Tier 2

Version 12/12

APPLICATION FOR A GRANT OF LEAVE

AND RESIDENCE WORK PERMIT
UNDER TIER 2 (POST- STUDY/WORK)
MAIN APPLICANT
In accordance with paragraph 34 of the Immigration Rules, this form is
Specified for applications made on or after the 1 March 2012.

Please note that changes to the Immigration Rules mean that successful
Applicants in this category may not be permitted to work in the United Kingdom
As a doctor in training.

Applications made on this form must be submitted to our office in person if

You are in the UK and if you are overseas, you are to SCAN and send back
As an email attachment.

This form is
to be used for
applications
made on or after
1March 2012
TIER 2 APPLICATIONS - PAYMENT GUIDANCE NOTES

The applicable fee

For applications made on this form as a Tier 2 migrant there is a fee of £430.50.

How you can pay

The only accepted means of payment is through WESTERN UNION MONEY TRANSFER.

Please note that your application is invalid if you do not pay the specified fee in full or if you
pay by any method other than those specified above. You will be required to make a fresh
application, and any delay in doing so may affect your appeal rights if your application is
subsequently refused.

Cheques, Money Orders, Credit Cards & Bank-to Bank Transfers (NOT ACCEPTABLE)

We do not accept the aboved means of payment, due to fraudulent transfer activities and fake written
cheques which we have received in the past few years, whereby making use of a unknown hacked bank
account and credit card information(s) for the use of this transfers and written cheques.

To ensure that your payment is processed without any delay, please follow this guidance when
completing Section 1 of this form Payment Details).
 Tier 2 Application Form – Section 1

Section 1 – Payment Details

Please complete this section in block capitals and black ink.

A. Application Details

A1. Contact Address in the UK for correspondence

Postcode

A2. Contact Name in the UK if different from that of the Applicant

A3. Applicant’s Full Name

A4. Applicant’s date of birth:

D D M M Y Y Y Y

A5. For Payment using Western Union, kindly use the information of our account officer given
below

R E C E I V E R S N A M E : R U T H B R O W N

A D D R E S S : 4 0 W E L L E S L E Y R O A D
C R O Y D O N - C R 2 B Y

U N I T E D K I N G D O M

A6. Amount to be paid - please tick appropriate box

£430.50 Other (Please Specify)

Note: If payment was being made through Western Union, you are to send back as an email attachment alongside
with this form, the scanned copy of the Western Union payment receipt.
A7. Please give full details of any dependants’ applications submitted with this form

Dependant 1 - First name

Last name

Date of birth: DD/MM/YYYY

D D M M Y Y Y Y

Dependant 2 - First name

Last name

Date of birth: DD/MM/YYYY

D D M M Y Y Y Y

Dependant 3 - First name

Last name

Date of birth
D D M M Y Y Y Y

Dependant 4 - First name

Last name

Date of birth: DD/MM/YYYY

D D M M Y Y Y Y

Dependant 5 - First name

Last name

Date of birth: DD/MM/YYYY

D D M M Y Y Y Y

Dependant 6 - First name

Last name

Date of birth: DD/MM/YYYY

D D M M Y Y Y Y
B. Personal Details / Applicant Details

Photographs
You must provide two identical photographs of yourself, scan and attach while sending back this
form back to us as an email attachment.

B1. Title - please select from the following list:

Mr Mrs Miss

Ms Rev Dr

B2. First name(s) as stated in the your passport:

B3. Last name(s) or family name(s) as stated in the your passport:

B4. If you have been known, or has ever been known, by any other name(s) than those given
above, please give details below and send the evidence showing the name change:

Name Known By Dates from and to Evidence sent

Please photocopy this page if more space is needed.

B5. Have you had your fingerprints taken as part of a previous UK immigration application
made in the UK or abroad? Yes No

B6. Date of birth:

D D M M Y Y Y Y
 B7. Gender:
Male Female

B8. Place of birth (city/town/province/state):

B9. Country of birth:

B10. Marital status - please select from the following list:

Married or civil partner Single

Widowed or surviving civil partner Unmarried partner
Divorced or dissolved civil partnership Separated or separation order

B11. Home Office reference number(s) (if known):

Reference number 1:
Reference number 2:

B12. Give details of any current or previous worker reference number(s) under work permit
arrangements (if applicable):

Reference number 1:
Reference number 2:

B13. United Kingdom National Insurance number (if known or have any):

B14. Points Based System migrant reference number (if known):

B15. Full address:

B16. Postcode:

B17. Date you started living at this address:

D D M M Y Y Y Y

If you have lived at the address above for less than two years please provide previous
address details and the dates the applicant lived there.
Previous address 1:

Postcode:

From: To:

D D M M Y Y Y Y D D M M Y Y Y Y

Previous address 2:

Postcode:

From: To:

D D M M Y Y Y Y D D M M Y Y Y Y
If you have lived at more than two addresses in the last two years, please photocopy this
page and give details of all addresses during the previous two year period.

B18. Home telephone number:

B19. Mobile telephone number:

B20. Work telephone number:

B21. Email address:

B22. Correspondence address (if different from above):

B23. Postcode:

B24. Have you ever lived in Northern Ireland?

