependants details Title: Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Dr ☐
Name
Family Name

Given Names

Do they currently use Yes ☐ No ☐

any other name?

Title: Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Dr ☐

Page 16 of 32 ASF1_ V4.0

Other names used
Family Name

Given Names

Day Month Year

Date of birth Male ☐ Female ☐

Nationality ☐ Spouse
☐ Child under 18
Gender ☐ Unmarried partner
☐ Other
Relationship to you

If other, please explain

why you are
requesting support for
this person and
provide evidence.

If applicable please
provide the other
parent’s details
(Name, DOB, and
Nationality) and an
explanation as to why
they are unable to
support them. (If the
child’s parent is not Yes ☐ No ☐
part of the claim)
If yes, you must provide an explanation for this.
Is the child’s other
parent (not included
on this form) claiming
any support for the
child?

Does this dependant Yes ☐ No ☐

live with you?

Address

Page 17 of 32 ASF1_ V4.0

Why does this
dependant not live at
your address?

Section 16A. Tell us about your dependant’s visa applications.

Visa applications

Has your dependant

ever applied for a visa Yes ☐ No ☐
to enter the UK?
Tell us about your
dependants’ visa Was the visa granted?
application If the visa was not granted why
not?
Date visa issued
Valid from

Valid until

Visa reference

What financial information or

assets did they declare to
support their application, or in
support of your application?

Do they still have access to

these assets?
If you do not have access to
the assets they declared in the
visa application, why not?

Part 16B. Tell us about your dependant’s UK employment history.

Employment of
dependants
Have they ever had a
National Insurance Yes ☐ No ☐
Number (NINO)?

If “Yes” please provide

their National
Insurance number.

Is this dependant
currently in
employment (working) Yes ☐ No ☐
in the UK?

Page 18 of 32 ASF1_ V4.0

Name of their
employer or business

Address House Number or Name

Street Name

Town or City

County

Postcode

Start date Day Month Year

Their previous
employment details:
Name of previous
employer or business

Address House number or name

Street name

Town or city

County

Postcode

Start Date (dd-mm-yyyy)

End date (dd-mm-yyyy)

Section 16C. Tell us about your dependant’s education in the UK.

Education
Does your dependant
attend School, College Yes ☐ No ☐
or University?

Name of School
College or University

How long have they

been attending?
From To

Page 19 of 32 ASF1_ V4.0

Section 16D. Tell us about any monetary assets your dependants have
Dependant monetary access to in the UK.
assets in the UK
Does your dependant
have any cash funds? Yes ☐ No ☐

Currency Value
Does your dependant
have any bank and or Yes ☐ No ☐ Provide details here
saving accounts?
Do you have any
credit cards and or Yes ☐ No ☐ Provide details here
Loans?
Does your dependant
Yes ☐ No ☐ Provide details here
have a PayPal
account?
Does your dependant Yes ☐ No ☐ Provide details here
have a private
pension?
Does your dependant
have any Yes ☐ No ☐ Provide details here
investments?

You must provide Name of bank Account Sort Code Balance of

details of any accounts or organisation Number Account
held using the table
below, and indicate
that you have
included, at least,
statements for the last
6 months.

Page 20 of 32 ASF1_ V4.0

Section 16E. Tell us about any monetary assets your dependants have
Dependant monetary access to abroad.
assets abroad

Does your dependant Yes ☐ No ☐

have any cash funds
outside of the UK? Currency Value

Currency Value

Do they have any

bank and or saving Yes ☐ No ☐
accounts?

Do you have any

Yes ☐ No ☐
credit cards and or
Loans?
Do they have a PayPal
account? Yes ☐ No ☐
Do they have a private
pension? Yes ☐ No ☐
Do they have any
investments? Yes ☐ No ☐

You must provide Name of Account Sort Code Balance of Currency

details of any accounts bank or Number Account
held using the table organisation
below, and indicate
that you have
included, at least,
statements for the last
6 months.

Section 16F. Tell us about the material assets your dependant has in the UK.
Dependant material
assets in UK
Do they own any land Yes ☐ No ☐
in the UK?
Provide details of the Where is it? Estimated value? Can you liquidate or rent it? You must provide
land that they own supporting evidence.

Do they own any Yes ☐ No ☐

property in the UK?
Where is it? Estimated value? Can you liquidate or rent it? You must provide
supporting evidence.
Provide details of the
property they own

Page 21 of 32 ASF1_ V4.0

Do they have a car or Yes ☐ No ☐
other vehicle?

Provide details of the Registration number

car or other vehicle
Value

If they have not yet

sold this vehicle,
please provide an
explanation why.

Section 16G. Tell us about the material assets your dependant has abroad.
Dependants material
assets abroad
Do they own any land
abroad? Yes ☐ No ☐
Provide details of the Where is it? Estimated value? Can you liquidate or rent it? You must provide
land that they own supporting evidence.

Do they own any Yes ☐ No ☐

property abroad?
Where is it? Estimated value? Can you liquidate or rent it? You must provide
Provide details of the supporting evidence.
property that they own

Section 16H. Tell us about the Welfare or Benefits your dependant is

Dependant Welfare receiving.
and Benefits
Are they in receipt of
If yes, you must give details and provide evidence
any UK welfare or Yes ☐ No ☐
benefit payments or
support or have they
been in the previous 6
months?

