HMRC Test

Sponsor Change of Circumstances – Submission Sheet
Other changes to your sponsor details

Your change request has been successfully submitted online. We advise you to retain a copy of this submission
sheet for your records.

You can view the progress and outcome of the request by selecting the ‘Licence summary, applications and services’,
‘Request changes to sponsor details’ then ‘View recent and outstanding change requests’ menu options in SMS.

You must now print this submission sheet, complete the relevant sections (using black ink) and send it to us.

Where a new representative is being appointed or you are notifying us of your intention to surrender part or
the whole of your licence, the sheet must be signed by the current Authorising Officer.

Sponsor organisation name: Health Bridge Limited (t/a Zava)
Application reference: S00895876/157519
Date submitted: January 14, 2020
Type of change: Other

Supporting evidence

Where the change requires you to provide supporting evidence, please tick the relevant documents in the list below
to confirm you have included them with the submission sheet.
You must provide originals or appropriately certified documents with original certification.

[A certified copy is one that includes a signed statement, either by the issuing authority or by a practicing solicitor or
notary. The certifier must confirm that it is an accurate copy of the original document. Please note that for certified
copies, each page of a document submitted must be certified, clearly detailing the certifier’s name, signature and the
organisation he/she represents. If a certifier’s details cannot be verified, the document will be rejected.]

Type of change Supporting evidence

Change in accreditation / registration / inspection status For educational establishments, a copy of the latest
accreditation / inspection report

Change to organisation size / charitable status Confirmation from the registering body of current
status

Please tick the option that applies to this request

Your organisation is subject to the small companies
regime as set out in paragraphs 381 - 384 of the
Companies Act 2006 on GOV.UK

Your organisation has charitable status

Addition of branches or sites Your organisation is not subject to the small
companies regime and does not have charitable status

If new premises rented: lease or rental agreement or
a signed affidavit or letter from a practising solicitor or
notary confirming the details of the lease

If new premises owned: Land Registry document

Addition of linked entities D1 planning permission (Tier 4 only, if teaching to
be conducted on premises)

Affidavit by one of your partners / senior executives
or letter from a practising solicitor or notary confirming
full details demonstrating common ownership or control

Removal of branches, sites or linked entities Annual Report
Digital technology (digitech) application No evidence is required if your are removing branches,
Merger / de-merger / takeover / acquisition / sale of sites or linked entities from your licence. However, if
business you wish to submit any documentation please attach
this submission sheet.
Appointing a representative
Surrender part of licence (please state category or Completed digital technology declaration (available
from appendix A of guidance for Tier 2/5 sponsors)
categories to be surrendered)................................
Surrender whole licence Certified copy of Purchase Agreements with original
Make licence dormant certification

An affidavit signed by one of your partners / senior
executives or letter from a practising solicitor or notary
confirming the sale/purchase

Evidence of TUPE transfer or similar provisions,
including full details of all sponsored migrants
transferring

Other – please state. We will not accept utility bills
or bank statements as evidence of the change
Number of migrants who have transferred from your
licence under TUPE or similar provisions
Number:........

Signed representative and Authorising Officer
declaration (see below)
Reason(s) for surrender or dormancy (please tick
all that apply)

No longer wish to sponsor non-EEA migrants

Business has ceased trading

Insolvency

Business going into administration

Surrendering licence as part of merger / takeover
Evidence required

Signed surrender declaration (see below)

Details of appointed administrator
Number of migrants still sponsored by you or with a
migrant leave application outstanding.
Number:........

All signatures must be original. We will not accept copies or stamped signatures.

Representative declaration

If you are appointing a new representative, the newly appointed representative who is dealing with all matters on
your behalf must read and sign the following declaration. Failure on the part of your representative to sign this
declaration will result in this change not being made.

1. I have been appointed by the organisation to act on their behalf;

2. I confirm that the organisation is a licensed sponsor and any information I provide will be, to the best of my
knowledge and belief, true and correct;

3. I will provide the organisation with all correspondence from the Home Office relating to their licensed sponsor
status;

4. I declare that I am permitted to provide immigration advice and immigration services by section 84 of the
Immigration and Asylum Act 1999; and

5. I am aware that it is an offence under the Immigration Act 1971, as amended by the Immigration and Asylum
Act 1999 and the Nationality, Immigration and Asylum Act 2002 to do an act which facilitates the commission
of a breach of immigration law by an individual who is not a citizen of the European Union, knowing or having
reasonable cause to believe that the act has this effect.

Name: Date:
Representative organisation:
OISC registration number (if applicable):
Signature:
Position in organisation:

Authorising Officer declaration

I hereby declare the above information is, to the best of my knowledge and belief, true and correct.

Name:

Signature: Date:

Position in organisation:

All signatures must be original. We will not accept copies or stamped signatures.

Surrender declaration - to be completed by the Authorising Officer

I confirm that the information provided on this form is accurate and I wish to surrender the whole / part [delete as
appropriate] of my sponsor licence.

Name:

Signature: Date:

Position in organisation:

You must now send this submission sheet, together with any supporting evidence, to the following address
within 10 working days of the date the online request was submitted:

Sponsor Casework Operations
Maintenance Team
Home Office
PO Box 3468
Sheffield
S3 8WA