Immigration Information Form

Applicant Details
LSBU ID
Name
Date of Birth
Programme
Have you previously applied for a visa to enter or remain in the UK? / Where are you planning to submit your visa application from? / Do you currently have a visa application
pending with the Home Office?

Yes

No /
Inside the UK
Outside the UK Country:______/
Yes
No
Have you ever taken an Educational Testing Service (ETS) TOEIC test? (NB this is NOT IELTS –please read website before answering: ) / If you are eligible, will dependents be joining you to the UK while you study (e.g. spouse, partner, children)?

Yes

No /
Yes Number _____

No
Have you ever had a visa refused? / Visa refusal grounds and reason:

Yes If yes, please provide details here
No
Do you have any criminal convictions? / Criminal conviction grounds and reason:
Yes If yes, please provide details here
No

Important:

If you have previously applied for a visa to enter or remain in the UK, please include details of all UK visas that you have been granted, and complete the form clearly and accurately. For non-Tier 4 visas (e.g. Visit, Tier 2) you only need to complete the first three columns highlighted in bold.

Give as much information as you can in the table below. There is space below to give more details should it be necessary.

Visa type(1) / Visa start date / Visa end date / Name of Course Visa was issued for / Institution name / Level of study(2) / Course start date (actual) (3) / Course end date / Qualifications completed whilst on this visae.g. PGDip, BSc, MSc

If any of the following apply to you, please give a detailed explanation in the Notes box below:

  1. There are gaps in your immigration history;
  2. You have failed to complete a course that you were sponsored for;
  3. You completed a course for which you were not originally sponsored for;
  4. Any further relevant information you would like to state

Notes

By signing below you assert the following:

-I have read and understood the document ‘Tier 4 Sponsorship and the issuing of Confirmation of Acceptance for Studies (CAS)’ (available here:

-I have attached all relevant documentation regarding my immigration history. (Including, but not limited to: copies of all UK visas, enrolment/CAS letters, completed UK qualifications, permission to switch, appeal letters, academic progress, Home Office correspondence etc. as appropriate.)

-I confirm that the information given in this form is correct and complete. I understand that the University reserves the right to withdraw any offer or cancel a registration made on the basis of the information which proves to be false or misleading.

Signature: (must be hand written*)Date: (must be hand written*)

______

*Electronic signatures are not accepted