applicant on form SET(DV) - UK Border Agency - the Home Office
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<strong>SET</strong>(<strong>DV</strong>)Versi<strong>on</strong> 06/2014Applicati<strong>on</strong> ForIndefinite Leave To RemainIn The <strong>UK</strong> As AVictim Of Domestic ViolenceAnd A Biometric Immigrati<strong>on</strong> DocumentIn accordance with paragraph 34 of <strong>the</strong> Immigrati<strong>on</strong> Rules, this <strong>form</strong> is a specified<strong>form</strong> for <strong>the</strong> purpose of <strong>the</strong> Immigrati<strong>on</strong> Rules as of 2 June 2014 and must be usedfor all applicati<strong>on</strong>s made <strong>on</strong> or after that date for <strong>the</strong> purpose stated <strong>on</strong> this page.You also need <strong>the</strong> separate guidance documents listed below, which you shouldread before making your applicati<strong>on</strong>:- <strong>SET</strong>(<strong>DV</strong>) guidance notesSpouse orcivil partnerof a pers<strong>on</strong>present andsettled in<strong>the</strong> <strong>UK</strong>Unmarried orsame-sexpartner of apers<strong>on</strong> presentand settled in<strong>the</strong> <strong>UK</strong>- <strong>UK</strong> Visas & Immigrati<strong>on</strong> photograph guidanceIf you do not already have <strong>the</strong>se documents, you can get <strong>the</strong>m from our website atwww.ukba.homeoffice.gov.ukOur applicati<strong>on</strong> <strong>form</strong>s change periodically. If you obtain this <strong>form</strong> some time beforeapplying, please check that it is still <strong>the</strong> versi<strong>on</strong> which must be used when you areready to apply.Biometric immigrati<strong>on</strong>document (BiometricResidence Permit(BRP))Applicati<strong>on</strong>s <strong>on</strong> this <strong>form</strong> may be made by post <strong>on</strong>ly.You must send your applicati<strong>on</strong> to <strong>the</strong> following address:<strong>Home</strong> <strong>Office</strong> - <strong>SET</strong>(<strong>DV</strong>)Indefinite Leave to RemainPO Box 492DurhamDH99 1WUWORKING TOGETHER TO PROTECT THE PUBLICThis <strong>form</strong> isvalid <strong>on</strong>ly forapplicati<strong>on</strong>s made<strong>on</strong> or after 2 June2014
PAYMENT guidanceThe feeIf you are a single <str<strong>on</strong>g>applicant</str<strong>on</strong>g> <strong>on</strong> <strong>form</strong> <strong>SET</strong>(<strong>DV</strong>)and no dependants are applying with you, <strong>the</strong>reis a fee of £1093.The fee does not need to be paid if you are destituteat <strong>the</strong> time of making <strong>the</strong> applicati<strong>on</strong>. Seepart 4 of <strong>the</strong> separate guidance notes menti<strong>on</strong>edat <strong>the</strong> fr<strong>on</strong>t of <strong>the</strong> <strong>form</strong>.If you are claiming an exempti<strong>on</strong> from paying<strong>the</strong> fee because you are destitute, tick <strong>the</strong> box atitem 5 <strong>on</strong> page 4 to c<strong>on</strong>firm this.The premium service at our Premium ServiceCentres is not available for applicati<strong>on</strong>s <strong>on</strong> <strong>form</strong><strong>SET</strong>(<strong>DV</strong>).If <strong>on</strong>e or more dependants are applying with you,<strong>the</strong> fee increases by £1093 for each dependantapplying as shown in <strong>the</strong> table below.Number of <str<strong>on</strong>g>applicant</str<strong>on</strong>g>sFeeYourself and 1 dependant £2186Yourself and 2 dependants £3279Yourself and 3 dependants £4372Yourself and more than 3dependantsAdd £1093 to <strong>the</strong>amount above foreach additi<strong>on</strong>aldependantUnless you are destitute at <strong>the</strong> time of making<strong>the</strong> applicati<strong>on</strong> and have ticked <strong>the</strong> box at item 5<strong>on</strong> page 4 to c<strong>on</strong>firm this, please note that yourapplicati<strong>on</strong> will be rejected as invalid if you d<strong>on</strong>ot pay <strong>the</strong> specified fee.Biometric enrolment feeAs part of your applicati<strong>on</strong> you are required toenrol your biometric in<strong>form</strong>ati<strong>on</strong>. You will becharged an additi<strong>on</strong>al handling fee for this servicepayable to <strong>the</strong> Post <strong>Office</strong> Ltd. You mustpay <strong>the</strong> fee by cash or debit card when youattend Post <strong>Office</strong> Ltd. to enrol your biometrics.Each dependant included <strong>on</strong> your applicati<strong>on</strong>must also pay this additi<strong>on</strong>al fee when <strong>the</strong>y enrol<strong>the</strong>ir biometric in<strong>form</strong>ati<strong>on</strong>. Do not send <strong>the</strong> biometricenrolment fee with your applicati<strong>on</strong> fee.Applicants <strong>on</strong> some immigrati<strong>on</strong> routes areexempt from paying an enrolment fee at <strong>the</strong> Post<strong>Office</strong> Ltd. If you are in <strong>on</strong>e of <strong>the</strong>se categoriesyou will be in<strong>form</strong>ed of this when we send you abiometric notificati<strong>on</strong> letter.Your applicati<strong>on</strong> may be rejected as invalid if youdo not enrol your biometrics when requestted.For more in<strong>form</strong>ati<strong>on</strong> about enrolling biometricsand <strong>the</strong> current fee, please visit <strong>the</strong> followingsecti<strong>on</strong> of our website.www.gov.uk/biometric-residence-permitsWHO MAY APPLY WITH YOU?You may include your children under <strong>the</strong> ageof 18 if <strong>the</strong>y are applying as your dependants.But <strong>the</strong>y must pay <strong>the</strong> specified fee if <strong>the</strong>y applyseparately.Children aged 18 or over may not be included.They must apply individually and pay <strong>the</strong> specifiedfee in each case.How can you pay?You must pay by <strong>on</strong>e of <strong>the</strong> methods specifiedbelow. Please note your applicati<strong>on</strong> willbe rejected as invalid if you pay by any o<strong>the</strong>rmethod.• Cheque• Postal Order• Credit card 1 - Visa (including Electr<strong>on</strong>) orMasterCard or American Express (Amex)• Debit card - Delta, Maestro* (including Solo)• Banker’s draft* Maestro - we will <strong>on</strong>ly accept Maestro cardsissued in <strong>the</strong> <strong>UK</strong>.Cheques and postal ordersYou must make <strong>the</strong> cheque or postal order(s)payable to <strong>Home</strong> <strong>Office</strong> Leave to Remain andcross <strong>the</strong> cheque or postal order(s) A/C Payee<strong>on</strong>ly. Write <strong>the</strong> full name, nati<strong>on</strong>ality and dateof birth of <strong>the</strong> main <str<strong>on</strong>g>applicant</str<strong>on</strong>g> <strong>on</strong> <strong>the</strong> back of <strong>the</strong>cheque and/or each postal order and keep <strong>the</strong>postal order stub(s).Make sure that <strong>the</strong> date and <strong>the</strong> amount (wordsand figures) are correct and that <strong>the</strong> cheque issigned properly.Attach your cheque or postal order(s) to <strong>the</strong> fr<strong>on</strong>tof <strong>the</strong> applicati<strong>on</strong> <strong>form</strong>.Completing <strong>the</strong> paymentdetails pageTo ensure that your payment is processed withoutany delay, please note <strong>the</strong> points belowwhen completing <strong>the</strong> payment details.1-2 The address at 1 should be <strong>the</strong> c<strong>on</strong>tactaddress in <strong>the</strong> <strong>UK</strong> for any corresp<strong>on</strong>dence. If itis not your home address (eg a solicitor or o<strong>the</strong>rauthorised immigrati<strong>on</strong> adviser may be submitting<strong>the</strong> applicati<strong>on</strong>), give <strong>the</strong> c<strong>on</strong>tact name at 2.1 Please note that when making large or multiple paymentsusing your credit card, <strong>the</strong> anti-fraud measures that banks operatesometimes stop <strong>the</strong> full payment being taken. This can happen fora number of reas<strong>on</strong>s. To prevent this you may in<strong>form</strong> your bank ofyour intenti<strong>on</strong> to make large or multiple payments in advance sothat your bank allows <strong>the</strong> full payment to be taken when you submityour applicati<strong>on</strong>.Please be aware that not all banks offer this service.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 2 of 28
