Application form for

2022/23 Dependants’ Grants

To find out how we’ll use the information you provide go to www.gov.uk/studentfinance to read our
Privacy Notice before completing this form.

Customer Reference Number 6 8 1 5 5 0 1 0 3 0 0

Nahidah Muqsood Rana

Name
Date of birth (DDMMYYYY) 0 6 0 8 1 9 9 4

43 Longhorn Av
Contact address
Gloucester Postcode GL1 2AS

Who should complete this form?

Complete this form if you want to apply for any of the following Dependants’ Grants:
• Parents’ Learning Allowance
• Childcare Grant
• Adult Dependants’ Grant
Also use this form if you have already applied for Childcare Grant and want to add additional
children.
If you no longer need Childcare Grant for one or more of your children call us on 0300 100 0607.
If you are applying for Adult Dependants’ Grant for an adult who is or will be claiming student
finance, you are not eligible to apply for an Adult Dependants’ Grant for them.
If at any point during your studies the adult dependent on you claims student finance and you are in
receipt of Adult Dependants’ Grant, you should notify us immediately.
For more information on Dependants’ Grants go to www.gov.uk/studentfinance
How do I complete this form?
• Answer every question in sections 1 & 2, then sign and date the declaration.
• If any questions do not apply to you, please write ‘N/A’ or ‘None’ as your answer.
• You need to send evidence with your application whenever you see this icon.
• If any questions are left blank we will not be able to process this application.
Any photocopied financial documents you send to us with this form will be securely destroyed
once we have checked them.
Where do I send my form?
Once you have completed this form, signed and dated the declaration, please return it to
Student Finance England
PO Box 210
Darlington
DL1 9HJ

SFE/DEPG/2223/A 1
1 SFE/DEPG/2223
 Section 1 Student financial questions
Unearned income
a  stimate the total taxable unearned income,
E
before deductions, that you expect to
receive in academic year 2022/23. 0
What is the source of this income?

What is taxable unearned income?

Taxable unearned income is any income you receive from the following sources:
• Bank or building society gross interest • Trusts or sponsorships
• Property, lettings or rent • Any other payment received for attending the
• Dividends or investments course

Don’t include any:

• Earnings from full or part-time work • Teacher Training Bursaries
• Maintenance Loan or grant payments you may • Higher Education Bursaries (for care leavers)
receive • Bounties paid by the armed services to reservists
• Payments you receive from parents under a or disablement or invalidity pensions
covenant • ISAs

Payments from an employer

b  ill you be employed during the
W
academic year? No Yes if no go to e
c  ill your employer be releasing you to
W
attend your course for the academic year
2022/23? if no go to e
No Yes
If ‘Yes’, how much will your employer pay
you for time spent attending your course
during this period?

What should I include in my answer?

Only enter an amount for question b if you are being released from employment by your employer to
attend your course. Only include salary or wages that you will receive from that employer for days you are
attending your course.
Any earnings from salary or wages entered here may affect your student finance entitlement. Do not provide
any amount here if you are a student who is working while studying but have not been specifically released
by your employer to attend your course.

2 SFE/DEPG/2223
 Section 1 Student financial questions
d  uring the academic year 2022/23, will
D
you or your employer pay any money into
a pension fund on your behalf? No Yes if no go to e
If ‘Yes’, how much during this period?

Dependent children Child 1 full name

e  hen stating the child’s income, include
W Nicholas Bonev
their income from all sources after income
tax and National Insurance contributions in Relationship to you
tax year 2020-21.
son
Do include any income the child gets from:
• working Date of birth (DDMMYYYY)
• interest earned on savings 0 5 0 7 2 0 2 0
• investments
• any maintenance payments Who do they live with?
Don’t include income from: mother
• Child Benefit
Income from all sources after income tax and
• Child Tax Credit or the childcare element
of Universal Credit social security
• Government Child Trust 0
You must provide
• copies of birth certificates; and
• evidence of Child Tax Credits and/or Child Child 2 full name
Benefits for each child named.

Relationship to you

Date of birth (DDMMYYYY)

Who do they live with?

Income from all sources after income tax and

social security

If you have more than two dependent children, give details for each additional child on the
additional notes at the end of this form.

