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POINTS BASED SYSTEM FORM (VAF9 JAN 2010)
APPENDIX 8: TIER 4 (GENERAL) STUDENT
SELF-ASSESSMENT
This form is for use outside the UK only
This form is provided free of charge.
For official use only
READ THIS FIRST
This form must be completed in blue or black ink.
Please ensure you submit all relevant, original documents as indicated in the sections. 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.
An applicant aged over 16 can choose to apply either as a Child (Student) or a (General) Student and meet the
appropriate criteria.
Please ensure you also complete the main Personal Details form.
1.1 Given name(s)
1.2 Family name
Part 1 About You
Parent/Guardian 2 (if applicable)
2.6 Give your parent or guardian’s family name 2.5 Give your parent or guardian’s given name
Parent/Guardian 1
2.1 Give your parent or guardian’s given name >>>>>>>>>>> 2.2 Give your parent or guardian’s family name
2.4 Give details of your relationship to your guardian 2.3 Give your parent or guardian’s full contact address,
including postal code.
Part 2 Parent/Guardian details to be completed only where the applicant is 16 or 17 years old.
2.7 Give your parent or guardian’s full contact address,
including postal code.
2.8 Give details of your relationship to your guardian
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Part 1
1.1 名字
填写格式:拼音(和护照一致)+汉字+电码
1.2 姓氏
填写格式:拼音(和护照一致)+汉字+电码
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仅16、17岁的申请人填写。成年学生跳过到Part 3
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2.9 Give the full address of where you will be residing in the
UK including the postal code. If this is not known and your
sponsor is arranging your accommodation give the contact
details of the person doing this, and/or the temporary address
you will use on arrival.
2.10 You must provide a letter of consent to this application
from your parent(s) or legal guardian. Put a cross (X) in the box
to confirm you have done so (See the Tier 4 Policy Guidance for
details of what this must contain).
Part 3 Tier 4 Sponsor (Education Provider) contact details
3.1 Give the full name of your Tier 4 Sponsor
3.2 Give your Tier 4 Sponsor’s Licence Number >>>>>>>>>> 3.3 Give the full address of your Tier 4 Sponsor including
postal code
2.12 Provide full details of up to two adults who will accompany you
Full name Full name
Telephone No. Telephone No.
Nationality Nationality
Passport No Passport No
Exact relationship to you Exact relationship to you
Address including postal code Address including postal code
2.11 Will you be travelling to the UK alone? Put a cross in the relevant box
Yes - Go to Part 3 No - Complete Question 2.12
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Part 3(这部分需要填写的信息都可也在学校给的CAS Statement上找到)
3.1 学校的名字
3.2学校的执照号
3.3学校的地址和邮编
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4.3 Give the full address of your primary site of study, including
postal code. See the Tier 4 Policy Guidance for an explanation of
primary site of study.
4.2 Give the start and end dates for your course of study >>>
From
To
D D M M Y Y Y Y
D D M M Y Y Y Y
Part 4 Course details
4.1 Give the title of your course of study >>>>>>>>>>>>>>>
Part 5 Attributes You should refer to the Immigration Rules and the Tier 4 Policy Guidance. You require 30 points from this part, or your application will be refused.
5.1 Confirmation of Acceptance for Studies (CAS) Select to confirm you are claiming points for having a valid Confirmation >>>
of Acceptance for Studies, Put a cross (x) in the box
5.6 Are you coming to the UK to study an English language qualification that is CEFR level B2 or above or to study English as a
foreign language? Put a cross (X) in the relevant box.
English Language course
ATAS certificate
5.7 Have you been assessed by means of an academic/professional reference? If so you must provide evidence of each of the
references listed in the Confirmation of Acceptance for Studies. Put a cross (X) in the relevant box to indicate what you have provided.
The original reference
Go to Part 6
Not Applicable
A copy of the reference together with an original letter from your
sponsor confirming it is a true copy. Go to Part 6
5.8 Are you required to obtain permission from the Academic Technology Approval Scheme (ATAS)? (See the Tier 4 Policy
Guidance for the circumstances when this is required) Put a cross (X) in the relevant box.
