1.5 If you are between 16-18 years old, please tick to confirm you have provided a document to confirm your >>>>>>>>>> parents or legal guardians support your application and consent to the arrangements for your care in the UK
Put a cross (x) in the relevant box
POINTS BASED SYSTEM FORM (VAF9 NOV 2014) APPENDIX 3: TIER 1 (ENTREPRENEUR) SELF- ASSESSMENT
This form is for use outside the UK only. This form is provided free of charge.
READ THIS FIRST
This form must be completed in blue or black ink.
Only complete after you have obtained your points score from the electronic Self-Assessment
Points Calculator (www.ukba.homeoffice.gov.uk/pointscalculator ). Please follow the guidance notes carefully
and complete all questions as indicated.
Please ensure you submit all relevant, original documents as indicated in the sections. It is better to explain why you
do not have a document than to submit a false document. Your application will be automatically refused, and you
may be banned from coming to the UK for 10 years if you use a false document, lie or withhold relevant information.
You may also be banned if you have breached immigration laws in the UK
Please ensure you also complete the main Personal Details form.
For official use only
1.1 Given name(s)
1.2 Family name
1.3 Occupation (this is your current or most recent job)
Attributes - Initial Applications:
You need to score a total of 75 points from Parts 2 – 5. You can score 25 points from either Part 2 or Part 3 (not from both). You should refer to the Immigration Rules and Tier 1 (Entrepreneur) Policy Guidance.Access to no less than £200,000 [25 points available]
About you
Part 2
Part 1
2.1 Do you have access to funds amounting to no less than £200,000?
Put a cross (x) in the relevant box
2.1 Are you relying on third party funding for any of the £200,000?
Put a cross (x) in the relevant box Yes No
Yes No 1.4 Please tick to confirm that you are 16 years old or over Put a cross (x) in the relevant box >>>>>>>>>>>>>>>>>>>>>>>>
one or more registered UK entrepreneurial seed funding competition endorsed by the UKTI
one or more UK Government Departments, made available for specific purpose of establishing or expanding a UK Business Give the name of the seed funding competition (listed as endorsed on the UKTI website)
Give the name of the UK Government Department
4.1 Are the funds held in one or more regulated financial institutions?
Put a cross (x) in the relevant box
5.1 Are the funds disposable in the United Kingdom?
Put a cross (x) in the relevant box
6.1 Will you be part of an entrepreneurial team?
Put a cross (x) in the relevant box Yes No
Yes No Yes No Name Date of Birth
D D
M M
Y Y Y Y
Nationality Passport NumberPlease provide details of the other member of the entrepreneurial team
3.1 Do you have access to funds amounting to no less than £50,000 from: Put a cross (x) in the relevant box one of more registered Venture Capitalist firms regulated by the Financial Conduct Authority
Give the name of the Venture Capitalist firm (s) together with the registration number for this activity with the FCA
Money is disposable in the United Kingdom [25 points available]
Part 5
Money is held in one or more regulated financial institutions [25 points available]
Part 4
Entrepreneurial Teams
Part 6
Access to no less than £50,000
Table of evidence listing each piece of evidence provided
All documents must be original. For each source of funds on which you are relying to claim points you must provide a letter from the financial institution holding the funds showing:
• That the money is available to you, your business or your entrepreneurial team; and • That the institution is regulated by the home regulator; and
• That the money is disposable in the UK.
If you are part of an entrepreneurial team, both your names must be shown
If third party funding is used, you must provide a letter from every third party granting permission for you to have access to the money and a letter of confirmation from a legal representative or legal representatives confirming that the signatures are valid (2 pieces of evidence). If the third party is a Venture Capitalist firm, a seed funding competition or a UK Government Department, the letter must confirm the award and the amount of money in the award. If you are part of an entrepreneurial team sharing funds, both of you must have equal access to funds and each document must show both names.
You must complete the following table to confirm the specified documents provided with this application to demonstrate each source of funds. One line is completed (line 0) as an example only.
Source No Letter from third
party granting permission to use the money, if applicable.
Letter from the FCA registered Venture Capitalist firm; seed funding competition; or UK Government Department; or combination of these totalling £50,000 of funds Amount of money in UK Pounds Sterling in this institution
0
Bank of Somewhere
YES
Capitalist, Seed funding state if ventureor Govt Dept
£
X0,000
1£
2£
3£
4£
5£
6£
7£
8£
9£
10£
Totals Total amount of money claimed Number of pieces of evidence: >>>>> >>>>>>> >>>>>>> >>>>>>>Legal representative’s letter confirming validity of permissions if third party money is used.