3 SFE/DEPG/2223
 Section 2 Parents’ Learning Allowance, Childcare
Grant and Adult Dependants’ Grant
a  re you under 25, living with a partner
A
and applying for Childcare Grant or No Yes if no go to c1
Parents’ Learning Allowance?

b  ive the total estimated income after

G You Your partner
Income Tax and National Insurance
deductions in academic year 2022/23 for:
How much of this will be Child Tax Credit You Your partner
or the child element of Universal Credit
for academic year 2022/23?

c1 Do you want to apply for Childcare Grant? No Yes if no go to d1

c2  uring the academic year, do you or your

D
partner expect to receive: No Yes – you can’t currently apply for
• the childcare element of Working Tax Childcare Grant.
Credit or Universal Credit; or You can only apply for
• Tax-Free Childcare from HM Revenue and Childcare Grant if you stop
Customs (HMRC); or claiming support from any of
• Childcare Allowance from the National these sources.
Health Service (NHS) as part of a student
finance package?

c3  ive details of the children you

G Child 1
need Childcare Grant for during this Forename(s)
academic year
Nicholas
Only name children that you haven’t
applied for previously Surname
Childcare start date must not be earlier
Bonev
than your academic year start date
Date of birth (DDMMYYYY)
0 5 0 7 2 0 2 0
Childcare start date (DDMMYYYY)
0 5 0 7 2 0 2 0

Child 2
Forename(s)

Surname

Date of birth (DDMMYYYY)

Childcare start date (DDMMYYYY)

If you need more space for additional children, give the details above on the additional
notes at the back of this form.
4 SFE/DEPG/2223
 Section 2 Parents’ Learning Allowance, Childcare
Grant and Adult Dependants’ Grant

d1 Are you applying for Adult Dependants’ Grant if no go to the

No Yes
declaration on page 6

d2 Who is your adult dependant?

Your husband
If you are applying for Adult Dependants’
Grant for an adult who is or will be claiming Your wife
student finance, you are not eligible to apply
for an Adult Dependants’ Grant for them. Your civil partner
If at any point during your studies the adult go to the declaration
Your partner
dependent on you claims student finance on page 6
(if you are 25 or over)
and you are in receipt of Adult Dependants’
Grant, you should notify us immediately.
other adult dependant

d3  ill your other adult dependant’s

W
income be more than £3,796 for the
No Yes
academic year 2022/23?

Applying for an Adult Dependants’ Grant

You will not be able to apply for Adult Dependants’ Grant if your other adult dependant’s income is more
than £3,796 in the academic year 2022/23.

d4  ive your adult dependant’s income for

G
the 2020-21 tax year.
Income

All salary/wages and self-employed income

(include income from property)
All pension income (including private, occupational
and state)
If you receive a lump sum pension, only declare
the amount you received that you paid tax on.
All gross taxable income from interest, investments
and dividends

Taxable state benefits

All other taxable income

Deductions

Private pension contributions and Additional

Voluntary Contributions (AVCs)

Allowable expences on which tax relief was

claimed

5 SFE/DEPG/2223
 Declaration
• I confirm that to the best of my knowledge and belief, the information I have provided is true and complete.
If it is not I understand I may not receive financial support, any support I have received may be withdrawn
and I could be prosecuted.
• I agree to give the Student Loans Company Ltd (SLC) any information they require to process my
application and agree to tell them immediately if my circumstances change in any way that might affect my
entitlement to financial support. I understand that if I do not do this, I may not receive any further payments,
and may have to repay the financial support I have already received.
• I agree that in the event of receiving an overpayment of financial support, I am obligated to repay this in full.
Childcare Grant
• I understand and agree that in order to receive Childcare Grant, my personal details and my children’s
details will be shared to a contracted third party who will be handling the administration of Childcare Grants
on behalf of SLC.
• I understand that if I do not inform SLC of any change of circumstances that affect the amount of Childcare
Grant I am entitled to, I will have to pay back any overpayment.
• I confirm that neither I nor my husband, wife, civil partner or cohabiting partner have chosen to receive
support for childcare from the childcare element of: (i) the Working Tax Credit; (ii), the Universal Credit; (iii)
Tax-Free Childcare; and/or (iv) the NHS Childcare Allowance; and I agree to tell SLC immediately if I or my
husband, wife, civil partner or cohabiting partner does receive this support. I understand that SLC reserves
the right to share my personal data with HMRC to check whether I am in receipt of childcare support from
HMRC.

Your full name (in BLOCK CAPITALS)

NAHIDAH MUQSOOD RANA
Your signature Today’s date (DDMMYYYY)
2 6 0 4 2 0 2 3

6 SFE/DEPG/2223
 Additional notes
If you are providing extra information please clearly mark what section and question the information
is about.

7 SFE/DEPG/2223