No - Go to Question 5.8
No - Go to Part 6
Yes - Go to Question 5.7
Yes - Go to Question 5.9
5.5 Have you been assessed by your sponsor by other means, for example references, by progress on a continuing
course of study, as part of a study abroad programme, by your sponsor’s internal test, a portfolio of artwork, or other
means (state which)? (Please do not submit this) Put a cross (X) in the relevant box.
No - Go to Question 5.6
Yes - Say how you have been assessed in the space below
then Go to Question 5.6
5.4 You must send all of the original certificate(s) of qualification and/or original transcripts of results that are >>>>>>>>
listed in the CAS. Put a cross (X) in the box to confirm you have done so
5.3 Confirm which of the following options applies. Put a cross (x) in the relevant box
Studying - Go to Question 5.4
Undertaking a foundation course as a Postgraduate Doctor
or Dentist - Go to Question 5.11
Undertaking a post as a Sabbatical Officer
Go to Question 5.10
5.9 Put a cross (X) in the box to confirm you have provided the original of your Academic Technology Approval >>>>>>>
Scheme (ATAS) clearance certificate. Then Go to Part 6
5.2 What is your Confirmation of Acceptance >>>>>>>
for Studies Number?
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Part 4(这部分信息可以在CAS Statement
上找到)
4.1 课程的名称
4.2课程的起止日期
4.3主要的授课地址(4.1中所列课程的授课地址,如果是语言课程,那么写语言中心的地址)
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5.1 方框中画x
5.2 CAS号码
5.3 选择Studying
5.4 方框中画x
5.5 选No
5.6 选Yes
5.7 选Not Applicable
5.8 选No
5.9 空着
5.10 空着
5.11 空着
5.12 空着
0404 04
Part 6
Maintenance (Funds) You must have a minimum level of funds to cover your course fees and support
yourself. You should refer to the Immigration Rules and the Tier 4 Policy Guidance. You need 10 points from this
part, or your application will be refused.
6.1 How much are the fees for your course of study? The figure should be the same as in the CAS
which will be used as the specified evidence for this. If you will be studying at a Residential Independent
School this will include course fees and boarding or lodging fees.
£
6.2 Have any of your course fees been paid? Put a cross (X) in the relevant box.
Yes - Paid to Overseas Higher Education Institution
(Zero fee on CAS) - Go to Question 6.3
No - Go to Question 6.4
Yes - Paid to UK Education Provider. Enter the amount in the
box below then - Go to Question 6.3
£
Shown in the CAS An official, original receipt
6.3 Put a cross (X) in the relevant box to show what document has been provided as evidence of payment.
Initial application – Go to Question 6.6
Further period of study following a course of less than six months (No reduced maintenance level) – Go to Question 6.6
Further period of study following a course completed more than four months ago (No reduced maintenance level)
Go to Question 6.6
Further period of study following a course of six months or more within your last period of leave and completed less than four months
ago; or to complete an existing course of study where you have studied at least six months of the course and been studying within
the last four months; or if you are applying to continue in Tier 4 as a sabbatical officer or as a Postgraduate Doctor or Dentist where
you completed a course that was at least six months duration within your last period of leave and this leave finished within the last
four months. Go to Question 6.9
6.5 Put a cross (X) in the relevant box to confirm whether you are making an initial application or an extension application.
6.6 Initial application
Put a cross (X) in the relevant box to confirm your primary site of study. See the Tier 4 Policy Guidance for an explanation of the Inner
London Boroughs and how to assess your primary site of study.
Inside the Inner London Boroughs
Go to Question 6.7
Outside the Inner London Boroughs
Go to Question 6.8
6.7 You must have £800 per month to cover >>>>>>>>>>>>>
maintenance in the UK (up to a maximum of 9 months).
See the Tier 4 Policy Guidance for a full explanation of maintenance
charges. Calculate the amount you will require and enter this in the
space provided. Go to Question 6.12
6.8 You must have £600 per month to cover maintenance in
the UK (up to a maximum of 9 months).
