Tier 1 Dependants Form

TIER 1
(DEPENDANT)
VERSION 08/08
Application for an extension of

stay as a dependant of a person
who has leave to remain under the
points based system
This form should also be used by the dependants of
applicants who are applying for re-instatement as a highly
skilled migrant under the terms of paragraph 34-42 of the
HSMP Forum Ltd. Judicial Review: Policy Document
In accordance with paragraph 34 of Immigration Rules, this form is specified for

applications made on or after 30 June 2008
You also need the separate guidance notes for this form. Please read them before making
your application. If you do not already have them, you can get them from our website at
www.ukba.homeoffice.gov.uk
Please note that changes to the Immigration Rules mean that successful applicants is this
category may not be permitted to work in the UK as a doctor in training. Please refer to
the UK Border Agency website at www.ukba.homeoffice.gov.uk
Please send or courier your application to the following address:

This form is
UK Border Agency to be used for
Tier 1 (Dependants)
PO Box 496
applications made
Millburngate House on or after 8
Durham August 2008
DH99 1WQ
Contents Page
Section 1 -
Payments Details
A. Payment Details
Section 2 -
Dependant’s Details
B. Personal Details
C. Passport/Travel Document Details
D. Immigration History
E. Personal History
Section 3 -
Main Applicant’s Details
F. Main Applicant’s Personal Details

G. Dependant’s Relationship to Main Applicant
Section 4 -
Application Details
H. Further Details
J. Maintenance
K. Public Funds
Section 5 -
Declarations
L. Dependant Declaration
M. Representative’s Details and Declaration
Section 6 -
Summary Sheet
Tier 1 (Dependant) Application Form (06/08) - page 1 of 33

TIER 1 (dependant) APPLICATION -
PAYMENT GUIDANCE NOTES
You can pay by any of the following methods:
• Cheque/Bankers Draft
The applicable fee • Postal Order
• Credit card - Mastercard or Visa (including
For an application made on this form, the fee is £395 Electron)
unless the dependant meets the criteria given to be • Debit card - Delta, Maestro* (including Solo)
considered free of charge.
* We can only accept Maestro cards issued in the UK .
Free of charge - for this application to be considered
free of charge, the dependant must be the spouse, We do not accept any other form of payment. Please
civil partner, unmarried or same-sex partner, or child do not send cash.
under 18 of the main applicant. Furthermore the
dependant’s application must be made at the same time
Cheques and postal orders
as the main applicant’s application. To assist in the
processing of the application, you are advised to send
You must make the cheque or postal order payable to
any dependant applications in the same envelope as
‘Home Office’ and cross the cheque or postal order
that of the main applicant.
A/C Payee only. Please write the full name and date
of birth of the applicant on the back of the cheque
In addition, dependant children over 18 are not and/or postal order and keep the postal order stub(s).
required to pay a fee where: Please make sure that the date and the amount (words
and figures) are correct and that the cheque is signed
• The dependant is applying as the dependant of a correctly. Attach your cheque or postal order(s) to the
person who has applied for re-instatement as a highly front of the application form.
skilled migrant under the terms of paragraph 34-42
of the HSMP Forum Ltd. Judicial Review: Policy
Document; and
Completing the payment details page
• the dependant was under 18 years of age at the time
To ensure that your payment is processed without any
the main applicant switched their immigration status
delay, please follow this guidance when completing
from HSMP to another category.
Section 1 of this form (Payment Details).
£395 – Standard fee for Tier 1 (Dependant)
A1 Tick the fee appropriate to your application - see
application.
above guidance
A2 Dependant’s full name
In all other dependant applications, including those for
A3 Dependant’s date of birth
children aged 18 or over, the standard fee above will
A4 Home Office reference number (if known)
apply for each dependant. This also includes where the
A5 Main applicant’s nationality
main applicant is exempt from the charge by virtue of
A6 Main applicant’s name
their nationality, and the dependant is not applying at
A7 Main applicant’s date of birth
the same time as the main applicant.
A8 Main applicant’s Home Office reference number (if
known)
Applications made on this form may not be made in
person at a Public Enquiry Office of the UK Border
Agency. Correspondence - we need the details of the person to
contact if we have a query regarding the payment.
Fee exemptions
A9 Name of contact for correspondence
There are no exemptions to the standard fee for A10 Address for correspondence
dependants. The exemption relating to main applicants
of certain nationalities does not apply to dependants. Method of payment
How can you pay?

A11 Tick one of the boxes to show which method of
payment you are using
A12 - A14 If paying by cheque enter the bank account
number, sort code and cheque number
Paying by credit / debit card
A15 The name as displayed on the credit/debit card

A16 Card number - this is the long number across the
centre of the card
A17-A19 Enter the details where available on the card
A20 The Card Verification Value (CVV) is a three-digit
security code, found on the back of the card on the
signature strip - it consists of the last 3 digits.
A21-A22 Cardholder’s signature - the person named on

the credit/debit card must sign and date
Consideration process
• If the payment submitted does not cover the

full cost of your application, it will be an invalid
application and the form, together with any
documentation submitted, will be returned to you.
• The fee charged is for the processing and
consideration of the application. This fee will be
payable once the application form is received by the
UK Border Agency or its payment processing agent,
regardless of the outcome of the application.
• We cannot begin the consideration process until the
payment has cleared. We allow 5 working days for
payments made by cheque to clear, credit/debit cards
and postal orders will clear immediately.
• Should the application be withdrawn at any time
during the consideration process the fee will not be
refunded.