3 This should be <strong>the</strong> full name of <strong>the</strong> main<str<strong>on</strong>g>applicant</str<strong>on</strong>g> as given in his or her passport or traveldocument.4 Date of birth - for example, 3 January1980 should be written 03 01 1980 in <strong>the</strong> spacesprovided.5 If you do not select a fee <strong>the</strong>n we cannottake a payment and your applicati<strong>on</strong> will berejected as invalid.8-12 Complete <strong>on</strong>ly if paying by card.11 The Card Verificati<strong>on</strong> Value (CVV) is a3-digit security code found <strong>on</strong> <strong>the</strong> back of <strong>the</strong>card <strong>on</strong> <strong>the</strong> signature strip - it c<strong>on</strong>sists of <strong>the</strong> last3 digits. For Amex <strong>the</strong> security code c<strong>on</strong>sists ofAUTHORISED SIGNATURECVV4567 1231234-digits and is found <strong>on</strong> <strong>the</strong> fr<strong>on</strong>t of <strong>the</strong> card.AMERICAN EXPRESSCVV 123412341234 123456 12345If you do not provide <strong>the</strong> CVV number, we cannottake <strong>the</strong> payment and your applicati<strong>on</strong> will berejected as invalid.12 It is <strong>the</strong> cardholder as named <strong>on</strong> <strong>the</strong> creditor debit card who must sign and date.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 3 of 28
PAYMENT DETAILS:<strong>SET</strong>(<strong>DV</strong>)If you are claiming exempti<strong>on</strong> from paying <strong>the</strong> fee, please complete items 1-4 below as we need <strong>the</strong>se detailsfor administrative purposes. If you are not claiming fee exempti<strong>on</strong>, please complete this page as required.In ei<strong>the</strong>r instance, you should use block capitals and black ink after first reading <strong>the</strong> payment guidance.1 C<strong>on</strong>tact address in <strong>the</strong> <strong>UK</strong> for corresp<strong>on</strong>dencePostcode2C<strong>on</strong>tact name in <strong>the</strong> <strong>UK</strong> if different from that of <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>3Applicant’s full name4Date of birthDay M<strong>on</strong>th YearPAYMENT DETAILS5 Amount - please tick <strong>the</strong> amount you are payingSingle <str<strong>on</strong>g>applicant</str<strong>on</strong>g> - no dependants£1093If you are claiming an exempti<strong>on</strong> frompaying <strong>the</strong> fee tick this boxMain <str<strong>on</strong>g>applicant</str<strong>on</strong>g> and two dependants£3279Main <str<strong>on</strong>g>applicant</str<strong>on</strong>g> and <strong>on</strong>e dependant£2186Main <str<strong>on</strong>g>applicant</str<strong>on</strong>g> and three dependants£4372If more than 3 dependants are applying with you, please state <strong>the</strong> number in <strong>the</strong> space belowand enter <strong>the</strong> correct amount specified in <strong>the</strong> payment guidance in <strong>the</strong> appropriate box.Main <str<strong>on</strong>g>applicant</str<strong>on</strong>g> and .............. dependants£6How are you paying? Please tick a box.PostalorderChequeDebit orcredit cardBanker’sdraft7Paying by cheque - please give cheque details belowCheque numberAccount numberSort code8Paying by card - please complete 8-12 belowWhich card are you using for payment?Please tick a box.Visa /Electr<strong>on</strong>MasterCard /AmexDelta Maestro /Solo9Name <strong>on</strong>card101112CardnumberCarddetailsCardholder’ssignatureValid fromExpiry dateCard security number - CVV(3 digit numberor 4 digitnumber forAmex)DateIssue No.(whereavailable)<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 4 of 28
If you are producing a double-sided copyof this applicati<strong>on</strong> <strong>form</strong>, please include thispage and make sure it falls <strong>on</strong> <strong>the</strong> reverseof <strong>the</strong> payment details page in <strong>the</strong> two-sidedcopy.For administrative reas<strong>on</strong>s, it’s importantthat <strong>the</strong> rest of <strong>the</strong> <strong>form</strong> begins with Secti<strong>on</strong>1 - Applicant’s Details facing upwards.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 5 of 28
For official use <strong>on</strong>ly - unique reference numberIs your partner a serving or discharged memberof her Majesty’s Forces? Please tick:YesNo<strong>SET</strong>(<strong>DV</strong>)Versi<strong>on</strong> 06/20141.11.4Your title - please tick1.2 Your gender - please tick1.3Mr Mrs Miss Ms O<strong>the</strong>rYour dateof birthYour full name as in your passport or travel documentSECTION 1 - APPLICANT’S DETAILSIf o<strong>the</strong>r, what is your title?MaleDay M<strong>on</strong>th YearFemalePhotographsYou must provide two identical photographs of yourself with yourfull name <strong>on</strong> <strong>the</strong> back of each <strong>on</strong>e. Please place <strong>the</strong> photographs,toge<strong>the</strong>r with those of any dependants included in secti<strong>on</strong> 2, in asmall sealed envelope and attach it across this space with a stapleor paper clip at <strong>the</strong> right-hand side of <strong>the</strong> page/envelope.Please make sure that <strong>the</strong> staple or paper clip does not damageor mark <strong>the</strong> photographs. All photographs must be as specified in<strong>the</strong> separate photograph guidance.1.5Surname or family name1.6Any o<strong>the</strong>r name(s) by which you are or have been known1.7Nati<strong>on</strong>ality1.8Place of birth - town or city and country1.9Passport or travel document number1.10<strong>Home</strong> <strong>Office</strong> reference if you have <strong>on</strong>e1.11Nati<strong>on</strong>al insurance number if you have <strong>on</strong>e1.12 BRP Reference Number1.13Your <strong>UK</strong> address - please in<strong>form</strong> us immediately if this changes1.14Your daytime teleph<strong>on</strong>e numberPostcodeYour mobile teleph<strong>on</strong>e number if you have <strong>on</strong>e1.15Your email address if you have <strong>on</strong>e. We may use your email address to communicate with you about <strong>the</strong> status of yourapplicati<strong>on</strong>. Please write your email address clearly in block capitals and note that we can <strong>on</strong>ly send updates to <strong>the</strong>email address you provide1.16Please re-enter your email address in block capitals in <strong>the</strong> box below<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 6 of 28
1.17Name and address in <strong>the</strong> <strong>UK</strong> for all corresp<strong>on</strong>dence about your applicati<strong>on</strong> if different from 1.13Postcode1.18If you have completed 1.17 and <strong>the</strong> address is that of your immigrati<strong>on</strong> adviser, please state <strong>the</strong>ir <strong>Office</strong> of <strong>the</strong> Immigrati<strong>on</strong>Services Commissi<strong>on</strong>er (OISC) number<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 7 of 28
SECTION 2 - CHILDREN UNDER 18 APPLYING WITH YOUIf you have any children under 18 living with you in <strong>the</strong> <strong>UK</strong> who are applying for indefinite leave to remain as yourdependants, this is where you give <strong>the</strong>ir details. If more than 2 children are applying, please give <strong>the</strong>ir details <strong>on</strong> aphotocopy of this page, enclose it with this <strong>form</strong>, and place <strong>the</strong> photographs in a sealed envelope attached to secti<strong>on</strong>1 as instructed <strong>the</strong>re. Children aged 18 or over must apply separately.Child’s full nameNati<strong>on</strong>alityBRP Reference NumberPhotographsPlace of birth - town or city and countryYou must provide twoidentical photographsof each dependantwho is applying.Date of birthDay M<strong>on</strong>th YearGender-please tickMaleFemaleWrite <strong>the</strong> child’sfull name <strong>on</strong> <strong>the</strong> back ofeach photograph andenclose both photographsin an envelope attachedto secti<strong>on</strong> 1 asinstructed <strong>the</strong>re.Child’s full nameRelati<strong>on</strong>ship to youWho pays for <strong>the</strong> child’s support?To your partnerWho does <strong>the</strong> child live with?Nati<strong>on</strong>alityBRP Reference NumberPhotographsPlace of birth - town or city and countryYou must provide twoidentical photographsof each dependantwho is applying.Date of birthDay M<strong>on</strong>th YearGender-please tickMaleFemaleWrite <strong>the</strong> child’sfull name <strong>on</strong> <strong>the</strong> back ofeach photograph andenclose both photographsin an envelope attachedto secti<strong>on</strong> 1 asinstructed <strong>the</strong>re.Relati<strong>on</strong>ship to youWho pays for <strong>the</strong> child’s support?To your partnerWho does <strong>the</strong> child live with?SECTION 3 - exempti<strong>on</strong> from paying <strong>the</strong> fee3.1 Are you claiming exempti<strong>on</strong> from paying <strong>the</strong> applicati<strong>on</strong> fee? Yes No3.2 If you have answered yes, are you claiming exempti<strong>on</strong> from paying <strong>the</strong> fee because you aredestitute? See Note 1.Note 1YesNoSee part 4 of <strong>the</strong> guidance notes for <strong>the</strong> definiti<strong>on</strong> of being destitute and for <strong>the</strong> kind of supporting evidence needed if you areclaiming to be destitute.If you are claiming exempti<strong>on</strong> from <strong>the</strong> fee but have answered “no” to questi<strong>on</strong> 3.2, your applicati<strong>on</strong> will be rejected asinvalid because destituti<strong>on</strong> is <strong>the</strong> <strong>on</strong>ly ground <strong>on</strong> which you may be exempted from paying <strong>the</strong> fee in an applicati<strong>on</strong> <strong>on</strong> <strong>form</strong><strong>SET</strong>(<strong>DV</strong>).<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 8 of 28