See the Tier 4 Policy Guidance for a full explanation of maintenance
charges. Calculate the amount you will require and enter this in the
space provided. Go to Question 6.12
£ £
6.4 Put a cross (X) in the box to confirm you have sufficient funds to cover all course fees due for payment. >>>>>>>>>>>
5.11 If you intend to be a Postgraduate Doctor or Dentist we will use the CAS from your sponsor provided in >>>>>>>>>
Question 5.1. You must also provide an original letter from the relevant Postgraduate Dean. Put a cross (X) in the box to
confirm you have done so.
5.12 You must send us all of the original certificate(s) and/or original transcripts of results of your United Kingdom >>>>
qualification in Medicine or Dentistry that are listed in the CAS. Put a cross (X) in the box to confirm you have done so.
Postgraduate Doctor or Dentist
• If you are beginning a new course give the fees for the first year of the course, or for the entire course, if it less than one year’s duration.
• If you are a applying for a further period of leave to continue an existing course, give the course fees that you still need to pay to the end
of the current academic year, if you are part way through the year; or for the next academic year if you will continue on your course at
the start of the next academic year. If you have no course fees to pay put £0.00 in the box.
• If this will be part of a study abroad programme give any fees you will be required to pay to the UK education provider for the first year of
your course, or for the entire course, if it is less than one year’s duration.
• If you have no fees to pay the UK education provider put £0.00 in the box.
Sabbatical Officer
5.10 Put a cross (X) in the box to confirm you will be a Sabbatical Officer. Then Go to Part 6 We will use the Confirmation >>
of Acceptance for Studies from your sponsor, provided in Question 5.1, as evidence.
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附注
Part 6(费用的相关信息见CAS Statement)
6.1 学费是多少
6.2 是否已经交了部分学费
6.3 选Show in the CAS
6.4 画X
6.5 选择Initial application
6.6 根据实际情况选择学校的所在地:
大伦敦地区内-转问题6.7/大伦敦地区外-转问题6.8
6.7/6.8 所需的生活费用?
计算方式:
问题6.7 800*课程时长(如果课程时长超过9个月,那么只算9个月就可以了),转到6.12
问题6.8 600*课程时长(如果课程时长超过9个月,那么只算9个月就可以了),转到6.12
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6.17 Do you have any fees and maintenance still due for payment? Put a cross (X) in the relevant box.
6.18 Do you have money in your own name? Put a cross (X) in the relevant box.
Yes - Complete the boxes below
Yes - Go to question 6.20
Have money in own and parent / legal guardians bank
account. - Go to question 6.19
No - No money due, no evidence needed
Go to Part 7
No - Go to question 6.19
Course fees >>>>>>>>>>>>>>>>>
Maintenance >>>>>>>>>>>>>>>>>
Total >>>>>>>>>>>>>>>>>>>>>>>
£
£
£
Birth Certificate naming Student and Parent(s)
Certificate of adoption naming the student and the adoptive
parent(s)
Court document naming the student and the legal
guardian(s)
6.19 Put a cross (X) to confirm that you have provided a letter from your parent or legal guardian. >>>>>>>>>>>>>>>>>>>>
Put a cross (X) to confirm that you have provided one of the following pieces of evidence of the relationship.
Shown in the CAS
An original letter to confirm the financial sponsorship from
an official financial sponsor or Government sponsor.
An official, original receipt
You are receiving official financial sponsorship from your Tier 4
licensed sponsor (e.g. a scholarship or bursary), and details
of the financial sponsorship are included in the CAS.
6.13 Put a cross (X) in the relevant box to show what document has been provided as evidence of payment.
6.15 Put a cross (X) in the relevant box to confirm what evidence of financial sponsorship you have provided.
6.10 You must have £800 per month to cover >>>>>>>>>>>>>
maintenance in the UK (up to a maximum of 2 months).
See the Tier 4 Policy Guidance for a full explanation of maintenance
charges. Calculate the amount you will require and enter this in the
space provided. Go to Question 6.12
6.14 Showing funds
Do you receive support from a financial sponsor that meets the UK Border Agency definition of a financial sponsor?
(See Tier 4 Policy Guidance for definitions) Put a cross (X) in the relevant box
6.11 You must have £600 per month to cover maintenance in
the UK (up to a maximum of 2 months).