Tier 1 (Dependant) Application Form - Section 1
section 1 - payment details
A. APPLICATION DETAILS
Dependants should refer to the Points-based system - Dependants help text which accompanies this application form.
Please complete this section in block capitals and black ink.
A1. Is the application to be:

Paid for - the applicant is making £395 Free of charge - see page - go to question A2
a standard Tier 1 (Dependant) 3 of this document
application
A2. Dependant’s Full Name
A3. Dependant’s date of birth A4. Home Office reference number(s) - if known
D D M M Y Y Y Y
A5. Nationality
A6. Main applicant’s full name
A7. Main applicant’s date of birth A8. Home Office reference number(s) - if known
D D M M Y Y Y Y
A9. Contact name
A10. Contact address
Postcode
A11. Please select the method of payment from the list below
United Kingdom postal order (payable to ‘Home Cheque (payable to ‘Home Office’) - go to
Office’) - go to Section B question A9
Visa / Mastercard - go to question A12 Delta / Maestro - go to question A12
A12. Account number A12. Sort code A14. Cheque number - go to Section B
- -
A13. Please debit the following account £395
Name on card
A14. Card number (the long number across the centre of the card)
A15. Valid from A16. Expiry date A17. Issue number A18. CVV security number
(where (3 digit number on
M M / M M M M / Y Y available) back of card)
A19. Cardholder’s signature A20. Date
D D M M Y Y Y Y

If you are producing a double-sided copy of this

application form, please include this page and
make sure it falls on the reverse of the payment
details page in the two-sided copy.
For administrative reasons, it is important that

the rest of the form begins with Section 2 -
Applicant’s Details facing upwards

section 2 - dependant’s details
Dependants should refer to the Points Based System - Dependants help text which accompanies this
application from. Failure to complete this section may lead to a delay in the consideration of the
application.
B. Personal Details
Staple here B1. Title - please select from the following list: Mr.
Attach two identical Mrs.

photographs of you
Miss
(the dependant) here with a
staple or paper clip Ms
Dr
Do not use glue or other
sticky adhesive Other
If “Other”, what is your title?
B2. First name(s) as stated in the dependant’s passport
B3. Last name(s)/family name(s) as stated in the dependant’s passport
B4. If the dependant is known, or has ever been known, by any other name(s) other than those given
above, then please provide details of the name(s) and date(s) and indicate the evidence provided
showing the name change:
Name known by Dates known by (from and to) Evidence provided
Please photocopy this page if additional space is required
B5. Dependant’s date of birth B6. Place of birth (city/town)

D D M M Y Y Y Y
B7. Country of birth B8. Gender
Male Female

B9. Marital Status - please tick
Opposite
Married Civil Partner or same sex Widowed
partner
Single Separated Divorced Dissolved

Civil
Partnership
Separation Surviving
Order Civil Partner
B10. Home Office reference number(s) - if known
B11. UK National Insurance number (if known) B12. PBS migrant reference number (if known)
B13. Full address
B 14. Postcode
B15. Date dependant started living at this address

D D M M Y Y Y Y
B16. Home telephone number
B17. Mobile telephone number
B18. Work telephone number
B19. Email address

B20. Correspondence address (if different from above)
B 21. Postcode
B22. Has the dependant ever lived in Northern Ireland?

Yes - go to question B23 No - go to Section C
B23. Please provide details of the dependant’s previous addresses in Northern Ireland and the dates
between which the dependant lived there
Previous address 1:
Postcode
From D D M M Y Y Y Y To D D M M Y Y Y Y
Previous address 2:
Postcode
If the dependant has lived at more than 2 addresses in Northern Ireland please photocopy this page and provide
details of all other Northern Ireland addresses and dates the dependant lived there

C. Passport/Travel Document Details
Dependants should refer to the Points Based System - Dependants help text which accompanies this
application form.
For the application to be valid and complete the dependant’s current passport / travel documents
must be provided unless it is not available for one of the reasons specified on the application form.
The dependant should also provide all previous passport(s) and/or travel document(s) that they have
used to travel to and remain in the UK. All passports and/or travel documents provided should be the
original documents and not copies.
C1. Under what nationality did the dependant travel to the UK?
C2. Does the dependant currently hold additional Yes - go to question C3

nationalities?
No - go to question C4
C3. Please give details of all other nationalities currently held
C4. Has dependant previously held any other Yes - go to question C5

nationalities?
No - go to question C6
C5. Please give details, including relevant dates, of all other nationalities previously held

C6. Please provide details of the dependant’s current and previous passport(s) and/or travel
document(s) that he/she has used to travel to and remain in the UK. Please note that for the application
to be valid and complete the dependant’s current passport/travel document must be provided unless it
is not available for one of the reasons specified on the application form.
Current Passport or travel document
Passport / Passport or If no, please state

Issue Expiry Place
Travel document Nationality travel document location of Passport or
date date of issue
number enclosed? travel document
Lost - complete C7
Yes Stolen - complete C8
Expired - returned to
national authorities
No Elsewhere in the
UK Border Agency -
complete C7
Previous passports/travel documents
Passport / Passport or If no, please state

