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Student Finance .<J

Declaration - 2016117 student fi na nce services

Forename(s) Student Finance Services
Jenel Cristian PO Box 306
Darlington
Surname DL1 gNU
Ciocan
Customer Reference Number 5

24 84

You must sign, date and return this Student Finance Declaration to complete your
application for student finance.

Total amount we will pay your university or college: t 8830.00 We will pay the amount here unless
we are notified of any changes

Before signing this declaration you should read the following carefully. This is your student finance
contract.
This declaration covers all of the student finance available to you for academic year 2016117.

By signing this Declaration you are confirming that you have lf you have applied for a course of study in England you
read the terms and conditions about the Tuition Fee Loan should read the guide to terms and conditions and Data
because they will affect you if you apply for the loan at any Protection Statement at www.gov. u Ustudentfi nance
time in academic year 2O16117. lf you don't apply for the
Tuition Fee Loan in 2016117 the terms and conditions will not The following declarations apply to you
affect you. I declare that:

Your application for{haneiat-supporf, mayie delayed--- - a ffi<noutledge-andagee-thaf anyloan(s) made to-raeby the
unless you sign and date this Declaration.
lender (which includes any persons exercising functions on
o I confirm that to the best of my knowledge and belief, the behalf of the Secretary of State pursuant to section 23(4) oI
the Teaching and Higher Education Act 1998 as amended
information I have given on this form is true and complete from time to time or successor legislation, 'the Act') will be on
and I understand that if I have given the Student Loans the terms set out in these declarations and in Regulations
Company false information, or have not given them complete which are made under section 22 of the Act as amended
information, I may not receive financial support, any support I from time to time.
have had may be withdrawn and I could be prosecuted.
b lf I breach any of the terms under which any loan(s) will be
o I agree to give the Student Loans Company any additional -
made, I agree that I will be obliged to pay any charges and
information they require to enable them to process my penalties which may apply under the Teaching and Higher
application and agree to tell them immediately if my Education Act 1998 and the Regulations made under that Act,
circumstances change in any way that might affect my as amended from time to time or successor legislation and/or
entitlement to financial support. Regulations.

o I understand that if I do not tell the Student Loans Company I agree to take all future action requested by the lender and
provide the lender with all information required to ensure
about any change in my circumstances, which may affect my repayment, in accordance with the Regulations referred to in
entitlement, I may not be eligible to receive any outstanding paragraph a.
instalments or payments that they have told me about, and
that I may have to repay all or part of the financial support I I agree that from the date I submit this form until the date
have already received in the year. when my loan(s), together with all and any interest, penalties
and charges which apply, is fully repaid I will notify the lender
Note: Where your place of study is in England the term 'the of any changes in the personal details (including National
lender' means the Secretary of State for Business, lnsurance number) and contact details I have provided as
lnnovation and Skills; where your place of study is in Wales required in accordance with the Regulations referred to in
the term 'the lender'means the Welsh Ministers; where your paragraph a.
place of study is in Northern lreland the term 'the lender'
means the Department for Employment and Learning. ln the event that I leave the United Kingdom to reside
outside the United Kingdom or that for any other reason I
am outside the UK tax system, I undertake to inform the
lender in accordance with the Regulations referred to in
paragraph a and I undertake to provide the lender with
my new and any subsequent contact details until my loan,

lf you have applied for a course of study in Wales you should o ln the event that I leave the United Kingdom to reside outside
read the guide to terms and conditions at
www.studentfinancewales.co.uk and the Data Protection the United Kingdom or that for any other reason I am outside the
Statement at www.studentfinancewales.co.u Udataprotection UK tax system, I undertake to inform the lender in accordance
with the Regulations refened to in paragraph k and I undertake
The following Declarations apply to you to provide the lender with my new and any subsequent contact
details until my loan, together with all and any interest, penalties
I declare that: and charges which apply, is fully repaid.

f I acknowledge and agree that any loan(s) made to me by the The following paragraphs apply to ALL students.

lender (which includes any persons exercising functions on I declare that:
behalf of the Welsh Ministers pursuant to section 23(4) of the
Teaching and Higher Education Act '1998 as amended from time p The particulars I have given in this form are correct.
to time or successor legislation, 'the Act') will be on the terms set q I have read and understood the guide to terms and conditions
out in these Declarations and in Regulations which are made
under section 22 of the Act as amended from time to time. available online.