YES
£
Letter from financial institution holding the money, confirming the amount of money, that the institution is regulated by the home regulator and that the money is transferable to the UK.
7.1 Will you be part of an entrepreneurial team?
Put a cross (x) in the relevant box
7.5 Does the value of any living accommodation form part of any investment in premises that are also used for this business? Put a cross (x) in the relevant box
Yes No Yes No Name Date of Birth
D D
M M
Y Y Y Y
Nationality Passport NumberPlease provide details of the other member of the entrepreneurial team
7.3 Were any of these funds already invested and considered as part of your initial application
Tier 1 (Entrepreneur) Extensions
Part 7
7.2 Have you invested no less than £200,000 (or £50,000 if applicable) in cash directly into one or more UK businesses during your initial leave as a Tier 1 (Entrepreneur)?
Put a cross (x) in the relevant box
Yes No
Yes Yes - some funds invested No – no funds
7.4 How much money did you show had been invested in UK business as part of your application (value in pounds sterling)?
£
7.6 If you answered yes to the above question, what is the value of the living accommodation (in pounds sterling)?
£
7.7 If you answered Yes – some of the funds invested or No – no funds invested in 7.3, please give details of your investments in the following table:
Name of business Company registration number if appropriate Date of investments (dd/mm/yyyy) Amount of investment less the value of any accommodation
Business premises in the UK
Business bank
account Business is subject to UK taxation
Registered as Self Employed or a Director within six months
You must have registered within as self employed or as a director of a new or existing business within six months of your specified date. 7.8 Do you wish to use your date of entry into the UK as your specified date? Put a cross (x) in the relevant box
Yes - evidence must be provided No – we will use the date your initial Tier 1
7.13 Are you the sole partner or director in your business?
Put a cross (x) in the relevant box
7.14 Are you in receipt of any UK Public funds?
Put a cross (x) in the relevant box
Yes No
Yes No Created two full time equivalent jobs
7.11 You must have created the equivalent of two fulltime (30 hours per week) posts for a minimum of 2 resident workers for 12 months. Please provide details:
Name of employee Name of employing business
State date of period of employment in the format dd/mm/ yyyy
End date of period of employment in the format dd/mm/yyyy Hourly rate in pounds sterling Total number of hours employment
7.12 Did you set up a new business or join an existing one? Put a cross (x) in the relevant box
If you answered no to the above question, you must complete the following table:
Names of other partners(s)/director(s) Are these partners(s) or director(s) also Tier 1 Entrepreneur migrants (answer yes or no)?
If yes, please state the dates they became partner(s) or directors(s)
Are they part of your entrepreneurial team (answer yes or no)?
If they are not part of your entrepreneurial team, please list the names of the holders of the jobs they have created
7.9 Within six months of the specified date were you either registered as self employed or as a director of a new or existing business? Put a cross (x) in the relevant box
Engaged in Business Activity at the time of your application
7.10 Are you currently engaged in business activity as self employed or a director of a new or existing business?
Put a cross (x) in the relevant box
Existing business – further evidence of increase in jobs must be provided
Yes - evidence must be provided
Yes - evidence must be provided
New business No
If you have ticked Housing and Homelessness Assistance please go to question 7.16 In all other cases go to question 7.18
7.16 Please provide further details of your ‘Housing and Homelessness Assistance’. Include whether your housing provided by the local housing authority, a housing association, or other organisation, the name of the relevant authority and details of the arrangement.
7.17 If the housing is provided by your local council, housing authority or as part of an agreement between your employer and the housing authority, give details below. You must also provide evidence of this from your local housing authority.
7.18 If you have claimed public funds, please provide details to explain why you believe you are able to claim the relevant fund(s).
Go to part 8 7.15 The public funds relevant for the purposes of the Immigration Rules are listed below. Please tick the relevant boxes to show
which of these are being received. Attendance Allowance
Income-Based Jobseeker’s Allowance Child Benefit
Income Related Employment Child Tax Credit
Severe Disablement Allowance Disability Living Allowance
State Pension Credit Working Tax Credit
Carer’s Allowance
Income Support Council Tax Benefit
Personal Independence Payment Council Tax Reduction
Social Fund Payment Housing Benefit
Universal Credit
Housing and Homelessness Assistance
You need a minimum standard of English language in order to score 10 points. Without this your application will be refused. You should refer to the Tier 1 (Entrepreneur) Policy Guidance.