Issue Expiry Place
Travel document Nationality travel document location of Passport or
date date of issue
number enclosed? travel document
Lost - complete C7
No Elsewhere in the
UK Border Agency -
complete C7
Lost - complete C7
No Elsewhere in the
UK Border Agency -
complete C7
Please photocopy this page if additional space is required

C7. If any of the required passports/travel documents are not enclosed then please give details why
the dependant is unable to provide them
C8. If any of the required passports and/or travel documents were stolen please provide the police
report number, the police station and the date reported to the police.
Police report number Police station Date reported to police

D. Immigration History
It is mandatory to complete section D. If it is not complete the application will be invalid and will be
returned to the dependant. Dependants should refer to the Points Based System - Dependants help
text which accompanies this application form.
D1. Did the dependant obtain entry clearance or a visa before entering the Yes No
UK?
Please note: In order to qualify for further leave to remain in the UK as the dependant of a person
under the Points Based System, the individual must have either travelled to the UK with entry
clearance as the dependant of the main applicant; or have been last granted leave to remain as a
dependant of the main applicant in a qualifying category. If the dependant does not meet either of
these criteria it is likely that his/her application will be refused. Please see the guidance notes for
further information.
D2. From within which country overseas and at which post did the dependant obtain entry clearance
or a visa before travelling to the United Kingdom?
Country
Post (City)
D3. When was the entry clearance or visa issued?
D D M M Y Y Y Y
D4. Please enter the reference number on the entry clearance or visa within the dependants passport
or travel document
D5. Are either the dependant’s current and/or any one of their previous passport(s) or travel
document(s) unavailable?
Yes - go to question D6 No - go to question D11
Please note for the application to be valid and comnplete the dependant’s current passport/
travel document must be provided unless it is not available for one of the reasons specific on the
application form.
D6. At which port did the dependant enter the UK?
D7. Please give full details of the dependant’s method of entry into the UK
Aeroplane Sea Channel tunnel
Other If other, please specify

D8. Please give details of the journey, including where the dependant travelled from, ticket booking/
reference number, and transport operator
Ticket booking/reference
Details of journey Operator
number
D9. For what purpose did the dependant enter the UK?
D10. When did the dependant arrive in the UK?
D D M M Y Y Y Y
D11. What is the dependant’s current immigration status in the UK?
D12. When does the dependant’s current leave expire?
D D M M Y Y Y Y
D13. Has the dependant ever remained in the UK beyond the end of their period of leave?
Yes - go to question D14
No - go to question D15
D14. Please give the reason(s) why the dependant remained beyond the end of their period of leave
and the dates of the overstay.
D15. Has the dependant ever worked in the UK without immigration permission to do so (i.e.
contrary to this/her conditions of stay)?

D16. Please give the reason(s) why the dependant worked in the UK without immigration permission
to do so and the dates this work was undertaken.
D17. Has the dependant ever illegally entered the United Kingdom?

D18. Please give details and the dates on which this occurred
D19. Has the dependant ever been removed or deported from the UK?
D20. Please give details and the dates on which this occurred
D21. Does the dependant currently have other applications with the Agency on which they are
awaiting a decision?
D22. Please give details of the application, including the date the application was submitted, what
the application for (i.e. the category) and the payment reference number - then go to question D23
D23. Was this application submitted before the dependant’s leave expired?

D24. Has the dependant’s leave now expired?
D25. The dependant is not able to submit a further application. However, they can, if they wish to
vary the grounds of the existing application.
Please tick this box to confirm if the dependant wishes to vary the grounds of the existing
application - then go to question D26
D26. Does the dependant wish the Agency to process the current outstanding application?
D27. Does the dependant currently have an appeal with the Asylum and Immigration Tribunal
on which they are awaiting a decision?

No - go to Section E
D28. Please give details of the appeal, including the date the appeal was submitted, what the appeal
is for (i.e. category) and the payment reference number (where applicable) - then go to question D29
D29. Has the dependant’s leave now expired?

D30. The dependant is not able to submit a further application. However, they can choose to provide
additional grounds to the outstanding appeal.
Please tick this box to confirm if the dependant wishes to vary the grounds of the existing
application - then go to question D31.
D31. Does the dependant wish to withdraw the outstanding appeal with the Asylum and Immigration
Tribunal?
Yes - go to Section E
No The dependant is not able to submit a further fresh application.

E. Personal History (Criminal convictions, war crimes, etc.)
It is mandatory to complete Section E. If it is not complete the application will be invalid and will be
returned to the dependant.
The dependant must answer every question on this section. It is an offence under Section 26(1)(c) of
the Immigration Act 1971 to make a statement or representation which they know to be false or do
not believe to be true. Information given will be checked with other agencies.
E1. Has the dependant had any criminal convictions in the UK or any other country (including traffic
offences) or any civil judgements made against them?
Yes - go to question E2
No - go to question E3
E2. If they have answered yes to question E1 above they should give details below for each criminal
conviction and/or civil judgement, starting with the most recent one - but first see Note 1 about
criminal convictions and/or civil judgements, give details on a copy of this page and enclose it with
this form.
Note 1 - Convictions spent under the Rehabilitation of Offenders Act 1974 need not be disclosed. More
information about the Act is given toward the end of this section.
Name of person convicted or against whom a civil judgement was made
Nature of the criminal offence or the civil action (give details on a separate sheet and enclose it with this form
if you need more space)
Details of the sentence or civil judgement (give details on a separate sheet if you need more space)
Date of sentence / judgement
D D M M Y Y Y Y
Country where the sentence was passed or the civil judgement was made