g lf I breach any of the terms under which any loan(s) will be r I acknowledge and agree that in the event that I have: (i)

made, I agree that I will be obliged to pay any charges and reached the age of 18 years; and (ii) have entered into one or
penalties which may apply under the Teaching and Higher more agreements for a loan under section 22 of the Teaching
Education Act 1998 and the Regulations made under that Act, and Higher Education Act 1998 (and relative secondary
as amended from time to time or successor legislation and/or legislation) before I reached the age of 18 years, upon signing
Regulations. this declaration I am agreeing to ratify any and all such student
loans. I understand that ratification of any agreement for a loan
h I agree to take all future action requested by the lender and made with me before I reached the age of 18 years is a statutory
precondition of my eligibility for student support after attaining the
provide the lender with all information required to ensure age of 18 years.

repayment, in accordance with the Regulations referred to in s I undertake to repay the lender any loan(s) made to me, together
paragraph f.
with all and any interest, penalties and charges which apply.
i I agree that from the date I submit this form until the date when
t I agree that any loan(s) made to me as a consequence
my loan(s), together with all and any interest, penalties and
charges which apply, is fully repaid I will notify the lender of any of the acceptance of my application is/are contract(s) between
changes in the personal details (including National lnsurance me and the lender which binds me from the payment to me of the
number) and contact details I have provided as required in first loan advance and that the repayment of any such loan(s),
together with all and any interest, penalties and charges which
j accordance with the Regulations referred to in paragraph f. apply, will be due by me to the lender as a debt.

ln the event that I leave the United Kingdom to reside outside the u I agree that I shall be obliged to make repayment of my loan(s),
United Kingdom or that for any other reason I am outside the UK
tax system, I undertake to inform the lender in accordance with together with all and any interest, penalties and charges which
the Regulations referred to in paragraph f and I undertake to apply, to such address as shall be notified to me in writing and
provide the lender with my new and any subsequent contact that any services in respect of my loan(s) may be provided at
such address or other address(es) as the lender may from time
details until my loan, together with all and any interest, penalties to time determine and that the service of providing the loan is
and charges which apply, is fully repaid. provided at the lender's principal address.

lf you have applied for a course of study in Northern lreland v I agree that any action for repayment and/or in respect of or in
you should read the guide to terms and conditions available
at www.studentfinanceni.co.uk and the Data Protection connection with my loan(s) and/or all and any interest, penalties
Statement at www.studentfinanceni.co.uUdataprotection and charges which apply, will be brought before the ordinary
civil courts and shall be governed by the general rules of civil
The following Declarations apply to you procedure.

I declare that: w I agree that my request for a loan, the loan and the contract

k I acknowledge and agree that any loan(s) made to me by the between me and the lender shall be governed by the taw of the
place of my course of study.
Department for Employment and Learning, 'the lender' (which
includes any person exercising functions on behalf of the x I inevocably agree that the courts of the part of the United
Department for Employment and Leaming pursuant to Article 4
(3) of the Education (Student Support) (Northern lreland) Order Kingdom in which my place of study is situated shall have
1998 as amended from time to time or successor legislation, 'the non-exclusive jurisdiction to hear any action or proceedings
Order') will be on the terms set out in the Loan Request Form arising out of or in connection with the loan and the contract
including these Declarations and in Regulations which between me and the lender and I irrevocably submit to the
are made under Article 3 of the Order as amended from time to jurisdiction of those courts and waive any objection to the
time. jurisdiction of those courts, provided that this shall not limit the
lender's rights to take proceedings against me in any
I lf I breach any of the terms under which any loan(s) will be made, other court of competent jurisdiction.

I agree that I will be obliged to pay any charges and penalties y I understand that the Student Loans Company will check
which may apply under the Education (Student Support) (Nl)
Order 1998 and the Regulations made under that Order, as my National lnsurance number and personal details with the
amended from time to time or successor legislation and/or Department for Work and Pensions (DWP). lf I do not know my
Regulations. National lnsurance number, or if the number I provide cannot be
authenticated, DWP will trace and give my number to the lender.
m I agree to take all future action requested by the lender and
provide the lender with all information required to ensure z lf I have broken the terms of this contract I agree that the lender
repayment, in accordance with the Regulations referred to in
may share information held about me and my account with any
paragraph k. person, including the government or a government agency of
another country, who may assist in establishing my whereabouts
n I agree that from the date I submit this form until the date when and/or in taking action to recover outstanding loan amounts.

my loan(s), together with all and any interest, penalties and
charges which apply, is fully repaid I will notify the lender of any
changes in the personal details (including National lnsurance
number) and contact details I have provided as required in

accordance with the Regulations referred to in paragraph k.

Your fulll rnrame (in BLOCK CAPITALS)

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