Section 17. Tell us who helped you to complete this form

Additional
details
Who helped you ☐ Legal representative
complete this form ☐ Voluntary Sector
☐ Relative
☐Other
☐Nobody

Page 22 of 32 ASF1_ V4.0

Name of person or Title: Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Dr ☐
organisation who
assisted you. Family Name

Given Names

Organisation name

House Number or Name

Address of person or
organisation who Street name
assisted you.
Town or City

County

Postcode

Telephone number
and email address of
the person who
assisted you

Section 18. Section 95 declaration

If you are applying for section 4 support, do not sign here.

You must also complete sections 19 to 25 and sign the
declaration at Section 26

Page 23 of 32 ASF1_ V4.0

Once you submit this application you have agreed to accept the
following terms:
• I confirm that the information I have given on this form is correct
and complete.
• I understand that if I give false information, you may take action
against me and I could be prosecuted.
• I confirm that I will tell you if my or my dependants’
circumstances change or there is new information that is
relevant to this application.
• I agree that you can pass the information on this form to
the prescription pricing authority so they can give me and
my family help toward health costs.
• You can use this information to check that my family and I are
entitled to help, and to prevent and detect fraud and money
laundering. I also understand that such
agencies may provide the Home Office with information about
me.
• You may undertake a search with Experian for the purposes of
verifying my identity. To do so Experian may check the details I
supply against information held on any database (public or
otherwise) to which they have access. They may also use my
details in the future to assist other companies for verification
purposes. A record of the search will be retained.

The Home Office will use the personal information you provide to
consider your application. We may also share your information with
other public and private sector organisations in the UK and
overseas. For more detail please see the Privacy Notice for the
Border, Immigration and Citizenship system at:
[Link]/government/publications/personal-information-use-in-
borders-immigration-and-citizenship. This also sets out your rights
under the Data Protection Act 2018 and explains how you can
access your personal information and complain if you have
concerns about how we are using it.

I agree to the use of the data provided in this application in

accordance with the Home Office’s Information Charter: I confirm
that I agree to all the above statements

Name:

Signature:

Date:

Page 24 of 32 ASF1_ V4.0

If you are applying for section 95 support and you do not have
any additional details that you wish to add on page 31, you do
not need to complete and print the remaining pages of this
form.

Section 19. APPLICATION for SECTION 4 SUPPORT

I Consider that I am eligible for support under section 4

because:

Part 1 - I am destitute, (Note: You should demonstrate, in your

answers to questions below, that you are without adequate
accommodation or the means of obtaining it now, or within 14
days, or, if you have adequate accommodation, that you cannot
meet your other essential living needs now, or within 14 days. If
you have been without support from the Home Office or a local
authority for some time, you will be expected to explain how you
have supported yourself during this period and provide evidence
where necessary).

Part 2 – and I satisfy at least one of the criteria listed below

(please tick all that apply) as set out under 3(2) of the
Immigration and Asylum (Provision for Accommodation to
Failed Asylum-Seekers) Regulations 2005.

☐ I am taking all reasonable steps to leave the UK or place myself

in a position in which I am able to leave the UK. This could
include complying with attempts to obtain a travel document to
facilitate departure.

☐ I am unable to leave the UK by reason of a physical

impediment to travel or for some other medical reason.

☐ I am unable to leave the UK because in the opinion of the

Secretary of State there is currently no viable route of return
available.

☐ I have made an application in Scotland for judicial review of a

decision in relation to my asylum claim or, in England and Wales
or Northern Ireland, I have applied for such a judicial review and
been granted permission or leave to proceed.

☐ The provision of accommodation is necessary for the purpose of

avoiding a breach of a person’s Convention rights, within the
meaning of the Human Rights Act 1998.

Page 25 of 32 ASF1_ V4.0

Section 20. About Tell us what steps you have taken, are taking, to leave the UK
your steps to leave voluntarily, if any.
the UK voluntarily
Have you tried to
obtain documentation Yes ☐ No ☐
to be able to return
home?

Tell us the steps you

are taking to obtain a
travel document.

Have you applied for Yes ☐ No ☐

Assisted Voluntary
Return (AVR)?

What date did you Day Month Year

apply?

Have you been offered Yes ☐ No ☐

a flight that you have
failed to take up?

Details

Section 21. About

your impediment to
travel
Give a brief
explanation as to why
you cannot leave the
UK

Have you submitted a

section 4 medical Yes ☐ No ☐
declaration form or a
maternity declaration
(MATB1)?
Please submit if you
have not done so
already.
Section 22. No
viable route to return

Page 26 of 32 ASF1_ V4.0

Please say why you
think you have no
viable route home.
Section 23. About
your Judicial Review
Has your case been
given permission to
proceed or granted
leave to proceed to Yes ☐ No ☐
Judicial Review?
Section 24.
Avoiding a breach of
ECHR
Have you submitted
an ECHR further
submission that you Yes ☐ No ☐
wish to be considered
by the Home Office as
a fresh claim for
asylum?