SECTION 4 - EVIDENCE OF DOMESTIC VIOLENCEIn this secti<strong>on</strong> we ask for in<strong>form</strong>ati<strong>on</strong> and documentary evidence to satisfy us that you are a victim of domesticviolence. You must answer <strong>the</strong> relevant questi<strong>on</strong>s and provide evidence from independent and objective sources.The documents must relate to violence committed against you by your partner and/or by his or her family. Whereavailable, <strong>the</strong> evidence must come from <strong>the</strong> sources detailed below but you may also provide evidence from o<strong>the</strong>rsources. We do not accept witness statements by your friends or family, or letters from official sources that <strong>on</strong>lyprovide unproven reports.4.1 Have any of <strong>the</strong> legal acti<strong>on</strong>s described in a), b) and c) below been taken against <strong>the</strong>pers<strong>on</strong>(s) who committed <strong>the</strong> violence of which you claim to be a victim?YesNoIf yes, please provide relevant documentary evidence and tick <strong>on</strong>e or more boxes immediately below to show whichyou are providing. You should <strong>the</strong>n go to 4.3. If no to this questi<strong>on</strong>, go to 4.2.a) An injuncti<strong>on</strong>, n<strong>on</strong>-molestati<strong>on</strong> order or o<strong>the</strong>r protecti<strong>on</strong> order (o<strong>the</strong>r than an ex-parte or interim order) (seeNote 2). Where <strong>the</strong> order refers to any undertakings made in writing by ei<strong>the</strong>r you or <strong>the</strong> pers<strong>on</strong>(s) who committed<strong>the</strong> violence, you must provide <strong>the</strong>se.Note 2We cannot accept an ex-parte or interim order.b) A relevant court c<strong>on</strong>victi<strong>on</strong>.c) A relevant police cauti<strong>on</strong>. This should include <strong>the</strong> full name, date of birth and nati<strong>on</strong>ality of <strong>the</strong> pers<strong>on</strong>(s)who committed <strong>the</strong> violence, as well as <strong>the</strong>ir address(es) at <strong>the</strong> time of <strong>the</strong> incident(s), and now, if different; and<strong>the</strong> date, time and place of <strong>the</strong> incident(s) in respect of which <strong>the</strong> cauti<strong>on</strong> was issued or a prosecuti<strong>on</strong> is takingplace.4.2If you are not able to provide any of <strong>the</strong> evidence listed in 4.1, you should provide at least two of <strong>the</strong> types of evidencelisted at a) to g) below. Tick <strong>the</strong> relevant boxes to show which you are providing.a) A medical report from a hospital doctor or GMC registered family practiti<strong>on</strong>er (GP) or doctor employed by HerMajesty’s Armed Forces who has examined you c<strong>on</strong>firming that <strong>the</strong> injuries are c<strong>on</strong>sistent with being a victim ofdomestic violence. The report must include <strong>the</strong> doctor’s GMC Registrati<strong>on</strong> Number and must provide <strong>the</strong> date ofyour first registrati<strong>on</strong>, <strong>the</strong> dates of visits in which domestic violence was reported, and an extract from <strong>the</strong> recordof <strong>the</strong>se details.b) An undertaking given to a court that <strong>the</strong> pers<strong>on</strong>(s) who committed <strong>the</strong> violence will not approach you.c) A police report c<strong>on</strong>firming that, because of a domestic violence incident, <strong>the</strong>y attended <strong>the</strong> address at which<strong>the</strong> incident(s) took place. A copy of <strong>the</strong> incident log must be provided. It must show <strong>the</strong> address(es) at which <strong>the</strong>incident(s) took place.d) A letter from a social services department c<strong>on</strong>firming its involvement in c<strong>on</strong>necti<strong>on</strong> with domestic violencecommitted against you.e) A letter of support or a report from a domestic violence support organisati<strong>on</strong>/refuge.f) If you are <strong>the</strong> subject of a multi-agency risk assessment c<strong>on</strong>ference (MARAC), evidence from <strong>the</strong> chair of <strong>the</strong>MARAC stating that you have been <strong>the</strong> victim of domestic violence.g) O<strong>the</strong>r documentary evidence - if you are unable to provide any evidence as listed in 4.1 and 4.2 a - f above,please explain <strong>the</strong> reas<strong>on</strong> for this in <strong>the</strong> space below and list any o<strong>the</strong>r evidence you are providing. C<strong>on</strong>tinue <strong>on</strong>a separate sheet and enclose it with this <strong>form</strong> if you need more space.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 9 of 28
4.3SECTION 4 - EVIDENCE OF DOMESTIC VIOLENCEYou must also providea letter signed by you stating whe<strong>the</strong>r you are still living with your partner and, if <strong>the</strong> marriage or relati<strong>on</strong>ship has brokendown, whe<strong>the</strong>r domestic violence was <strong>the</strong> reas<strong>on</strong> for this.4.4 In <strong>the</strong> space below, please describe <strong>the</strong> incident(s) of domestic violence against you, including <strong>the</strong> date(s), time(s), andplace(s) of <strong>the</strong> incident(s). Provide full details of <strong>the</strong> incident(s) in a letter and enclose it with this <strong>form</strong>.4.5 Did any<strong>on</strong>e o<strong>the</strong>r than your partner commit domestic violence against you? If yes, please Yes Noprovide <strong>the</strong>ir name(s) and relati<strong>on</strong>ship to you below.NameRelati<strong>on</strong>ship to youNameRelati<strong>on</strong>ship to youNameRelati<strong>on</strong>ship to you4.6 Did you report <strong>the</strong> violence to any agencies, services, o<strong>the</strong>r bodies or individuals? If not, pleaseYes Noexplain why in <strong>the</strong> space below. C<strong>on</strong>tinue <strong>on</strong> a separate sheet if you need more space andenclose it with this <strong>form</strong>.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 10 of 28
SECTION 5 - YOUR PARTNERThe pers<strong>on</strong> referred to as your partner in this and o<strong>the</strong>r parts of <strong>the</strong> <strong>form</strong> is <strong>the</strong> pers<strong>on</strong> you were given leave to enteror remain in <strong>the</strong> <strong>UK</strong> to live with as a spouse, civil partner, unmarried or same-sex partner. In this <strong>form</strong>, he or she isstill referred to as your partner even though you may have separated from him or her.5.1 Your partner’s full nameNati<strong>on</strong>alityDate of birthDay M<strong>on</strong>th Year5.2What was <strong>the</strong> address at which you lived with your partner?Postcode5.3 When did your relati<strong>on</strong>shipbreak down?5.4 Are you and your partnerliving apart?Yes No If yes, when did youstart living apart?5.5 If you are still living with your partner, please explain <strong>the</strong> reas<strong>on</strong> for this in <strong>the</strong> space below. Provide any relevant supportingevidence if you are still with your partner because <strong>the</strong>re is no alternative accommodati<strong>on</strong>. C<strong>on</strong>tinue <strong>on</strong> a separate sheetand enclose it with this <strong>form</strong> if you need more space.5.6You must also provide documentary evidence to show that you and your partner were living toge<strong>the</strong>r from <strong>the</strong> time whenyou were granted leave to enter or remain as a partner until such time as your relati<strong>on</strong>ship broke down (see Note 3).Note 3 The evidence requested at 5.6 should take <strong>the</strong> <strong>form</strong> of at least 5 items of corresp<strong>on</strong>dence ei<strong>the</strong>r addressed to you jointly or inboth your names, or addressed individually to each of you at <strong>the</strong> same address.Examples of acceptable corresp<strong>on</strong>dence include:- Bank statement(s)/letter(s)- Building society saving(s) book(s)/letter(s)- Council tax bill(s) or statement(s)- Water rates bill(s) or statement(s)- Electricity bill(s) or statement(s)- Letter(s) or o<strong>the</strong>r document(s) from government departments or agencies, for example: HM Revenue and Customs,Department for Work and Pensi<strong>on</strong>s, <strong>DV</strong>LA and TV Licensing- Insurance policy(ies)/letter(s)- Mortgage statement(s)/agreement- Tenancy agreement- Teleph<strong>on</strong>e bill(s) or statement(s)- Loan offer(s)/agreement(s)- Letter(s) or o<strong>the</strong>r document(s) from your GP, a hospital oro<strong>the</strong>r local health service about medical treatments, appointments,home visits or o<strong>the</strong>r medical matters5.7If you are unable to provide <strong>the</strong> required documentary evidence to show that you and your partner were living toge<strong>the</strong>r untilsuch time as your relati<strong>on</strong>ship broke down, please explain <strong>the</strong> reas<strong>on</strong>s for this in <strong>the</strong> space below. C<strong>on</strong>tinue <strong>on</strong> a separatesheet and enclose it with this <strong>form</strong> in you need more space.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 11 of 28