The dependant must answer questions E3 to E8 below even if they have answered no to question E1. For
help in answering these questions, please see the definitions on the next page.
E3. Has the dependant ever been charged in any country with a criminal offence for which he/she
has not been tried in court?
Yes No
E4. In times of either peace or war has the dependant ever been involved, or suspected of
involvement, in war crimes, crimes against humanity or genocide?
Yes No
E5. Has the dependant ever been involved in, supported or encouraged terroist activites in any
country?
Yes No
E6. Has the dependant ever been a member of, or given support to, an organisation which has been
concerned in terrorism?
Yes No
E7. Has the dependant ever, by means or medium, expressed views that justify or glorify terrorist
violence or that may encourage other to terrorist acts or other serious criminal acts?
Yes No
E8. Has the dependant ever engaged in any other activities which might indicate that he/she may
not be considered to be a person of good character?
Yes No
E9. If the dependant answered yes to question E3, E4, E5, E6, E7, or E8 above they should give
further details in the space provided below. If they need more space they should continue on a
separate sheet.

REHABILITATION OF OFFENDERS ACT 1974
The Rehabilitation of Offenders Act 1974 enables criminal convictions to become ‘spent’ or ignored after a
‘rehabilitation period’. The length of the rehabilitation period depends on the sentence given. For a custodial
(prison) sentence the rehabilitation period is decided by the original sentence, not the time served. Prison
sentences of more than two and a half years can never become spent and should always be disclosed. Further
information on rehabilitation periods can be found at Nacro’s Resettlement Plus Helpline on 020 7840 6464
or by obtaining a free copy of their leaflet on 020 7840 6427.
DEFINITIONS
For the purposes of answering questions E4 to E8, the following information provides guidance on actions
which may constitute war crimes, crimes against humanity, genocide, or terrorist activities.
This guidance is not exhaustive. The full definitions of war crimes, crimes against humanity and genocide
can be found in Schedule 8 of the International Criminal Court Act 2001 at www.opsi.gov.uk/acts/
acts2001/20010017.htm or purchased from The Stationery Office (telephone 0870 600 5522). It is the
dependant’s responsibility to satisfy him/herself that they are familiar with the definitions and can answer the
questions accurately.
War crimes
Grave breaches of the Geneva Conventions committed during an armed conflict. This includes an internal
armed conflict and an international armed conflict. The types of acts that may constitute a war crime
include willful killing, torture, extensive destruction of property not justified by military necessity, unlawful
deportation, the intentional targeting of civilians and the taking of hostages.
Crimes against humanity

Acts committed at any time (not just during armed conflict) as part of a widespread or systematic attack,
directed against any civilian population with knowledge of the attack. This would include offences such as
murder, torture, rape, severe deprivation of liberty in violation of fundamental rules of international law and
enforced disappearance of persons.
Genocide
Acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group.
Terrorist activities Any act committed, or the threat of action, designed to influence a government or
intimidate the public and made for the purposes of advancing a political, religious or ideological cause and
that involves serious violence against a person; that may endanger another person’s life; creates a serious risk
to the health or safety of the public; involves serious damage to property; is designed to seriously disrupt or
interfere with an electronic system.
Organisations concerned in terrorism

An organisation is concerned in terrorism if it commits or participates in acts of terrorism; prepares for
terrorism; promotes or encourages terrorism (including the unlawful glorification of terrorism); or is
otherwise concerned in terrorism.

section 3 - main applicant’s details
It is mandatory to complete Section 3. If it is not complete the application will invalid and will be
F - Main Applicant’s Personal Details

F1. Title - please select from the following list: Mr.
Mrs.
Miss
Ms
Dr
Other
If “Other”, what is your title?
F2. First name(s) as stated in the main applicant’s passport
F3. Last name(s)/family name(s) as stated in the main applicant’s passport
F4. Date of birth F5. Home office reference number(s) (if known)
D D M M Y Y Y Y
F6. PBS migrant reference number(s) (if known)
F7. Nationality
F8. The main applicant should sign here to indicate that they give their consent to dependant being
included on their application / existing leave
Signature Date
D D M M Y Y Y Y

G. Dependant’s Relationship to Main Applicant
G1. What is the dependant’s relationship to the main applicant?
Spouse - go to Other - go
Civil partner - go
section H to question
to section H
G2
Opposite or same If other,

Child under 18 -
sex partner - go please give
go to question G2
to section H details
G2. Does the dependant receive financial assistance from a source other than the main applicant?
Yes - go to question G3 No - go to question G4
G3. Please give details:
Amount conntributed to
Name Relationship to dependant
support per month (£s)
G4. Has the dependant ever been married or in a civil partnership?

Yes Please give details
No
G5. Has the dependant ever lived in a relationship akin to marriage or civil partnership?
Yes Please give details

No
G6. Is the dependant working in the UK?

