Household income for the year ended 5 April 2016
Who should fill in this form?
Parts A, B and C - the student
Parts D, E and F - the parent, step parent, parent's partner or husband, wife, civil partner or partner. If this
is the first time the student is applying for support, you must send us a copy of the relevant documents to support
the income details you give us in part E. For example, P60, self-assessment, tax credit award, state benefits letter
etc. Any income documentation must cover the whole year. If you are not sure what documents to send then
contact us for help.
Important - If you do not fill in the form correctly, we will have to ask you to fill it in again. This will seriously delay
the student receiving their full entitlement. If you need help filling in the form, contact us for help.
Part A - student details
Name
Date of Birth
D
D
/
M
M
/
Y
Y
Y
Y
SAAS reference number
Part B - student income
In the table below, please give us an estimate of how much income you expect to receive during the academic
year. DO NOT enter income from employment or benefits you receive that we do not take into account, for
example, Child Benefit, Child Tax Credit, Disability Living Allowance etc. DO enter maintenance you receive from
an absent parent, private pensions, trust income, interest from bank/building society or other savings accounts
and benefits we take into account , for example, Working Tax Credits, Incapacity Benefit, Employment Support
Allowance, War Pension etc. If you are not sure what income to tell us about, then contact us for help.
Type of income
Estimate of income you expect to receive
between 1 August 2016 and 31 July 2017
NONE
NONE
NONE
NONE
Part C - student declaration





As far as I know, the details above are complete and accurate.
I agree to give you any further information you may ask for.
I agree to tell you immediately if I do not matriculate, if I withdraw from my course of study or if my
circumstances change in any way that might affect any amount I have received, or had paid on my behalf.
I understand that if I give you false information or do not give you complete information, you may
prosecute me and withdraw my support.
I agree to pay any amount I have received, or that has been paid on my behalf, which is more than the
award due to me.
Your signature
Date
D
D
/
M
M
/
Y
Y
Y
Y
Household Income
Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT
t / 0300 555 0505 w / www.saas.gov.uk
Part D - person 1 and person 2 details
Father, stepfather, parent’s partner or
husband, wife, civil partner (Person 1)
Mother, stepmother, parent’s partner
(Person 2)
Name
Relationship to student
National Insurance Number
Are you retired or unemployed?
Address of person 1 and 2
Part E - person 1 and person 2 gross income and deductions
Important - if you do not enter income for both person 1 and 2, please tell us why in the box below, for example,
'separated'. You will need to send us relevant evidence that proves your single status.
Reason for one person’s income
Gross yearly income and deductions
Person 1
Person 2
PAYE income for year ending 5 April 2016 from salary, wages, commission, bonuses
and overtime. Write the total before deduction of income tax, NI and superannuation
contributions.
NONE
NONE
Net Profit from self-employment income from year ending between 6 April 2015 and
5 April 2016.
NONE
NONE
Taxable income from property and land.
NONE
NONE
Income from Working Tax Credit (DO NOT include Child Tax Credit).
Income from private, employers or retirement pensions.
NONE
NONE
NONE
NONE
State benefits, including pensions and allowances. Enter the yearly amount (DO NOT
include Child Tax Credits or Child Benefit).
NONE
NONE
Income from bonds, trusts, bank and building society accounts or investments.
NONE
NONE
Dividends you receive.
NONE
NONE
Other income (DO NOT include Child Tax Credit or Child Benefit). If you RECEIVE
maintenance, you only need to enter this if it is for another student in further or higher
education. DO NOT enter maintenance for a child still at school.
NONE
NONE
If you PAY maintenance for a child in further or higher education (not the applicant in
part A), enter their name, date of birth and how much you pay.
NONE
Part F - person 1 or person 2 declaration




As far as I know, the details above are complete and accurate.
I agree to give you any further information you may ask for.
I agree to tell you immediately if my circumstances change in any way that might affect this application for
support.
I understand that if I give you false information or do not give you complete information, you may
prosecute me and withdraw the support.
Your signature
Date
D
D
/
M
M
/
Y
Y
Y
Y
Household Income
Saughton House, Broomhouse Drive, Edinburgh, EH11 3UT
t / 0300 555 0505 w / www.saas.gov.uk