See the Tier 4 Policy Guidance for a full explanation of maintenance
charges. Calculate the amount you will require and enter this in the
space provided. Go to Question 6.12
Yes - Go to Question 6.15 No - Go to Question 6.17
6.12 Have any of your accommodation fees been paid to your sponsor? Put a cross (X) in the relevant box.
Yes - Paid to Overseas Higher Education Institution
Go to Question 6.13
Yes - Paid to UK Education Provider. Enter the amount in
the box below then - Go to Question 6.13
£
£ £
6.16 Complete the box(es) to indicate how much the official financial sponsor or Government sponsor is paying towards your
expenses.
For Course fees
£ £
For Maintenance
No - Go to Question 6.14
6.9 Extension application (following a course of six months or more and completed less than four months ago)
Put a cross (X) in the relevant box to confirm your primary site of study. See the Tier 4 Policy Guidance for an explanation of the Inner
London Boroughs and how to assess your primary site of study.
Inside the Inner London Boroughs
Go to Question 6.10
Outside the Inner London Boroughs
Go to Question 6.11
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附注
6.12 是否支付过任何的住宿费用给学校
按照实际情况填写
6.13 选择Shown in the CAS
6.14 如果是自费,选择No,
6.15 直接转到6.17
6.17 还没有支付的费用
根据实际情况选择,如果是YES,那么下方的费用计算方式如下
课程费用(课程总费用-定金)
生活费(生活总费用-定金)
总费用以上两项的总和
6.18 你的名下是否有资金?
这个根据资金的情况具体分析,如果自己存在客户本人名下,那么该项选Yes——直接转6.20;如果钱存在父母名下,那么选No——直接转6.19;如果资金由客户本人和父母一起出具,那么选择Have money in own and parent/legal guardians bank account——直接转6.19
6.19 如果有父母出资,那么申请人需要提供出生证明
6.20 根据实际情况选择
Personal bank or building society statement存款证明
Savings or building society pass books存折
letter from a bank or building society confirming the funds or the agreement of a loan银行出具的资金或贷款文件
Letter from a regulated financial institution confirming funds or the agreement of a loan正规金融机构出具的资金或贷款文件
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Part 7 Summary Sheet
Points Scoring Area Points Claimed Documents Provided (please list)
Please complete the summary sheet below, listing the points you have claimed and the documentation provided. You must provide the
required evidence as specified in this application form and the Tier 4 Policy Guidance. All documents must be originals unless otherwise
stated. Failure to submit required evidence is likely to lead to refusal of the application.
YOU MUST SUBMIT A PAPER COPY OF THIS APPENDIX WITH YOUR SUPPORTING
DOCUMENTS. ENSURE YOU ALSO COMPLETE THE PERSONAL DETAILS
FORM EITHER ON PAPER OR ON LINE. YOU SHOULD SIGN THE DECLARATION
AND SUBMIT THIS WITH YOUR OTHER DOCUMENTS.
Possession of a CAS
(30 points)
Maintenance (Funds) (10 points)
Total
Applicant’s signature Date
D D M M Y Y Y Y
I confirm I have completed the separate Personal Details form and accept the contents of the declaration.
Parent/Legal Guardian’s signature
(If applicant is 16 or 17 years old)
Date
D D M M Y Y Y Y
Translations
Any documents that have to be submitted in support of points claimed, which are not in English or Welsh must be accompanied by a
full translation that can be independently verified by the UK Border Agency. The original translation must contain confirmation from the
translator that it is
• an accurate translation of the original document
• the date of the translation
• the translator’s full name and signature, and
• the translator’s contact details.
Personal bank or building society statements
Letter from a bank or building society confirming the funds
or the agreement of a loan
Savings or building society pass books
Letter from a regulated financial institution confirming funds
or the agreement of a loan.
6.20 Put a cross (X) in the relevant boxes to indicate what evidence of funds has been supplied to cover all maintenance and fees
which you still need to pay. All documents must be originals. The funds must have been in your (or your parent or legal guardian’s)
bank account/building society account for 28 days prior to the date of your application.
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附注
CAS和CAS上列明,学校发放给学生该CAS的条件
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打字机文本
30
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打字机文本
10
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资金证明+存折
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打字机文本
40
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申请人签字,后面写日期(日月年)
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如果申请人16、17岁,那么此处需要其父母或监护人的签字,并写上日期