Yes - go to question G7 No - go to section H
G7. Please state the job title, number of hours worked and salary received by the dependant:
Job title Hours worked per week Salary (£s)

section 4 - main applicant’s details
H. Further Details
H1. Is the dependant submitting their application with the main applicant’s application?
Yes No
H2. Has the main applicant received notification that their application for leave to remain under the
Points Based System has been successful?
Yes No
H3. Under which category of the Points Based System has the main applicant applied?
Tier 1 - General - go to question H4
Tier 1 - Entreprenurs - go to Section J
Tier 1 - Post Study Work - go to Section J
Tier 1 - Investors - go to Section K
H4. Has the main applicant applied to have his/her application assessed in accordance with
paragraphs 39-42 of the HSMP Forum Ltd. Judicial Review Policy Document?
Yes No
Now go to Section J
J. Maintenance
J1. In order for the application to be approved the dependant must have a minimum level of funds. If
they do not have the required level of funds the application will be refused.
The level of funds the dependant must have access to depends on the length of time the main
applicant has been in the UK. Please indicate whether the main applicant has been in the United
Kingdom for:
Less than 12 months Please provide evidence of more than £1600 of available funds
12 months and over Please provide evidence of more than £533 of available funds
Please provide evidence that the dependant has access to available funds in order to support
themselves. Funds may be in the name of the dependant or the main applicant. Please tick the
relevant box(es) to indicate the evidence supplied:
Personal bank or building society statements covering a 3 month period
Building society pass book
Letter from bank or building society confirming funds and that they have been
banked for at least 3 months
Letter from a Financial Services Authority (FSA) regulated institution confirming

funds

K. Public Funds
It is mandatory to complete Section K. If it is not complete the application will be invalid and will be
K1. Is the dependant receiving any public funds?

Yes - go to question K2 No - go to Section 5
K2. The public funds which are relevant for the purposes of the Immigration Rules are listed below.
Please tick the relevant box(es) to show which of these are being received.
Attendance Allowance Housing and Homelessness Assistance
Carer’s Allowance Income-based Jobseeker’s Allowance
Child Tax Credit Income Support
Child Benefit Severe Disablement Allowance
Council Tax Benefit Social Fund Payment
Disability Living Allowance State Pension Credit
Housing Benefit Working Tax Credit
K3. If applicant or dependant is in receipt of housing and homelessness assistance please give
details of whether this housing is provided by the local housing authority, a housing association, or
other organisation and the name of the relevant authority and details of the arrangement.
K4. If the housing is provided by the main applicant’s or dependant’s local council/housing
authority or is part of an agreement between the dependant’s employer and the housing authority
then please provide details below and enclose evidence of this from the local housing authority.
Please tick the following box to indicate what evidence the dependant has supplied.
Original letter from the local housing authority
K5. If the main applicant or dependant believes that they are subject to an exception and are
eligible to claim public funds please provide details below and enclose evidence of this eligibility (if
appropriate).

section 5 - declarations
L. Dependant
It is mandatory to complete Section L. If it is not complete the application will be invalid and will be
The dependant must sign below to show that he/she has read and understood the following declaration.
It must be authorised by the dependant if he/she is over 18 years of age and not by a representative or
other person acting on his/her behalf.
The information I have given in this application is complete and is true to the best of my knowledge.
The photographs I have submitted with this application are a true likeness of myself and have my name on the
back of each.
If there is a material change in my circumstances or any new information relevant to my application becomes
available before it is decided, I will inform the UK Border Agency.
I agree to co-operate with UK Border Agency officials, or any other officials charged by the Secretary of State for
the Home Office, with conducting pre-issue and post-issue checks on compliance with the PBS applications.
I agree to my representative (where applicable) tracking my application with the UK Border Agency online, or the
UK Border Agency updating my representative on the progress of my application including whether the applica-
tion has been granted or refused.
I understand that if I knowingly submit any document or documents which are forged, fraudulent or not genuine,
and the Secretary of State has sought to verify the documents using processes specified by her, and has been unable
to verify conclusively that they are genuine, the application will be refused.
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 am aware that the rules and regulations governing points-based system applications may change in the future and
do not assume that the requirements covering any future applications will be the same.
I am aware that it is an offence under the Immigration Act 1971, as amended by the Immigration and Asylum Act
1999 and the Nationality, Immigration and Asylum Act 2002, to make, to a person acting in execution of any of
these Acts, a statement or representation which I know to be false or do not believe to be true, or to obtain or seek
to obtain leave to remain in the United Kingdom by means which include deception.
Information I provide to the UK Border Agency will be treated in confidence but it may be disclosed to other law
enforcement agencies, government departments, agencies, local authorities, foreign governments and other bodies
for immigration or research purposes or to enable them to perform their functions.
DECLARATION CONTINUED OVERLEAF

Dependant declaration - continued
The UK Border Agency may request information from other law enforcement agencies, Government departments
or Agencies, local authorities, the Police, foreign governments and other bodies for immigration or research
purposes to enable them to perform their functions.
The UK Border Agency may use the information I provide for training and research purposes.
Name
Signature
Date
D D M M Y Y Y Y

Tier 1 (Dependant) Application Form - Section
M. Representative’s Details and Declaration
You should fill in this section if you are a third party, such as a legal representative, dealing with the
application on behalf of an dependant.
M1. Have you helped a sponsor with an application to join the register of sponsors or a migrant to
apply under the points-based system before?
Yes Go to question M2
No Go to question M3
M2. Please give your points-based system reference number (if known):
Please complete the following details:

M3. Name of your organisation:
M4. Contact name within your organisation:
M5. Address:
M6. Postcode
M7. Telephone number:
M8. Email address:
M9. Is your organisation based in the United Kingdom?