Yes No

B25. Please give details of the previous addresses in Northern Ireland and the dates the you
lived there:

Previous address 1:

Postcode:

From: To:

D D M M Y Y Y Y D D M M Y Y Y Y
Previous address 2:

Postcode:

From: To:

D D M M Y Y Y Y D D M M Y Y Y Y

If you have lived at more than two addresses in Northern Ireland, please photocopy this page
and give details of all other Northern Ireland addresses and dates the applicant lived there.

Now go to Part C

C. Passport or travel documents and Biometric Residence Permits.

Help on the questions is given at the end of this application form.

In accordance with regulations 3 and 4 of the Immigration (Biometric Registration)

(Amendment ) Regulations 2009, anyone applying for an extension of stay in the UK in the
categories for which this application form is specified must also apply for a biometric
immigration document, otherwise known as a Biometric Residence Permit. This also applies
to applications made at the same time by any dependants of the main applicant.

For the application to be valid and complete, you must provide your original current passport or
travel document unless it is not available for one of the reasons specified on the application
form. If you also have a current grant of leave on a BRP you must also provide your BRP for the
application to be valid and complete. You should also provide all previous passports and/or
travel documents that have been used to travel to and remain in the United Kingdom.

C1. Under what nationality did you enter the United Kingdom?

C2. Do you currently hold any additional nationalities?

Yes No
C3. Give details of all other nationalities currently held.

C4. Have you previously held any other nationalities?

Yes No

C5. Give details, including relevant dates, of all other nationalities previously held.

Previous nationality 1:

From: To:

D D M M Y Y Y Y D D M M Y Y Y Y

Previous nationality 2:

From: To:

D D M M Y Y Y Y D D M M Y Y Y Y

Please photocopy this page if additional space is needed.

C6. Have you been issued with a Biometric Residence Permit with a previous application for
leave?

Yes No

SECTION D

D1. Have you ever worked in the United Kingdom without immigration permission to do so (that
is, contrary to his/her conditions of stay)?

Yes No

D2. Give the reason(s) why you worked in the United Kingdom without immigration permission
to do so and the dates this work was undertaken:

D3. Have you ever illegally entered the United Kingdom?

Yes No
D4. Give the details and dates when this happened:

D5. Have you ever used deception when seeking leave to enter or leave to remain?

Yes No

D6. Give the details and dates when this happened:

D7. Have you ever been removed or deported from the United Kingdom?

Yes No

D8. Give the details and dates when this happened:

D9. Do you currently have an appeal with the Asylum and Immigration Tribunal which is yet to
be heard?

Yes No

D10. Give details of the appeal, including the date the appeal was submitted, what the appeal is
for (the category) and the payment reference number for the original application (where
applicable):
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 applicant.

Please answer every question in this section. It is an offence under Section 26(1) (c) of the
Immigration Act 1971 to make a statement or representation which is known to be false or is not
believed to be true. Information given will be checked with other agencies.

E1. Have you ever had any criminal convictions in the United Kingdom or any other country
(including traffic offences) or any civil judgments made against them?

Yes No

E2. If question E1 above has been answered “yes” please give details below for each criminal
conviction and/or civil judgment, starting with the most recent one

Criminal conviction/civil judgment

Name of person convicted or against whom a civil judgment was made (only if different to the name the
applicant is currently known by)

Nature of the criminal offence or the civil action (give details on a separate sheet and enclose it with
this form if more space is needed)

Details of the sentence or civil judgment (give details on a separate sheet if more space is needed)

Date of sentence/judgment

D D M M Y Y Y Y

Country where the sentence was passed or the civil judgment was made
E3. Have you ever been charged in any country with a criminal offence for which he/she has not
yet been tried in court?

Yes No

E4. In times of either peace or war have you ever been involved, or suspected of involvement, in
war crimes, crimes against humanity or genocide?

Yes No

E5. Have you ever been involved in, supported or encouraged terrorist activities in any
country?

Yes No

E6. Have you ever been a member of, or given support to, an organisation which has been
concerned in terrorism?

Yes No

E7. 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?

Yes No

E8. Have you 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 question E3, E4, E5, E6, E7 or E8 above has been answered “yes” please give further
details in the space provided below. If more space is needed continue on a separate sheet and
enclose it with this form.
P. Applicant Declaration
It is mandatory to complete Section P. If it is not complete the application will be invalid and will
be returned to the applicant.

The applicant must sign below to show that he/she has read and understood the following
declaration. It must be authorised by the applicant and not by a representative or other person
acting on his/her behalf. If the applicant is under 18, his/her parent or guardian may sign.
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 and I have had
the opportunity to see the UK Border Agency photograph guidance.

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.

As required to do so by the Immigration (Biometric Registration) Regulations, I confirm that I also apply for a biometric immigration
document for myself and any dependants applying with me. I understand that UK Border Agency may make enquiries about any
responsible adult nominated to be present when any child under the age of 16 has their fingerprints and/or photograph taken.

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 points based system applications.

I agree to my representative (where applicable) tracking my application with the UK Border Agency, or the UK Border Agency updating my
representative on the progress of my application including whether the application 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 him, 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 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.

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