State the reason,

attaching evidence as
appropriate, why you
think a failure to
provide section 4
support would breach
your ECHR rights.
Section 25.
Previous section 4
applications
Have you previously
applied for section 4 Yes ☐ No ☐
support, had an
application for section
Name of applicant, date of application and Home Office reference number if
4 support refused or
known etc.
discontinued or ever
been the dependant of
another asylum
seeker?

If “Yes” to any part of

the question above,
please provide details

Section 26
Page 27 of 32 ASF1_ V4.0
Section 4 Declaration
The information you have provided in the section 4 application form
will be treated in confidence. However, it may be disclosed to other
UK government departments or agencies, local authorities, law
enforcement agencies, foreign governments and other bodies for
immigration or research purposes to carry out their functions. The
Home Office may also obtain information about you from other
organisations (including credit reference agencies) to assess
whether you are eligible for section 4 support.

Declaration
In submitting this application for support under section 4 of the
Immigration and Asylum Act 1999, I understand that I am also
accepting the conditions under which this support is provided.
Conditions may include specific standards of behaviour, reporting,
residence or complying with steps to facilitate departure from the
UK. These conditions will be set out in a notice in writing.
Additionally:

☐ I understand the criteria for eligibility for support under

section 4, and that I must continue to satisfy all relevant
criteria to remain eligible for and be provided with support.

☐ I understand that should a decision be taken to provide me

with support under section 4, I will be notified of the
conditions under which support is provided. I also understand
that should I fail to comply with any of these conditions the
support provided to me may be discontinued.

☐ I understand that should a decision be taken to provide

me with support under section 4, it may be necessary for
me to relocate to another area to access this support on a
no choice basis.

☐ I understand that any failure on my part to conform to the

Home Office’s reporting imposed in a notice in writing
may result in discontinuation of support.

☐ I understand that failure to disclose all necessary information

regarding myself or my dependants may lead to the withdrawal
of section 4 support.

☐ I understand that failure to disclose all necessary financial

information regarding myself or any dependants may lead
to the withdrawal of section 4 support.

☐ I understand that my dependants, if I have any, may also be

provided with support under section 4 subject to the same

Page 28 of 32 ASF1_ V4.0

conditions as myself. If any of the conditions on the continued
provision of support to my dependants vary from my own,
those conditions shall be set out separately to them in writing.

☐ I understand that you can use the information in my

application to check that my family and I are entitled to
support, and to prevent and detect fraud and money
laundering. I also understand that such agencies may
provide the Home Office with information about me.

☐ I understand that you may undertake a search with Experian for

the purposes of verifying my identity. To do so Experian may
check the details I supply against information on any database
(public or otherwise) to which they have access. They may also
use my details in the future to assist other companies for
verification purposes. A record of the search will be retained.

☐ I agree to the use of the data provided in this application in

accordance with the Home Office’s Information Charter.

The Home Office will use the personal information you provide to
consider your application. We may also share your information with
other public and private sector organisations in the UK and
overseas. For more detail please see the Privacy Notice for the
Border, Immigration and Citizenship system at:
[Link]/government/publications/personal-information-use-in-
borders-immigration-and-citizenship. This also sets out your rights
under the Data Protection Act 2018 and explains how you can
access your personal information and complain if you have concerns
about how we are using it.

I confirm that I agree to all the above statements

Signature:

Name: (print)

Date:

Page 29 of 32 ASF1_ V4.0

Section 27. Additional Information

Section 28. Documents Checklist

Use the table below as a checklist of all the supporting documents

you are providing with your application. Tell us how many of each of
the documents listed that you have included. Ensure that all

Page 30 of 32 ASF1_ V4.0

supporting documents and evidence is listed. Add extra lines if
necessary. All documents must be originals.

Document Number of
Pages

Section 29. Next Steps for Your Application

1. Ensure the application is complete and that you have

provided answers to all questions relevant to your claim for

Page 31 of 32 ASF1_ V4.0

support. Ensure that you have provided evidence to support
the answers in your application form where required.

See the guidance document to ensure you have included all

the necessary supporting documents and evidence which are
being enclosed with the application form. Failure to supply
documents and or evidence will lead to delays in reaching a
decision and may lead to the rejection of your claim.

2. Ensure you have read and signed the declaration for section
95 or section 4 support depending on which you are claiming
for.

3. Once you are satisfied that your application is complete,

collate your form and documents together and send to: PO
Box 471, Dover, CT16 9FN. If no original documents are
required then you can e-mail the application to
S95NewApplications@[Link] if you are
applying for section 95 support or S4@[Link]
if you are applying for section 4 support.

If you use recorded or special delivery, this will help us to

record the receipt of your application. Make sure you keep
the recorded delivery or special delivery number.

Consideration will be given to the information you have

provided.

You will be notified in writing of our decision.

4. If you need to contact us after you have applied please

contact: PO Box 471, Dover,
CT16 9FN. Telephone: 0808 8010 503

You must keep us informed of any changes to the

information that you have provided.

Page 32 of 32 ASF1_ V4.0