M10. Are you regulated by the OISC?

M11. Please provide your OISC registration number
Go to question M20
M12. Are you authorised to practice and regulated by a designated professional body or supervised
by such a person?
M13. Please select the relevant body from the following options:
The Law Society
The Law Society of Scotland
The Law Society of Northern Ireland
The General Council of the Bar of Northern Ireland
The Institute of Legal Executives
The General Council of the Bar
The Faculty of Advocates
M14. Please give the name of your supervisor (if applicable):
Go to question M20
M15. Are you:
• Authorised by an EEA body responsible for the regulation of the provision of legal advice in that EEA
state to provide immigration advice or services; or
• Acting under the supervision of someone authorised by an EEA body to provide immigration advice or
services?


M16. Please give the name of the registered or accredited EEA body (if applicable):
M17. Please give your supervisor’s name (if applicable):
M18. Are you under a category of person specified in an Order made by The Secretary of State under
subsection 84(4)(d) of the Immigration and Asylum Act 1999?

No Please see application form Help Text
M19. Please provide details

M20. This section must be completed by all representatives who are dealing with this application
on the dependant’s behalf. They must now read the declaration below and authorise as the
representative or other person acting on the dependant’s behalf.
• I have been appointed by the dependant to make this application;
• I confirm that the dependant has completed and verified the application and the application is, to the best
of my knowledge and belief, true and correct.
• Once the UK Border Agency has decided the application, I will give the dependant all correspondence
from the UK Border Agency relating to the decision;
• I am permitted to give immigration advice and immigration services by section 84 of the Immigration
and Asylum Act 1999;
• I am aware that it is an offence under the Immigration Act 1971, as amended by the Immigration and
Asylum Act 1999 and the Nationality, Immigration and Asylum Act 2002, to do an act which facilitates the
commission of a breach of immigration law by an individual who is not a citizen of the European Union,
knowing or having reasonable cause to believe that the act has this effect.
Name: Title: (Mr/Mrs/Miss/Ms/Dr etc.)
Signed: Date:
Name of representative organisation:
Position within organisation

Section 6 - Summary Sheet
Please complete this part of the form to help us to make sure that we have received the dependant’s documents
and to keep a record of them while they are with us.
In part A, tell us how many of each of the listed documents the dependant has provided with this application.
In part B, list any other documents and state how many in each case.
Continue on a separate sheet is necessary.
Part A - type of document How many? Part B - Other documents (continued) How many?
Passports and/or travel documents
Police registration certificates
Marriage or civil partnership certificate
Birth certificate
Driving Licence
Dependants must provide the required eveidence as specified in this application form and Points Based System
- Dependants Policy Guidance. Failure to submit required evidence is likely to lead to refusal of the application.
Once complete, please make sure that this application is addressed correctly to:
UK Border Agency
Tier 1 (Dependants)
PO Box 496
Millburngate House
Durham
DH99 1 WQ

Tier 1 (Dependant) Form - Help Text complied with:
Introduction • The correct application form must be completed and

submitted
This document provides information to help • The correct application fee must be paid
dependants to complete the PBS dependant application • 2 recent passport sized photographs of the applicant,
form. with the dependant’s name written on the back of
each photograph, must be supplied. Please note,
For further information on the dependant policy please passport-sized photographs supplied should measure
see section 6A of the Immigration Rules and the PBS 45mm x 35mm and should be:
Dependants Policy Guidance. These documents are • Colour photographs taken against a white wall
available on the UK Border Agency website at www. • Clear and of good quality and not framed or backed
ukba.homeoffice.gov.uk • Printed on normal photographic paper
• Full face, and without sunglasses, hat or other
All the above documents are available in Welsh, Braille, head covering, unless it is worn for cultural or
large print, audio and other alternative formats on religious reasons. If the application is successful,
request. For further information on alternative formats, the photographs provided will be reproduced in
and how to obtain these, please contact the Immigration the UK Residence Permit in your passport or travel
Enquiry Bureau on 0870 606 7766. document.
• For the application to be valid and complete the