8.1 Put a cross (x) in one box to indicate under which category of the English language requirement you are claiming points:
8.2 National of a majority English speaking country (10 points) National of a majority English speaking country.
Go to question 8.2 English language Test. Go to question 8.3
Degree taught in English. Go to question 8.5 Previous leave granted under the Business Persons categoryGo to question 8.8 Enter your nationality. This should be the nationality shown in the passport/travel document you wish to use for this programme.
Go to Question 8.10
English Language
8.3 English language test (10 points). Provide details of the test taken
8.4 Put a cross (x) in the following box to confirm the evidence you have supplied.
8.5 Degree taught in English (10 points)
The degree must be equivalent to a UK Bachelors degree or above. See Tier 1 (Entrepreneur) Policy Guidance Awarding Body:
Go to Question 8.10 Level of qualification:
Title of qualification:
Date of Award:
Award reference number:
D D
M M
Y Y Y Y
Year of Award
Y Y Y Y
Country of award >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> State/County/Province (if applicable)
Institution >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
End
Start
D D
M M
Y Y Y Y
D D
M M
Y Y Y Y
Qualification
Field of Study >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> Grade
8.6 Put a cross (x) in the relevant box to confirm how you verified you degree was taught in English The points-based calculator shows the degree was taught
in English; Go to Question 8.7
8.7 Put a cross (x) in the relevant box to indicate what evidence has been supplied
Original degree certificate - Go to Question 8.10 Original academic transcript - Go to Question 8.10
8.10 Put a cross (x) in the box to confirm that you claimed 10 points for your level of English language >>>>>>>>>>>>>>> 8.9 If you cannot provide original evidence of your previous entry clearance/leave to remain in the UK please supply as much detail as possible of your original application including the post of issue.
8.8 What evidence are you providing to show your original entry clearance/leave to remain in the UK?
Put a cross (x) in the relevant box
You must have a minimum level of funds to score 10 points for your level of funds. If you do not score 10 points your application will be refused. You must have £3,310 available funds for yourself plus £1,890 for each dependant accompanying you or intending to join you in the United Kingdom within 12 months of your arrival in the United Kingdom. This money must be held in your personal bank account for a consecutive 90 day period before the date of your application and not fall below the required amount at any time during that period. Refer to the Tier 1 (entrepreneur) Policy Guidance.
9.1 Calculate the amount of funds required for you >>>>>>> and the dependants named in the Personal Details
part of this application form and enter the amount here.
9.2 Put a cross (x) in the box to confirm that you have this amount of funds available and that it has been in your personal bank account for a consecutive 90 day period prior to your making this application.
Building society/savings account pass book Personal bank or building society statements covering a consecutive 90 day period
Letter from a bank or building society confirming funds and that
they have been in your bank for a consecutive 90 day period Letter from a regulated financial institution confirming funds and covering a consecutive 90 day period 9.3 Put a cross (x) in the relevant boxes to indicate what evidence of these funds has been supplied. All documents must be original.
9.4 Put a cross (x) in the box to confirm that you have claimed 10 points for your level of funds >>>>>>>>>>>>>>>>>>>>>
Points Scoring Area Points Claimed Documents Provided (please list)
Please complete the summary sheet below listing the points you have claimed and the documentation provided. You must provide the required evidence as specified in this application form and the Tier 1 (Entrepreneur) Policy Guidance. All documents must be original, unless otherwise stated. Failure to submit required evidence is likely to lead to refusal of the application.
YOU MUST SUBMIT A PAPER COPY OF THIS APPENDIX WITH YOUR SUPPORTING
DOCUMENTS. ENSURE YOU ALSO COMPLETE THE PERSONAL DETAILS FORM EITHER
ON PAPER OR ONLINE. YOU SHOULD SIGN THE DECLARATION AND SUBMIT THIS
WITH YOUR OTHER DOCUMENTS
Access to £200,000 (Part 2) Access to £50,000” (Part 3)
Financial institution is regulated (Part 4) Funds are disposable in the UK (Part 5) English language (Part 8)
Maintenance (Part 9) Total
Applicant’s signature Date
D D
M M
Y Y Y Y
I confirm I have completed the Personal Details separate form and accept the contents of the declaration.
