1
POINTS BASED SYSTEM FORM (VAF9 JULY 2011)
PERSONAL DETAILS
This form is for use outside the UK only.
This form is provided free of charge.
READ THIS FIRST
This form must be completed in English. You may use blue or black ink, or a computer.
Please follow the guidance notes carefully and complete all questions as indicated. If you run out of space please use
Part 7 – Additional Information.
The UK Border Agency may take a decision on your application based on the information contained here without
interviewing you. Therefore please ensure you submit all relevant documents, (please see the supporting documents
guidance at Annex A of this form and in the Self-Assessment Appendix “Not required for Tier 1 Exceptional Talent”
specific to the tier or sub-tier for which you are applying.
It is better to explain why you do not have a document than to submit a false document. Your application will be automatically
refused and you may be banned from coming to the UK for 10 years if you use a false document, lie or withhold relevant
information. You may also be banned if you have breached immigration laws in the UK.
Please ensure you also complete the relevant Self-Assessment point scoring Appendix.
01
On which date do you wish to travel to the UK >>>>>>>>>>>>>>>>>>>>>>>>>>> D D M M Y Y Y Y
2.1 Given name(s) (as shown in your passport) >>>>>>>>>>>
2.3 Other names (including any other names you are known by and/or any other names that you have been known by)
Part 1 About your Self-Assessment Appendix Read Guidance notes, Part 1
1.2 Which Appendix did you complete? >>>> Number Title
1.3 How many points did you score for Attributes, English, and Maintenance?
Attributes Maintenance
Part 2 About you Read Guidance notes, Part 2
English
1.1 Are you applying under the HSMP Forum JR Ruling for reinstatement as a highly skilled migrant having previously been
refused an extension? Put a cross (x) in the relevant box
1.4 For Tier 4 applicants only
I confirm that the funds for which I have claimed points in respect of maintenance (above) are available to me, in the manner
specified in the Immigration Rules, for use in studying and living in the UK and will remain so available for the duration of any Tier 4
leave granted unless used to pay for course fees and living costs in the UK. Put a cross (x) in the box to confirm
Yes Go to Part 2 No Go to 1.2
Male Female
2.5 Marital status? Put a cross (x) in the relevant box2.4 Sex Put a cross (x) in the relevant box >>>>>>>>>>>>>>>>
Single
Married /
Civil Partner
Unmarried Divorced /
Partner Dissolved Partnership
Widowed /
Separated
Surviving Civil Partner
2.2 Family name (as shown in your passport)
02
4.5 Contact details if different from above
For help completing this form please see the guidance
notes. If you require further guidance or information, your
local British Embassy or High Commission will be able
to assist you. More information can also be found on the
website: www.ukvisas.gov.uk
2.7 Place of birth
D D M M Y Y Y Y
2.9 Nationality
2.11 If ‘Yes’ please provide details
2.8 Country of Birth >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
2.10 Do you hold any other nationalities? >>>>>>>>>>>>>>>>
Put a cross (x) in the relevant box
Yes No If ‘No’ go to Part 3
2.6 Date of Birth >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
3.1 Current passport or travel document number >>>>>>>>>> 3.2 Issuing Authority
3.3 Date of issue >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> 3.4 Date of expiry
3.5 Is this your first passport? >>>>>>>>>>>>>>>>>>>>>>>>
Put a cross (x) in the relevant box
3.6 If ‘No’ give details of previous passports covering the last
10 years including where these passports are now.
Yes No If ‘Yes’ go to Part 4
D D M M Y Y Y Y D D M M Y Y Y Y
4.1 Your full residential address and postal code >>> 4.2 Home (landline) telephone number
4.3 Mobile telephone number
4.4 Email address
Part 3 Passport Information Read Guidance notes, Part 3
Part 4 Your contact details Read Guidance notes, Part 4
03
5.1 Is your partner accompanying you or joining you later? If they are travelling later please provide their date of travel in Part 7.