SECTION 5 - YOUR PARTNER5.8 Is your partner employed by <strong>the</strong> <strong>Home</strong>Yes No If yes, please give <strong>the</strong> name and address of<strong>Office</strong>?<strong>the</strong> unit where <strong>the</strong>y work.Name of unitAddress of unitPostcode5.9 Is your partner a serving or dischargedYes No If No, go to Secti<strong>on</strong> 6member of Her Majesty’s Forces?If Yes, go to 5.105.10Please provide <strong>the</strong> following details of your partner’s service:• What is/was your partner’s HM Forces service number?• What is/was your partner’s rank in HM Forces?5.11 Is your partner a British citizen? Please tick: Yes No If no, when did your partner join <strong>the</strong> armedforces?5.12 Is your partner still serving? Please tick: Yes No If no, when was your partner discharghed?If Yes, go to 5.135.13Please provide <strong>the</strong> following details of your partner’s current service:• Where is your partner currently posted? Please include country and length of posting.• Where is your partner currently located?<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 12 of 28
SECTION 6 - GENERALAnswer questi<strong>on</strong>s 6.1 to 6.3 <strong>on</strong>ly if you cannot provide your passport or o<strong>the</strong>r documentary evidence that you ei<strong>the</strong>rentered <strong>the</strong> <strong>UK</strong> with an entry clearance (visa) or were granted leave to remain as a partner.6.1When did you get married, enter into acivil partnership or start living toge<strong>the</strong>r inan unmarried or same-sex relati<strong>on</strong>ship?6.2Did you obtain an entry clearance as a partner?YesNoIf you answered no, go to 6.56.3 When and where were you issued with <strong>the</strong> entry clearance? When did you enter <strong>the</strong> <strong>UK</strong>?6.4 If you entered <strong>the</strong> <strong>UK</strong> more than 2 m<strong>on</strong>ths after you were issued with <strong>the</strong> entry clearance, please explain <strong>the</strong> reas<strong>on</strong>(s)for this in <strong>the</strong> space below. C<strong>on</strong>tinue <strong>on</strong> a separate sheet if you need more space and enclose it with this <strong>form</strong>.6.5If your applicati<strong>on</strong> as a victim of domestic violence is being made after <strong>the</strong> end of your leave as a partner, please explain<strong>the</strong> reas<strong>on</strong>s for this in <strong>the</strong> space below. C<strong>on</strong>tinue <strong>on</strong> a separate sheet if you need more space and enclose it with this<strong>form</strong>.7.1SECTION 7 - YOUR FINANCIAL SUPPORTWhat sources of financial support do you have? Please tick <strong>on</strong>e or more of <strong>the</strong> boxes.Employment Savings Benefits Family/Friends An agencyN<strong>on</strong>eO<strong>the</strong>r - pleasestate below.If you have ticked any of <strong>the</strong> boxes in 7.1 please give details of <strong>the</strong> financial support you are receiving and provide documentaryevidence to support this, such as pay slips, bank statements, savings books/statements, benefits received, m<strong>on</strong>ey receivedfrom family/friend(s), or a statement from <strong>the</strong> refuge or local authority assisting you including <strong>the</strong>ir c<strong>on</strong>tact details. If you haveticked N<strong>on</strong>e, please provide in<strong>form</strong>ati<strong>on</strong> and evidence of how you meet your essential living costs, such as basic accommodati<strong>on</strong>and food.7.2 How l<strong>on</strong>g have you been receiving thissupport?<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 13 of 28
SECTION 8 - PERSONAL HISTORYPers<strong>on</strong>al History (criminal c<strong>on</strong>victi<strong>on</strong>s, war crimes, etc.)It is mandatory to complete secti<strong>on</strong> 8. If it is not complete <strong>the</strong> applicati<strong>on</strong> will be invalid andwill be returned to <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>.This secti<strong>on</strong> asks about any criminal c<strong>on</strong>victi<strong>on</strong>s, any civil judgements or civil penalties madeagainst you or any dependants who are applying with you and details of any involvementyou or any dependants who are applying with you may have had in war crimes, genocide,crimes against humanity or terrorism. If you fail to answer all of <strong>the</strong>se questi<strong>on</strong>s as fully andaccurately as possible, your applicati<strong>on</strong> may be refused.It is an offence under Secti<strong>on</strong> 26(1)(c) of <strong>the</strong> Immigrati<strong>on</strong> Act 1971 to make a statement orrepresentati<strong>on</strong> which is known to be false or is not believed to be true. In<strong>form</strong>ati<strong>on</strong> given willbe checked with o<strong>the</strong>r agencies.8.1. Have you or any dependants who are applying with you been c<strong>on</strong>victed of any criminaloffence in <strong>the</strong> <strong>UK</strong> or any o<strong>the</strong>r country?Yes - go to questi<strong>on</strong> 8.2 No - go to questi<strong>on</strong> 8.38.2. Please give details below for each criminal c<strong>on</strong>victi<strong>on</strong>, starting with <strong>the</strong> most recent <strong>on</strong>e.If you or any dependants who are applying with you have received more than two c<strong>on</strong>victi<strong>on</strong>s,please photocopy this page and enclose it with this <strong>form</strong>.Note: We will carry out criminal record checks <strong>on</strong> all <str<strong>on</strong>g>applicant</str<strong>on</strong>g>s and dependants. You mustgive details of all unspent and spent criminal c<strong>on</strong>victi<strong>on</strong>s. This includes road traffic offencesbut not fixed penalty notices (such as speeding or parking tickets) unless <strong>the</strong>y were part of asentence of <strong>the</strong> court. This includes all drink-driving offences.Criminal c<strong>on</strong>victi<strong>on</strong> 1Country where c<strong>on</strong>victedNature of <strong>the</strong> offenceSentence givenDate sentenced D D M M Y Y Y YIf you or any dependants who are applying with you were sentencedto a period of impris<strong>on</strong>ment, what was <strong>the</strong> length of <strong>the</strong> pris<strong>on</strong>sentence imposed (in m<strong>on</strong>ths)?Criminal c<strong>on</strong>victi<strong>on</strong> 2m<strong>on</strong>thsCountry where c<strong>on</strong>victed<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 14 of 28
SECTION 8 - PERSONAL HISTORYNature of <strong>the</strong> offenceSentence givenDate sentenced D D M M Y Y Y YIf you or any dependants who are applying with you were sentenced toa period of impris<strong>on</strong>ment, what was <strong>the</strong> length of <strong>the</strong> pris<strong>on</strong> sentenceimposed (in m<strong>on</strong>ths)?m<strong>on</strong>ths8.3. Do you or any dependants who are applyingwith you have any civil judgments against you orany civil penalty under <strong>the</strong> <strong>UK</strong> Immigrati<strong>on</strong> Acts?Yes go to 8.4No go to 8.58.4. Give details for each civil judgment or any civil penalty under <strong>UK</strong> <strong>the</strong> Immigrati<strong>on</strong> Acts,starting with <strong>the</strong> most recent <strong>on</strong>e.If you or any dependants who are applying with you have received more than two civiljudgments and/or civil penalties under <strong>the</strong> <strong>UK</strong> Immigrati<strong>on</strong> Acts, please photocopy this pageand enclose it with this <strong>form</strong>.Details of judgment or civil penalty 1Date of judgment or civil penalty D D M M Y Y Y YCountry where judgment madeDetails of judgment or civil penalty 2Date of judgment or civil penalty D D M M Y Y Y YCountry where judgment made<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 15 of 28