Who should apply using this form? dependant’s current passport/travel document must
be provided unless it is not available for one of the
1 This form should only be completed by individuals
reasons specified on the application form.
who are already in the United Kingdom.
• The mandatory sections in the application form must
be completed.
Dependants should use this form if they are:
• Currently in the United Kingdom as the dependant 3 Dependants who are of a nationality that is required
spouse, civil partner, unmarried or same-sex partner to register with the Police must also include their Police
or child of a person in another immigration category Registration Certificate with their application.
who has, or is at the same time applying for, leave to
remain as a PBS migrant. Supporting evidence
• Currently in the United Kingdom as the dependant
spouse, civil partner, unmarried or same-sex partner It is the dependant’s responsibility to provide the
or child of a PBS migrant and seeking to extend evidence to support any statements made in their
their leave for a further period within their existing application. The dependant must satisfy the Assessing
category. Officer that the requirements for the category under
• Currently in the United Kingdom as the dependant which they have applied have been met. The Officer
spouse, civil partner, unmarried or same-sex partner must be satisfied, by considering the evidence provided
or child of a person who is making an application for that the dependant meets the necessary criteria.
re-instatement as a highly skilled migrant under the
terms of paragraphs 34-42 of the HSMP Forum Ltd. The dependant must be selective in submitting evidence,
Judicial Review: Policy Document. as sending large amounts of irrelevant or poor quality
documentation may delay the consideration of the
This application form should not be used by main application. It is only necessary to submit evidence that
applicants. A separate application form is available is directly appropriate to the application as requested, as
for this purpose and can be found on the UK Border unrelated evidence cannot be considered.
Agency website at www.ukba.homeoffice.gov.uk.
To assist Assessing Officers in considering the
Submitting a valid application documentation provided, the dependant should
highlight any relevant sections on the documentation
2 The dependant will only be considered to have provided. For example, in the funds area, if savings are
submitted a ‘valid’ application if the following has been held withthe
highlight more than one
relevant datessource, dependants
and amounts should
and also mark

the documents provided, to confirm which source of (GRC). The only exception to this is where the
funds the specific document relates to. dependant has previously submitted their GRC with
an earlier application. In such cases the dependant will
Any documentary evidence that the dependant provides therefore not be required to resubmit it.
should be original (unless otherwise stated).
B9 Dependants should indicate their marital status.
Where a document is not in English, the original
must be accompanied by a fully certified translation This status may be:
by a professional translator. All translations must be •Married - a person legally married in or outside the
independently verifiable if necessary. UK.
•Civil partner - a person in a same sex relationship and
Question - specific Help Text who has gone through a legal ceremony in the United
Kingdom under or by virtue of the Civil Partnership
Further advice for PBS dependants on specific Act 2004, or in the country of their residence.
questions to support the completion of the application •Unmarried partner, a person in a relationship with
form is detailed below. someone of the opposite or same sex, which has been
subsisting for two years or more but is not married or in
A9-A10 Please enter the details of the person a civil partnership.
responsible for payment in case we have a payment •Separation Order - a separated person who remains in
query. If we cannot process the payment, the law the civil partner of the other person.
application will be rejected and returned to the •Single - a person who is unmarried and not in a
dependant or their representative. relationship
that has subsisted for two or more years.
A11 Please complete this section if the dependant has •Separated - a person legally married in or outside the
indicated in the ‘Application details’ section that they are UK but no longer living with their married partner.
paying for the application. The dependant need only •Divorced - a person married in or outside the UK
complete the relevant sections. If they have indicated whose marriage has been legally dissolved.
that the application is exempt there is no need to •Widow - a person whose spouse has passed away and
complete this section. has not re-married or is currently in an unmarried
relationship that has subsisted for less than two years.
B1-B4 PBS dependants should provide full details of •Dissolved - a person who has been in a civil
their name and title. If the dependant has previously partnership which has been legally dissolved.
been known by any other name(s) they should provide
full details of each name, the date of each change and B10 All Home Office applications are given an
submit the relevant supporting legal documentation. individual reference number; this allows the Assessing
Officers to track and link past applications. Dependants
Evidence of name change(s) should show the should provide their full Home Office Reference
dependant’s full name before and after the change and number. This number can be found on any previous
may include: Home Office correspondence relating to the dependant.
The dependant may have numerous Home Office
•deed poll documents; and numbers, including HSMP reference numbers or Case
•both the old passport and the new passport. ID reference numbers; the dependant should provide all
such numbers.
Should the dependant submit documentation in support
of their application that refers to them under name(s) B12 Dependants who have made previous applications
not given in this section, that documentation will not be under the PBS will have been given a PBS Migrant
considered by the Assessing Officer. Reference number. This allows the Assessing Officers
to track and link past applications. Dependants should
B8 Dependants should indicate their gender. If the provide their full PBS Migrant Reference number. This
dependant has been the subject of Gender number can be found on any previous correspondence
Reassignment AND an application contains documents relating to applications under the PBS.
relating to previous identities, the dependant should
provide a relevant Gender Recognition Certificate C1-C5 Dependants should specify under which

nationality they entered the UK. They should also application on behalf of a migrant or sponsor they
provide details of any other nationalities they currently should Tier 1 (Dependant) Version 02/2008 provide
hold or have previously held. their PBS reference number.
C6-C8 The dependant must provide details of all M11 The Office of the Immigration Services
passports or travel documents, current or expired, that Commissioner (OISC) regulates UK based immigration
they have used to enter or remain in the UK including: advisers. As a requirement of Section 84 of the
Immigration and Asylum Act 1999, UK representatives,
•passport number who offer advice and services in relation to an
•issue date application will need to be registered with the OISC,
•expiry date unless they are exempt from the requirements to do
•place of issue. so. If the adviser is not a solicitor, barrister, or legal
executive the dependant should check that they are
Where the dependant needs more space than is available OISC authorised or exempt. An adviser could be
they should photocopy the relevant page of the committing a criminal offence, if they act on the
application form and submit this with their application. dependant’s behalf without being OISC authorised or
Where the dependant holds, or has held, other exempt. The representative should indicate whether
nationalities they should provide the relevant passport/ they are registered, or the basis on which they are
travel document for each nationality held and provide exempt from the registration requirement.
the above details.
M13 If the representative is regulated by a designated
The dependant must submit all of these passports/ legal professional body listed below, of if they work
travel documents with the application. They should be under the supervision of such a person, they will not be
original documents and not copies. required to register with OISC.
In certain circumstances certified photocopies will •The Law Society