(If single go to 5.6) Put a cross (x) in the relevant box
5.4 Spouse/Partner’s place and country of birth
5.5 Spouse/Partner’s nationality
5.7 If ‘Yes’ please provide full details about the child/children. If ‘No’ go to Question 5.8
5.3 Spouse/Partner’s date of birth >>>>>>>>>>>>>>>>>>>>>>
5.2 Full name of spouse/partner
Yes No
Not
Applicable
D D M M Y Y Y Y
5.6 Do you have any children under 18 accompanying you
or joining you at a later date? Put a cross (x) in the relevant box
Yes No
Full name Date of Birth Place of birth Passport number
5.8 Father’s given name(s) >>>>>>>>>>>>>>>>>>>>>>>>>>> 5.9 Father’s family name
5.10 Father’s date of birth >>>>>>>>>>>>>>>>>>>>>>>>>>> 5.11 Father’s place and country of birth
5.12 Father’s nationality
5.13 Mother’s given name(s) >>>>>>>>>>>>>>>>>>>>>>>>> 5.14 Mother’s family name
5.15 Mother’s date of birth >>>>>>>>>>>>>>>>>>>>>>>>>> 5.16 Mother’s place and country of birth
5.17 Mother’s nationality
D D M M Y Y Y Y
D D M M Y Y Y Y
Part 5a Your Family Read Guidance notes, Part 5a
Part 5b Your Parents Read Guidance notes, Part 5b
04
6.1 If you have a UK National Insurance Number what is the number? >>
Part 6 Previous Applications and Travel History Read Guidance notes, Part 6
6.2 Have you travelled to the UK in the last 10 years?
Put a cross (x) in the relevant box
6.3 Have you ever been refused a visa for any country
including the UK? Put a cross (x) in the relevant box
6.4 Have you been granted a visa for the UK in the last 10
years? Put a cross (x) in the relevant box
6.5 Have you ever been refused entry on arrival to the UK?
Put a cross (x) in the relevant box
6.6 Have you ever been in breach of your immigration
conditions for the UK? Put a cross (x) in the relevant box
6.7 Have you ever been deported, removed or otherwise
required to leave any country, including the UK?
Put a cross (x) in the relevant box
6.8 Have you made an application to the Home Office to
remain in the UK in the last 10 years?
Put a cross (x) in the relevant box
6.9 Do you have any criminal convictions in any country
(including traffic offences)? Put a cross (x) in the relevant box
Date Purpose Duration
Date Country Reason Reference number
Date Purpose Duration Reference number
Date Reason Reference number
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details belowYes No
Date Country Reason Reference number
Date Reason for application Granted/Refused Reason (if Refused) Reference number
Date Country Offence Sentence
05
Date Country Offence
If ‘Yes’ please provide details belowYes No
If ‘Yes’ please provide details in Part 7,
Additional information. Refer to Guidance
notes for definitions
Yes No
If ‘Yes’ please provide details in Part 7,
Additional information. Refer to Guidance
notes for definitions
Yes No
If ‘Yes’ please provide details in Part 7,
Additional information. Refer to Guidance
notes for definitions
Yes No
If ‘Yes’ please provide details in Part 7,
Additional information. Yes No
6.10 Have you ever been charged in any country with a
criminal offence for which you have not yet been tried in
court? Put a cross (x) in the relevant box
6.11 In times of either peace or war have you, ever been >>>
involved in, or suspected of involvement in, war crimes,
crimes against humanity or genocide?
Put a cross (x) in the relevant box
6.12 Have you, ever been involved in, supported, or >>>>>>
encouraged terrorist activities in any country? Have you,
ever been a member of, or given support to an organisation
that has been concerned in terrorism?
Put a cross (x) in the relevant box
6.13 Have you ever, by any means or medium, expressed >>>
views that justify or glorify terrorist violence or that may
encourage others to terrorist acts or other serious criminal
acts? Put a cross (x) in the relevant box
6.14 Have you engaged in any other activities that might >>>
indicate that you may not be considered a person of good
character? Put a cross (x) in the relevant box
7.1 Is there any other information you wish to give in support of your application?
Part 7 Additional Information Read Guidance notes, Part 7
0606
Part 8 Declaration Read Guidance notes, Part 8
I hereby apply for an entry clearance to the United Kingdom. The information I have given is complete and true to the best of my knowledge.
I have completed the separate Self-Assessment Appendix of this form to which this declaration also applies. I also declare that the
photograph submitted with this form is a true likeness of myself. I confirm that if, before this application is decided, there is a material
change in my circumstances or new information relevant to this application becomes available, I will inform the United Kingdom Diplomatic
Mission handling my application.
I am aware that it is an offence under the Immigration Act 1971 (as amended) to make a statement which I know to be false or not believe to be true, in
order to obtain a visa/entry clearance to the UK. I am also aware that my application will be automatically refused and I may be banned from going to
the UK for 10 years if I use a false document, lie or withhold relevant information. I may also be banned if I have breached immigration laws in the UK.
I am further aware that should I use a false document, lie or withhold relevant information my details may be passed to law enforcement agencies.
I declare that the documents that I have supplied with this application are genuine and the statements I have made with this application are truthful.
I understand that UK Border Agency (or a trusted third party) may make reasonable checks to confirm the accuracy and authenticity of evidence
I have provided and documents I have submitted with this application. I further understand that UK Border Agency (or a trusted third party) may also
make reasonable checks on any sponsors to my application to verify statements contained in the application and establish that I will comply or have
complied with the terms of any visa granted.
I understand that if the UK Border Agency has reasonable cause to believe that any document or documents I have submitted with this application are
forged, fraudulent or not genuine, and the UK Border Agency has sought to verify the documents using processes specified by it but has not been able
to verify them, no points will be awarded for these documents even if the UK Border Agency cannot prove that they are not genuine.
I confirm that the funds for which I have claimed points in respect of maintenance are available to me, in the manner specified in the Immigration Rules,
for use in studying and living in the UK and will remain so available for the duration of any Tier 4 leave granted unless used to pay for course fees and
living costs in the UK.