You must answer questi<strong>on</strong>s 8.5 to 8.10 below even if you have answered no to questi<strong>on</strong> 8.1.For help in answering <strong>the</strong>se questi<strong>on</strong>s, please see <strong>the</strong> definiti<strong>on</strong>s at <strong>the</strong> end of this secti<strong>on</strong>.8.5. Have you or any dependants who are applying with you everbeen charged in any country with a criminal offence for whichyou have not yet been tried in court?8.6. In times of ei<strong>the</strong>r peace or war have you or any dependantswho are applying with you ever been involved, or suspectedof involvement, in war crimes, crimes against humanity orgenocide?8.7. Have you or any dependants who are applying with you everbeen involved in, supported or encouraged terrorist activities inany country?8.8. Have you or any dependants who are applying with you everbeen a member of, or given support to, an organisati<strong>on</strong> whichhas been c<strong>on</strong>cerned in terrorism?8.9. Have you or any dependants who are applying with you ever,by any means or medium, expressed views that justify or glorifyterrorist violence or that may encourage o<strong>the</strong>rs to terrorist actsor o<strong>the</strong>r serious criminal acts?8.10. Have you or any dependants who are applying with youever engaged in any o<strong>the</strong>r activities which might indicate thatyou may not be c<strong>on</strong>sidered to be pers<strong>on</strong>s of good character?YesYesYesYesYesYesNoNoNoNoNoNo8.11. How l<strong>on</strong>g have you lived in <strong>the</strong> <strong>UK</strong>? Years M<strong>on</strong>thsPlease provide details of any periods of absence of more than 6 m<strong>on</strong>ths during that time.Date you left <strong>the</strong> <strong>UK</strong> Date you returnedto <strong>the</strong> <strong>UK</strong>Reas<strong>on</strong> for absence<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 16 of 28
8.12. Please state what ties you have with;• The country where you were born• Any o<strong>the</strong>r country whose nati<strong>on</strong>ality you hold• Any country where you have lived for more than 5 yearsYou should tell us about any family, friends, or o<strong>the</strong>r c<strong>on</strong>necti<strong>on</strong>s with that country.CountrySocial cultural or family ties8.13. If you have answered yes to questi<strong>on</strong> 8.5, 8.6, 8.7, 8.8, 8.9 or 8.10, you must give fur<strong>the</strong>rdetails in <strong>the</strong> space provided below. If you need more space, c<strong>on</strong>tinue <strong>on</strong> a separate sheetand enclose it with this <strong>form</strong>.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 17 of 28
SECTION 8 - PERSONAL HISTORYDEFINITIONSFor <strong>the</strong> purposes of answering questi<strong>on</strong>s 8.5 to 8.10, <strong>the</strong> following in<strong>form</strong>ati<strong>on</strong> provides guidance <strong>on</strong>acti<strong>on</strong>s which may c<strong>on</strong>stitute war crimes, crimes against humanity, genocide, or terrorist activities.This guidance is not exhaustive. The full definiti<strong>on</strong>s of war crimes, crimes against humanity and genocidecan be found in Schedule 8 of <strong>the</strong> Internati<strong>on</strong>al Criminal Court Act 2001 at www.opsi.gov.uk/acts/acts2001/20010017 or purchased from The Stati<strong>on</strong>ery <strong>Office</strong> (teleph<strong>on</strong>e 0870 600 5522). It is yourresp<strong>on</strong>sibility to satisfy yourself that you are familiar with <strong>the</strong> definiti<strong>on</strong>s and can answer <strong>the</strong> questi<strong>on</strong>saccurately <strong>on</strong> behalf of yourself and any dependants applying with you.War crimesGrave breaches of <strong>the</strong> Geneva C<strong>on</strong>venti<strong>on</strong>s committed during an armed c<strong>on</strong>flict. This includes an internalarmed c<strong>on</strong>flict and an internati<strong>on</strong>al armed c<strong>on</strong>flict. The types of acts that may c<strong>on</strong>stitute a war crimeinclude wilful killing, torture, extensive destructi<strong>on</strong> of property not justified by military necessity, unlawfuldeportati<strong>on</strong>, <strong>the</strong> intenti<strong>on</strong>al targeting of civilians and <strong>the</strong> taking of hostages.Crimes against humanityActs committed at any time (not just during armed c<strong>on</strong>flict) as part of a widespread or systematic attack,directed against any civilian populati<strong>on</strong> with knowledge of <strong>the</strong> attack. This would include offences such asmurder, torture, rape, severe deprivati<strong>on</strong> of liberty in violati<strong>on</strong> of fundamental rules of internati<strong>on</strong>al law andenforced disappearance of pers<strong>on</strong>s.GenocideActs committed with intent to destroy, in whole or in part, a nati<strong>on</strong>al, ethnical, racial or religious group.Terrorist activitiesAny act committed, or <strong>the</strong> threat of acti<strong>on</strong>, designed to influence a government or intimidate <strong>the</strong> public andmade for <strong>the</strong> purposes of advancing a political, religious or ideological cause and that involves seriousviolence against a pers<strong>on</strong>; that may endanger ano<strong>the</strong>r pers<strong>on</strong>’s life; creates a serious risk to <strong>the</strong> health orsafety of <strong>the</strong> public; involves serious damage to property; is designed to seriously disrupt or interfere withan electr<strong>on</strong>ic system.Organisati<strong>on</strong>s c<strong>on</strong>cerned in terrorismAn organisati<strong>on</strong> is c<strong>on</strong>cerned in terrorism if it commits or participates in acts of terrorism; prepares for terrorism;promotes or encourages terrorism (including <strong>the</strong> unlawful glorificati<strong>on</strong> of terrorism); or is o<strong>the</strong>rwisec<strong>on</strong>cerned in terrorism.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 18 of 28
SECTION 9 - BIOMETRIC RESIDENCE PERMITSIt is mandatory to complete this secti<strong>on</strong>. If it is not complete, <strong>the</strong> applicati<strong>on</strong> will be invalid and will bereturned to you.In accordance with regulati<strong>on</strong> 3 of <strong>the</strong> Immigrati<strong>on</strong> (Biometric Registrati<strong>on</strong>) (Amendment) Regulati<strong>on</strong>s2012 any<strong>on</strong>e applying for leave to remain in <strong>the</strong> <strong>UK</strong> in <strong>the</strong> categories for which this applicati<strong>on</strong> <strong>form</strong> isspecified must also apply for a biometric immigrati<strong>on</strong> document, o<strong>the</strong>rwise known as a biometric residencepermit. This also applies to applicati<strong>on</strong>s made at <strong>the</strong> same time by any dependants of <strong>the</strong> main<str<strong>on</strong>g>applicant</str<strong>on</strong>g>. For in<strong>form</strong>ati<strong>on</strong> about biometric residence permits, please see <strong>the</strong> separate <strong>SET</strong> (<strong>DV</strong>) guidancenotes, which you must read before completing this <strong>form</strong>.If you have a current grant of leave <strong>on</strong> a Biometric Residence Permit you must provide your BiometricResidence Permit for <strong>the</strong> applicati<strong>on</strong> to be valid and complete.1. Have you been issued with a Biometric Residence Permit with a previous applicati<strong>on</strong> for leave?Yes - go to questi<strong>on</strong> 2No - go to questi<strong>on</strong> 72. Please give details of your Biometric Residence Permit. Please note for <strong>the</strong> applicati<strong>on</strong> to be valid andcomplete your current Biometric Residence Permit must be provided, unless it is not available for <strong>on</strong>e of<strong>the</strong> reas<strong>on</strong>s specified <strong>on</strong> <strong>the</strong> applicati<strong>on</strong> <strong>form</strong>Biometric Residence Permit2.1 Biometric Residence Permit Number2.2 Nati<strong>on</strong>ality2.3 Issue dateD D M M Y Y Y Y2.4 Expiry dateD D M M Y Y Y Y2.5 Place of issueBiometric Residence Permit enclosed? Yes NoIf not enclosed <strong>the</strong>n please state <strong>the</strong> locati<strong>on</strong> of your Biometric Residence Permit.Returned to <strong>Home</strong> <strong>Office</strong> - go to questi<strong>on</strong> 3Lost - go to questi<strong>on</strong> 4Stolen - go to questi<strong>on</strong> 5<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 19 of 28
O<strong>the</strong>r - go to questi<strong>on</strong> 63. If <strong>the</strong> required Biometric Residence Permit has been returned to <strong>the</strong> <strong>Home</strong> <strong>Office</strong>, pleasegive details of <strong>the</strong> reas<strong>on</strong> and <strong>the</strong> date that it was sent to usD D M M Y Y Y Y4. If <strong>the</strong> BRP was lost, please give <strong>the</strong> date this was reported to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> Card ManagementServiceD D M M Y Y Y Y5. If <strong>the</strong> <strong>the</strong> BRP was stolen, please give <strong>the</strong> police report number, crime reference number, <strong>the</strong>police stati<strong>on</strong> and <strong>the</strong> date reported to <strong>the</strong> policePolice report numberCrime reference numberPolice stati<strong>on</strong>Date reported to <strong>the</strong> PoliceD D M M Y Y Y Y6. If <strong>the</strong> required BRP is not enclosed <strong>the</strong>n please give details why you are unable to provide it7. Have you had your fingerprints taken as part of a previous United Kingdom immigrati<strong>on</strong> applicati<strong>on</strong>made in <strong>the</strong> United Kingdom or abroad?Yes - go to questi<strong>on</strong> 8No - go to questi<strong>on</strong> 11<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 20 of 28