be accepted where the dependant does not have the •The Law Society of Scotland
original at that time. The dependant must provide •The Law Society of Northern Ireland
details as to its location and state when they will provde •The Institute of Legal Executives
it. The dependant must then ensure that the original •The General Council of the Bar
document is submitted as soon as they can. If the •The Faculty of Advocates
passport has been lost or stolen a Police crime report •The General Council of the Bar of Northern Ireland
number/report must be provided along with details of
the police station the loss was reported to and the date Dependants should indicate which organisation they are
it was reported. a member of.
For the application to be valid and complete the M14 The representative should indicate whether they
dependant’s current passport/travel document must be are personally a member of this organisation or whether
provided unless it is not available for one of the reasons they are working under the authorisation of another
specified on the application form. registered member.
D35 Please note that the dependant will need to contact M15 Where the representative is not a direct registration
the UK Border Agency/Asylum and Immigration holder and is working under the supervision of another
Tribunal direct should they decide not to continue with registered person, the representative should name
their current outstanding appeal. This action will not be the registered supervisor under whom they are working.
undertaken automatically as a result of the response to
this question. M16-M17 The representative should indicate whether
they are registered with or authorised by an EEA body
F1-F7 Dependants should give the full personal details responsible for the regulation of the provision of legal
of the family member who is applying under the PBS advice in that EEA state; or employed or supervised by
and upon whom they are dependant. the person registered as defined in Section 84(2)(d), (e)
and (f) of the Immigration and Asylum Act 1999.
M3 If the representative has previously submitted an

Section 4
PBS dependants should complete the summary sheet
before submitting their application.
Dependants should ensure that they list all the

supporting documentation they have submitted with
their application. If further space is required, the
summary sheet may be photocopied and attached to the
original form.

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TIER 1

Application for an extension of

In accordance with paragraph 34 of Immigration Rules, this form is specified for

Please send or courier your application to the following address:

F. Main Applicant’s Personal Details

Tier 1 (Dependant) Application Form (06/08) - page 1 of 33

How can you pay?

Tier 1 (Dependant) Application Form (06/08) - page 2 of 33

Paying by credit / debit card

A15 The name as displayed on the credit/debit card

A21-A22 Cardholder’s signature - the person named on

• If the payment submitted does not cover the

Tier 1 (Dependant) Application Form (06/08) - page 3 of 33

A1. Is the application to be:

A6. Main applicant’s full name

A9. Contact name

A10. Contact address

Visa / Mastercard - go to question A12 Delta / Maestro - go to question A12

Tier 1 (Dependant) Application Form (06/08) - page 4 of 33

If you are producing a double-sided copy of this

For administrative reasons, it is important that

Tier 1 (Dependant) Application Form (06/08) - page 5 of 33

Attach two identical Mrs.

B2. First name(s) as stated in the dependant’s passport

B3. Last name(s)/family name(s) as stated in the dependant’s passport

Name known by Dates known by (from and to) Evidence provided

Please photocopy this page if additional space is required

B5. Dependant’s date of birth B6. Place of birth (city/town)

Tier 1 (Dependant) Application Form (06/08) - page 6 of 33

B9. Marital Status - please tick

Single Separated Divorced Dissolved

B10. Home Office reference number(s) - if known

B13. Full address

B15. Date dependant started living at this address

B16. Home telephone number

B17. Mobile telephone number

B18. Work telephone number

B19. Email address

Tier 1 (Dependant) Application Form (06/08) - page 7 of 33

B20. Correspondence address (if different from above)

B22. Has the dependant ever lived in Northern Ireland?

Tier 1 (Dependant) Application Form (06/08) - page 8 of 33

C2. Does the dependant currently hold additional Yes - go to question C3

C3. Please give details of all other nationalities currently held

C4. Has dependant previously held any other Yes - go to question C5

Tier 1 (Dependant) Application Form (06/08) - page 9 of 33

Current Passport or travel document

Passport / Passport or If no, please state

Previous passports/travel documents

Passport / Passport or If no, please state

Tier 1 (Dependant) Application Form (06/08) - page 10 of 33

Police report number Police station Date reported to police

Tier 1 (Dependant) Application Form (06/08) - page 11 of 33

D3. When was the entry clearance or visa issued?

D6. At which port did the dependant enter the UK?

Tier 1 (Dependant) Application Form (06/08) - page 12 of 33

D10. When did the dependant arrive in the UK?

D11. What is the dependant’s current immigration status in the UK?

D12. When does the dependant’s current leave expire?

Tier 1 (Dependant) Application Form (06/08) - page 13 of 33

Yes - go to question D18

Tier 1 (Dependant) Application Form (06/08) - page 14 of 33

Yes - go to question D28