If I have not been required to submit certain evidential documents with this application because I am a low risk student, I confirm that I have these
documents and will provide them if requested to do so by the UK Border Agency.
I understand that my application will be refused if I do not comply with the request made.
I also understand that I may be required to provide a record of my fingerprints and a photograph of my face (“biometric data”) as part of my application.
If I refuse to do so, my application may be treated as invalid and, if so will not be considered further. (See Statutory Instrument 2006 No 1743 – The
Immigration (Provision of Physical Data) Regulations 2006, Regulation 7(1)).
I further understand that UK entry clearance applications may be handled by British Missions in other locations, including outside the country in which
I have applied for entry clearance and that this may involve the transferring of my application and supporting documents to and from another mission.
I understand that the UK Border Agency will be responsible for transferring my application and supporting documents safely. I understand in these
circumstances my application will still be handled in line with UKBA published customer service standards.
I am aware that I may be billed for any medical treatment undertaken in the UK and that I do not have recourse to public funds during my stay in the UK.
I understand that all information provided by me will be processed by the UK Border Agency in accordance with the Data Protection Act 1998.
I am aware that the UK Border Agency is the data controller in relation to the information provided me in this application form. I am aware that the
information I provide, including biometric data, will be treated in confidence, but it may be disclosed to other government departments, agencies,
local authorities, foreign governments, and other bodies, to enable the UK Border Agency or those bodies to perform their functions. Any disclosures
will be in accordance with the Data Protection Act 1998. I also understand that the information provided by me may also be used for staff training
purposes.
I also understand that the information provided by me, or information made available to the UK Border Agency during the processing of my application,
may be shared with my sponsors(s) or any person(s) acting on their behalf or any applicant linked to my application (for example to my spouse/partner
if we apply for visas for a trip together) for the sole purpose of considering my application. I am aware that if there is any information I do not want
you to disclose to them I will tell you by enclosing a letter with my supporting documentation. If such requests prevent you from making legitimate
enquiries, my application may be refused.
I declare that the information given on this form is correct to the best of my knowledge and belief and I also consent to the processing of information
provided by me by the UK Border Agency.
Applicant’s signature Date
D D M M Y Y Y Y
ENSURE YOU ALSO COMPLETE THE SEPARATE SELF-ASSESSMENT POINTS SCORING APPENDIX APPROPRIATE TO THE
TIER OR SUB-TIER UNDER WHICH YOU ARE APPLYING
07
Annex B - Self-Assessment Points Scoring Appendices
Appendix 2: Tier 1 (Investor)
Appendix 3: Tier 1 (Entrepreneur)
Appendix 4: Tier 1 (Post-Study Work)
Appendix 5: Tier 2 (Skilled Worker)
Appendix 6: Tier 5 (Temporary Worker)
Appendix 7: Tier 5 (Youth Mobility Scheme)
Appendix 8: Tier 4 (General Student)
Appendix 9 Tier 4 (Child Student)
Annex A - Supporting Documents Checklist
All applicants
A valid travel document or passport
One passport sized colour photograph. This must not be
more than 6 months old. (Please see photograph box below
for more details)
Previous passports
Biometric details
The appropriate fee
Personal Details section
Unless single, please provide evidence of your marital status
e.g. marriage or civil partnership certificate
The official record of any conviction(s), detailing the crime(s)
you were convicted of and the sentence(s) you received
Please complete this part of the form to help us to make sure that we have received your documents and to keep a record of them
while they are with us. Please tell us how many of each of the listed documents you have provided with this application. Please continue
on a separate sheet if necessary.
Type of document How many?
Passports and/or travel documents
Marriage or civil partnership certificate
Other (state which)
Other (state which)
Please ensure you submit all the relevant original documents that you want the Entry Clearance Officer to see when considering
your application. You should also supply the documents specified on the separate Self-Assessment Appendix for the specific
tier or sub-tier under which you are applying. The UK Immigration Rules make it clear that it is your responsibility to satisfy
the Entry Clearance Officer that you are genuinely seeking entry to the UK for the purpose and duration that you have stated.
Submission of particular documents does not guarantee that your visa will be issued. It is your decision how you satisfy the
Entry Clearance Officer that your intentions are as you state in your application. Further guidance on supporting documents
can be found on the UKBA web pages.
If you are unable to provide a document please explain why. Your application will automatically be refused and you may be banned from
coming to the UK for 10 years if you use a false document, lie or withhold relevant information. You may also be banned if you have
breached immigration laws in the UK.
Your photograph must be:
• Colour
• Passport style and size (45mm high x 35 mm wide)
• A recent and true likeness, showing full face, with no hat, helmet or sunglasses, although you can wear everyday glasses
• Original – that is not digitally or optically altered (for example it must not be ‘photo-shot’ or ‘touched-up’)
• Taken against an off-white, cream or light grey background so that your features are clearly distinguishable against the background
• Printed on low-gloss, plain-white photo quality paper (with no watermarks or embossing)
Photographs that do not conform to these standards will be rejected and may cause a delay in processing your application.