8. Give details when your fingerprints were taken9. Give details where your fingerprints were taken, including <strong>the</strong> town or city and country10. Give details of <strong>the</strong> British diplomatic post(s) involved if <strong>the</strong> applicati<strong>on</strong>(s) was/were made abroad11. Do you have a medical or physical c<strong>on</strong>diti<strong>on</strong> which may require special arrangements for your biometricfeatures to be recorded?Yes - go to questi<strong>on</strong> 12No - go to questi<strong>on</strong> 1312. Please provide us with <strong>the</strong> following documents:A letter from a treating clinician registered with <strong>the</strong> General Medical Council (GMC) giving details of <strong>the</strong>c<strong>on</strong>diti<strong>on</strong> and/or special needs and explaining any arrangements that may be necessary.Dependants and <str<strong>on</strong>g>applicant</str<strong>on</strong>g>s under <strong>the</strong> age of 16If <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> or any dependant included <strong>on</strong> this applicati<strong>on</strong> is under <strong>the</strong> age of 16 please completequesti<strong>on</strong>s 13, 14, 15 and 16. If not please go to questi<strong>on</strong> 17.13. Is <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>/dependant16 years old or more - go to secti<strong>on</strong> 17Less than 16 years old - go to questi<strong>on</strong> 1414. Give details of <strong>the</strong> pers<strong>on</strong> who will be accompanying <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>/dependant when he/sheattends <strong>the</strong>ir Biometric Residence Permit appointment14.1 Name of rep<strong>on</strong>sible adult14.2 Date of birthD D M M Y Y Y Y14.3 Place of birth<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 21 of 28
14.4 Relati<strong>on</strong>ship to child15. Is this pers<strong>on</strong> <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>/dependant’s parent/legal guardianYes - go to questi<strong>on</strong> 17No - go to questi<strong>on</strong> 1616. Please explain why a pers<strong>on</strong> o<strong>the</strong>r than <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>/dependant’s parent/legal guardian will beaccompanying <strong>the</strong> dependant17. DECLARATIONAs required by <strong>the</strong> Immigrati<strong>on</strong> (Biometric Registrati<strong>on</strong>) Regulati<strong>on</strong>s 2008 (as amended) I c<strong>on</strong>firm that Ialso apply for a biometric immigrati<strong>on</strong> document for myself and any dependants applying with me. If I ama sole <str<strong>on</strong>g>applicant</str<strong>on</strong>g> under <strong>the</strong> age of 16, or if any dependant child under <strong>the</strong> age of 16 is applying with me, Iunderstand that <strong>the</strong> <strong>Home</strong> <strong>Office</strong> may make enquiries about any resp<strong>on</strong>sible adult nominated to be presentwhen my/<strong>the</strong>ir fingerprints and/or a photograph are taken.SignatureDateD D M M Y Y Y Y<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 22 of 28
SECTION 10 - PHOTOGRAPHSIt is mandatory to provide <strong>the</strong> relevant photographs specified below. Please note that this applicati<strong>on</strong> will be invalid ifyou do not provide <strong>the</strong>m.The photographs must be in <strong>the</strong> <strong>form</strong>at in <strong>the</strong> separate <strong>UK</strong> Visas and Immigrati<strong>on</strong> photograph guidance provided withthis <strong>form</strong>. If <strong>the</strong>y are not, <strong>the</strong>y may be rejected as unacceptable and you will have to provide o<strong>the</strong>rs which are acceptable.This will delay c<strong>on</strong>siderati<strong>on</strong> of your applicati<strong>on</strong>.Tick <strong>the</strong> relevant box(es) to c<strong>on</strong>firm <strong>the</strong> photographs you are providing and enclose <strong>the</strong>m in a small sealed envelopeattached to secti<strong>on</strong> 1 as instructed <strong>the</strong>re.Two recent identical passport-size photographs of yourself with your full name written <strong>on</strong> <strong>the</strong> back of each photograph.Please see <strong>the</strong> separate photograph guidance <strong>on</strong> <strong>the</strong> approved <strong>form</strong>at.Two recent identical passport-size photographs of each child under 18 included in secti<strong>on</strong> 2 and applying forindefinite leave to remain in <strong>the</strong> <strong>UK</strong> with you, with <strong>the</strong>ir full name written <strong>on</strong> <strong>the</strong> back of each photograph.SECTION 11 - DOCUMENTSYou must provide <strong>the</strong> documents specified below which are relevant to your applicati<strong>on</strong>. If you do not, we reserve <strong>the</strong>right to decide your applicati<strong>on</strong> <strong>on</strong> <strong>the</strong> basis of <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> and documents provided.Tick <strong>the</strong> relevant boxes to show <strong>the</strong> documents you are providing. They must be originals.Please note that, in some cases, we may have to ask for o<strong>the</strong>r documents in additi<strong>on</strong> to those specified in this <strong>form</strong>.Passport and immigrati<strong>on</strong> documentsYour current passport or travel document. If you last entered <strong>the</strong> <strong>UK</strong> <strong>on</strong> a previous passport or travel document,please also provide this document if you have it.The current passport or travel document for each child under 18 included in secti<strong>on</strong> 2 and applying for indefiniteleave to remain in <strong>the</strong> <strong>UK</strong> with you. If <strong>the</strong>y last entered <strong>the</strong> <strong>UK</strong> <strong>on</strong> previous passport(s) or travel document(s), please alsoprovide <strong>the</strong>se documents if you have <strong>the</strong>m.Your Biometric Residence Permit if you have been issued with <strong>on</strong>e since entering <strong>the</strong> <strong>UK</strong>. See Note 5.Biometric Residence Permit for each child under 18 included in secti<strong>on</strong> 2 and applying for indefinite leave toremain in <strong>the</strong> <strong>UK</strong> with you if <strong>the</strong>y have been issued with <strong>the</strong>m since entering <strong>the</strong> <strong>UK</strong>. See Note 5.Note 5 Residence Permits have been issued to certain foreign nati<strong>on</strong>als since 25 November 2008 when <strong>the</strong>y have beengiven permissi<strong>on</strong> to remain in <strong>the</strong> <strong>UK</strong>. Unless reported lost or stolen, <strong>the</strong>y should be enclosed with any applicati<strong>on</strong> for fur<strong>the</strong>rpermissi<strong>on</strong> to remain in <strong>the</strong> <strong>UK</strong>.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 23 of 28
SECTION 11 - DOCUMENTSChildren’s birth certificatesA full birth certificate (<strong>on</strong>e which shows <strong>the</strong> parents’ names) for each child under 18 of your present marriage or civilpartnership or relati<strong>on</strong>ship who is applying for indefinite leave to remain in <strong>the</strong> <strong>UK</strong> with you.Evidence of previous cohabitati<strong>on</strong> with your partnerLetters or o<strong>the</strong>r corresp<strong>on</strong>dence as evidence that you and your partner lived toge<strong>the</strong>r from <strong>the</strong> time you were grantedleave to enter or remain in <strong>the</strong> <strong>UK</strong> as a partner until <strong>the</strong> relati<strong>on</strong>ship broke down.Evidence of domestic violenceEvidence of domestic violence as listed in secti<strong>on</strong> 4. If you are unable to provide any such evidence, you must providean explanati<strong>on</strong> of why you cannot do so.Evidence of relati<strong>on</strong>ship with your partnerA letter from you stating whe<strong>the</strong>r you are still living with your partner and, if <strong>the</strong> marriage or relati<strong>on</strong>ship has brokendown, whe<strong>the</strong>r domestic violence was <strong>the</strong> reas<strong>on</strong> for this.Evidence of destituti<strong>on</strong>Letters or o<strong>the</strong>r documents as evidence that you are destitute e.g. from <strong>the</strong> local authority or agency supportingyou c<strong>on</strong>firming that <strong>the</strong>y have assessed you and that for <strong>the</strong>ir purposes in providing support to you, <strong>the</strong>y accept that youare destitute at <strong>the</strong> time of this applicati<strong>on</strong>.If you are receiving support from a third party, e.g family and friends, you must provide a letter c<strong>on</strong>firming what supportarrangements are in place, toge<strong>the</strong>r with o<strong>the</strong>r documents to prove your inability to pay <strong>the</strong> applicati<strong>on</strong> fee.Please note that <strong>the</strong> <strong>UK</strong> <strong>Border</strong> <strong>Agency</strong> will decide whe<strong>the</strong>r you are destitute for <strong>the</strong> purposes of not paying <strong>the</strong> applicati<strong>on</strong>fee.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 24 of 28
SECTION 12 - C<strong>on</strong>sent for <strong>the</strong> <strong>Home</strong> <strong>Office</strong> to RequestVerificati<strong>on</strong> ChecksFrom <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> :I understand that you will check whe<strong>the</strong>r <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> and supporting documentati<strong>on</strong> that I havesupplied to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> from a bank or utility company is correct. ‘Correct’ means that documentsare unaltered originals issued by <strong>the</strong> bank or utility company and that <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> <strong>on</strong> <strong>the</strong>m is correctand applies to me or <strong>the</strong> pers<strong>on</strong> named as a customer <strong>on</strong> <strong>the</strong> document.I agree to <strong>the</strong> bank or utility company, without seeking any fur<strong>the</strong>r c<strong>on</strong>sent from me, telling you whe<strong>the</strong>r<strong>the</strong> in<strong>form</strong>ati<strong>on</strong> or documentati<strong>on</strong> I have supplied is correct or in what way (if any) it is not correct.I agree to <strong>the</strong> bank’s or utility company’s disclosure to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> of any relevant pers<strong>on</strong>al data<strong>the</strong>y hold <strong>on</strong> me for <strong>the</strong> above purposes. If I have not supplied correct in<strong>form</strong>ati<strong>on</strong> or supporting documentati<strong>on</strong>to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> <strong>the</strong> bank or utility company may disclose my relevant correct pers<strong>on</strong>aldata.If <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> or supporting documentati<strong>on</strong> also c<strong>on</strong>tains pers<strong>on</strong>al data relating to a joint customeror customers of mine <strong>on</strong> <strong>the</strong> bank or utility company account, or relates to ano<strong>the</strong>r pers<strong>on</strong> who is toprovide financial support, I c<strong>on</strong>firm that I have obtained <strong>the</strong> c<strong>on</strong>sent of those pers<strong>on</strong>s to <strong>the</strong> disclosureof <strong>the</strong>ir pers<strong>on</strong>al data to <strong>the</strong> extent reas<strong>on</strong>ably necessary for <strong>the</strong> above purposes.I understand that <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> obtained may be used as part of <strong>the</strong> decisi<strong>on</strong> making process aboutmy applicati<strong>on</strong> and may, if necessary, be disclosed to a court.[I understand that providing in<strong>form</strong>ati<strong>on</strong> or documentati<strong>on</strong> that is not correct will normally result in myapplicati<strong>on</strong> being refused and may lead to my prosecuti<strong>on</strong> for a criminal offence.]Name and address of <str<strong>on</strong>g>applicant</str<strong>on</strong>g>PostcodeSignatureDateIf you are submitting evidence of an account with a bank or utility company that is in jointnames of yourself (<strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>) and ano<strong>the</strong>r pers<strong>on</strong>/or people, each of those named <strong>on</strong> <strong>the</strong>sedocuments should sign <strong>the</strong> following declarati<strong>on</strong>. However, please note; if you feel that it is notsafe for you to approach and obtain permissi<strong>on</strong> from your sp<strong>on</strong>sor or third parties, you will notbe required to gain <strong>the</strong>ir c<strong>on</strong>sent.The above-named pers<strong>on</strong> (‘<strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>’) has given <strong>the</strong> <strong>Home</strong> <strong>Office</strong> documentati<strong>on</strong> about his or heraccounts with banks or utility companies (a ‘company’) so that <strong>the</strong> <strong>Home</strong> <strong>Office</strong> can check that is correct.I am a joint customer with <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> <strong>on</strong> some or all of those accounts. In<strong>form</strong>ati<strong>on</strong> about <strong>the</strong><str<strong>on</strong>g>applicant</str<strong>on</strong>g> may thus also reveal in<strong>form</strong>ati<strong>on</strong> about me.I agree to <strong>the</strong> company giving <strong>the</strong> <strong>Home</strong> <strong>Office</strong> relevant pers<strong>on</strong>al data it holds about me in relati<strong>on</strong> to<strong>the</strong> account. This <strong>on</strong>ly covers data about me as joint customer with <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> (and not about anyo<strong>the</strong>r accounts I hold in my sole name) and limited to what is necessary to c<strong>on</strong>firm that <strong>the</strong> documentati<strong>on</strong><strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> has supplied is correct. If that documentati<strong>on</strong> is not correct, <strong>the</strong> company may give<strong>the</strong> <strong>Home</strong> <strong>Office</strong> details of any inaccuracies / discrepancies in <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> that <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> hasprovided, and may also disclose to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> <strong>the</strong> correct in<strong>form</strong>ati<strong>on</strong> that <strong>the</strong>y have <strong>on</strong> recordabout <strong>the</strong> account.I agree that this in<strong>form</strong>ati<strong>on</strong> may be used as part of <strong>the</strong> decisi<strong>on</strong> making process about <strong>the</strong> applicati<strong>on</strong>and may, if necessary, be disclosed to a court.Name and address of joint customerPostcodeSignatureDate<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 25 of 28
SECTION 12 - C<strong>on</strong>sent for <strong>the</strong> <strong>Home</strong> <strong>Office</strong> to RequestVerificati<strong>on</strong> ChecksIf <strong>the</strong> account with <strong>the</strong> bank or utility company relates to ano<strong>the</strong>r pers<strong>on</strong> who is to provide <strong>the</strong><str<strong>on</strong>g>applicant</str<strong>on</strong>g> with financial support, that pers<strong>on</strong>* should sign <strong>the</strong> following declarati<strong>on</strong> :I am a friend or relative whom <strong>the</strong> above-named pers<strong>on</strong> (‘<strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>’) has stated will provide financialsupport. The <strong>Home</strong> <strong>Office</strong> is verifying this by checking <strong>the</strong> documentati<strong>on</strong> which <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> hassupplied about my accounts with banks or utility companies (a ‘company’). The company may thusreveal in<strong>form</strong>ati<strong>on</strong> about me to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> or to <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>.I agree to <strong>the</strong> company giving <strong>the</strong> <strong>Home</strong> <strong>Office</strong> relevant pers<strong>on</strong>al data it holds about me in relati<strong>on</strong>to my account. This is limited to what is necessary to c<strong>on</strong>firm that <strong>the</strong> documentati<strong>on</strong> <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>has supplied is correct. If that documentati<strong>on</strong> is not correct, <strong>the</strong> company may give <strong>the</strong> <strong>Home</strong> <strong>Office</strong>details of any inaccuracies / discrepancies in <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> that <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> has provided, and mayalso disclose to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> <strong>the</strong> correct in<strong>form</strong>ati<strong>on</strong> that <strong>the</strong>y have <strong>on</strong> record about <strong>the</strong> account.I understand that this may involve <strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g> obtaining fur<strong>the</strong>r details about <strong>the</strong> account.I agree that this in<strong>form</strong>ati<strong>on</strong> may be used as part of <strong>the</strong> decisi<strong>on</strong> making process about <strong>the</strong> applicati<strong>on</strong>and may, if necessary, be disclosed to a court.Name and address of third partyPostcodeSignatureDate*If <strong>the</strong> account is a joint account, all customers should sign.<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 26 of 28
SECTION 13 - DECLARATIONYou must now read <strong>the</strong> declarati<strong>on</strong> below and sign it. This must be signed by you (<strong>the</strong> <str<strong>on</strong>g>applicant</str<strong>on</strong>g>) and not by arepresentative or o<strong>the</strong>r pers<strong>on</strong> acting <strong>on</strong> your behalf.It is mandatory for <strong>the</strong> declarati<strong>on</strong> to be signed.Please note that this applicati<strong>on</strong> will be invalid if it is not signed as specified above.I hereby apply for indefinite leave to remain in <strong>the</strong> <strong>UK</strong> for myself and any children under 18listed in this <strong>form</strong>. The in<strong>form</strong>ati<strong>on</strong> I have given in this <strong>form</strong> is complete and is true to <strong>the</strong> bestof my knowledge.I c<strong>on</strong>firm that <strong>the</strong> photographs submitted with this <strong>form</strong> are a true likeness of myself and anychildren under 18 who are applying with me, as named <strong>on</strong> <strong>the</strong> back of each photograph, andthat I have had <strong>the</strong> opportunity to see <strong>the</strong> <strong>UK</strong> Visas and Immigrati<strong>on</strong> photograph guidance.I c<strong>on</strong>firm that if, before this applicati<strong>on</strong> is decided, <strong>the</strong>re is a material change in my circumstancesor new in<strong>form</strong>ati<strong>on</strong> relevant to this applicati<strong>on</strong> becomes available, I will in<strong>form</strong> <strong>the</strong> <strong>Home</strong><strong>Office</strong>.I c<strong>on</strong>sent to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> obtaining in<strong>form</strong>ati<strong>on</strong> or evidence from <strong>the</strong> agencies or o<strong>the</strong>rsources menti<strong>on</strong>ed in this applicati<strong>on</strong> <strong>form</strong> in c<strong>on</strong>necti<strong>on</strong> with my claim to be a victim of domesticviolence, and using such in<strong>form</strong>ati<strong>on</strong> or evidence in reaching a decisi<strong>on</strong> <strong>on</strong> my applicati<strong>on</strong>.I understand that all in<strong>form</strong>ati<strong>on</strong> provided by me to <strong>the</strong> <strong>Home</strong> <strong>Office</strong> will be treated in c<strong>on</strong>fidence;that it may be disclosed to o<strong>the</strong>r government departments, agencies, local authorities,<strong>the</strong> police, foreign governments and o<strong>the</strong>r bodies for immigrati<strong>on</strong> purposes or to enable <strong>the</strong>mto per<strong>form</strong> <strong>the</strong>ir functi<strong>on</strong>s; and that, if such bodies provide <strong>the</strong> <strong>Home</strong> <strong>Office</strong> with any in<strong>form</strong>ati<strong>on</strong>about me which may be relevant for immigrati<strong>on</strong> purposes, it may be used in reaching a decisi<strong>on</strong><strong>on</strong> my applicati<strong>on</strong>.I understand that my details may in certain circumstances be passed to fraud preventi<strong>on</strong> agenciesto prevent and detect fraud and m<strong>on</strong>ey laundering. I also understand that such agenciesmay provide <strong>the</strong> <strong>Home</strong> <strong>Office</strong> with in<strong>form</strong>ati<strong>on</strong> about me. Fur<strong>the</strong>r details explaining when in<strong>form</strong>ati<strong>on</strong>may be passed to or from fraud preventi<strong>on</strong> agencies and how that in<strong>form</strong>ati<strong>on</strong> may beused can be obtained from <strong>the</strong> <strong>Home</strong> <strong>Office</strong> website.I understand that documents provided in support of this applicati<strong>on</strong> will be checked for au<strong>the</strong>nticity;and that false documents will be retained and may result in my applicati<strong>on</strong> being refusedand in my prosecuti<strong>on</strong> and subsequent removal from <strong>the</strong> United Kingdom.I understand that <strong>the</strong> <strong>Home</strong> <strong>Office</strong> may also use <strong>the</strong> in<strong>form</strong>ati<strong>on</strong> provided by me for trainingpurposes.I am aware that it is an offence under <strong>the</strong> Immigrati<strong>on</strong> Act 1971, as amended by <strong>the</strong> Immigrati<strong>on</strong>and Asylum Act 1999 and <strong>the</strong> Nati<strong>on</strong>ality, Immigrati<strong>on</strong> and Asylum Act 2002, to make to a pers<strong>on</strong>acting in executi<strong>on</strong> of any of those Acts a statement or representati<strong>on</strong> which I know to befalse or do not believe to be true, or to obtain or to seek to obtain leave to remain in <strong>the</strong> UnitedKingdom by means which include decepti<strong>on</strong>.I understand that if I am in<strong>form</strong>ing <strong>the</strong> <strong>Home</strong> <strong>Office</strong> that I have changed my gender, <strong>the</strong>se detailsmay in certain circumstances be shared with o<strong>the</strong>r <strong>Home</strong> <strong>Office</strong> colleagues. I c<strong>on</strong>sent to this,where necessary and understand that this in<strong>form</strong>ati<strong>on</strong> will <strong>on</strong>ly be shared in limited circumstancesrelating to identity and security in line with Secti<strong>on</strong> 22 of <strong>the</strong> Gender Recogniti<strong>on</strong> Act.I am aware <strong>the</strong>y will o<strong>the</strong>rwise be treated in c<strong>on</strong>fidence and that my rights under <strong>the</strong> EqualityAct 2010, Data Protecti<strong>on</strong> Act 1998 and Article 8 of <strong>the</strong> European C<strong>on</strong>venti<strong>on</strong> <strong>on</strong> Human Rightswill be unaffected.SignatureDate<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 27 of 28
PHOTOGRAPHS AND DOCUMENTS CHECKLISTPlease complete this part of <strong>the</strong> <strong>form</strong> to help us check that we have received your photographs and documents. At“A”, tell us how many of each of <strong>the</strong> listed items you are providing with your applicati<strong>on</strong>. At “B”, list any o<strong>the</strong>r documentsprovided by you and state how many in each case. C<strong>on</strong>tinue <strong>on</strong> a separate sheet if necessary and encloseit with this <strong>form</strong>. All documents must be originals.Photographs of yourselfPhotographs of any children applyingPassportsHowA. Listed items many?B. O<strong>the</strong>r documentsTravel documentsBiometric Residence PermitsBirth certificate(s) of any children applyingInjuncti<strong>on</strong> or o<strong>the</strong>r court orderEvidence of court c<strong>on</strong>victi<strong>on</strong>Evidence of police cauti<strong>on</strong>Medical report of injuries sufferedPolice report of domestic violence incidentLetter(s) from social servicesLetter(s) from support organisati<strong>on</strong>Please note that in some cases, we may have to ask for o<strong>the</strong>rdocuments in additi<strong>on</strong> to those specified in this <strong>form</strong>.Is <strong>SET</strong>(<strong>DV</strong>) <strong>the</strong> right <strong>form</strong> for you and is it valid for use?See date and notes <strong>on</strong> fr<strong>on</strong>t page.FINAL CHECKSHowmany?To ensure that your applicati<strong>on</strong> is complete, please make <strong>the</strong> following final checks. Tick each box that is relevantto your applicati<strong>on</strong>.Have you completed <strong>the</strong> payment details page asrequired and have you made <strong>the</strong> correct payment ifrequired to do so?If you are claiming fee exempti<strong>on</strong> <strong>on</strong> <strong>the</strong> grounds ofdestituti<strong>on</strong>, have you provided documentary evidenceto prove it?Have you provided <strong>the</strong> photographs specified in secti<strong>on</strong>10 and are <strong>the</strong>y in <strong>the</strong> approved <strong>form</strong>at?If you are unable to send us any of <strong>the</strong> documentsspecified in secti<strong>on</strong> 11 which are relevant to yourapplicati<strong>on</strong>, or if you are unable to provide originals,have you given an explanati<strong>on</strong> and said when youwill be able to send <strong>the</strong>m?Have you completed secti<strong>on</strong> 8 and <strong>the</strong> rest of <strong>the</strong> <strong>form</strong>as specified?Have you provided your current passport or traveldocument and all o<strong>the</strong>r relevant documentsspecified in secti<strong>on</strong> 11 and are <strong>the</strong>y originals?Have you signed and dated <strong>the</strong> declarati<strong>on</strong> in secti<strong>on</strong>13?Finally, please make sure that <strong>the</strong> applicati<strong>on</strong> is addressed exactly as shown below.<strong>Home</strong> <strong>Office</strong> - <strong>SET</strong>(<strong>DV</strong>)Indefinite Leave to RemainPO Box 492DurhamDH99 1WU<strong>SET</strong>(<strong>DV</strong>) Applicati<strong>on</strong> Form (Versi<strong>on</strong> 06/2014) Page 28 of 28