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Postgraduate Loan Loan Request form Your details Customer Reference Number Full name Date of birth DAY MONTH YEAR / / How to complete this form Read the information below. Complete the form to tell us how much you want to borrow. Remember to read, sign and date the declaration before you return your completed form. Return your completed form to: Student Finance England, PO Box 210, Darlington, DL1 9HJ We ll write to you soon to confirm any changes to your loan amount. Information The maximum loan amount you can borrow is 10,000. The deadline for changing the amount of your loan is nine months from the first day of the final academic year of the. If you are reducing how much you want to borrow you can t ask for less than the amount you ve already been paid. If your is longer than 1 year: You can borrow a maximum of 5,000 in your 1st year and you ll get the rest in your 2nd year. Your total loan is paid over the first 2 years of your even if your is longer than this. /A

How long is your? 1 year You can apply for a Postgraduate Loan of up to 10,000. Go to page 3 Longer than 1 year You can apply for a Postgraduate Loan of up to 10,000. You can borrow a maximum of 5,000 in your 1st year and you ll get the rest in your 2nd year. Remember You ll only receive payments over the first 2 years of your, even if it s a 3 or 4 year. For example: If you request 9,000 in total and you want 3,000 in your 1st year - we ll give you the remaining 6,000 in your 2nd year of study. If your longer than 2 years you won t get any further payments in your 3rd or 4th year. Go to page 4 2

1 year s Only complete this section if you are a 1 year. If your is longer than 1 year go to page 4. Example 1 year s Martha is a 1 year 10,000 Gets it all in 1 year. How much would you like to borrow? the maximum 10,000. another amount? State the amount, Now read, sign and date the declaration on page 5. 3

2, 3 or 4 year s Examples 2, 3 or 4 year s Eric is a 2 year 10,000 Asks for 5,000 in his 1st year Gets the remaining 5,000 in his 2nd year Joanne is a 3 year 7,000 Asks for 2,000 in her 1st year Gets the remaining 5,000 in her 2nd year Peter is a 4 year 6,000 Asks for 0 in his 1st year Gets the remaining 6,000 in his 2nd year Remember You ll only receive payments over the first 2 years of your even if it s a 3 or 4 year. 1st - Tell us how much you d like to borrow in total for your. the maximum 10,000. another amount? State the amount, 2nd - Tell us how much you want to receive in your 1st year of study. Remember The maximum you can receive in your 1st year of study is 5,000 You ll get any remaining amount in your 2nd year. Year 1 How much would you like to receive? the maximum 5,000 another amount? State the amount, Now read, sign and date the declaration on the next page. 4

Declaration You must sign, date and return this form before any payment can be made to you. Before signing and returning your completed form, you should read the data protection statement and terms and conditions of your Postgraduate Loan online at www.gov.uk/postgraduateloan Your application for financial support may be delayed unless you sign, date and return this declaration. General Declaration I confirm that to the best of my knowledge and belief, the information I have provided is true and complete. If it is not I understand I may not receive financial support, any support I have received may be withdrawn and I could be prosecuted. I agree to give the Student Loans Company Limited ( SLC ) any information they require to process my application and agree to tell them immediately if my circumstances change in any way that might affect my entitlement to financial support. I understand that if I do not do this, I may not receive any further payments, and may have to repay the financial support I have already received. I confirm that I am not eligible to apply for in connection with my ; a healthcare bursary, any allowance under the Nursing and Midwifery Student Allowances (Scotland) Regulations 2007, or any allowance, bursary or award of similar description made under section 67(4)(a) of the Care Standards Act 2000. I agree that except in relation to social work bursaries, if I am eligible to apply for, or in receipt of, any such allowance, bursary, or award of similar description while in receipt of a Postgraduate Loan, I am obliged to repay the Postgraduate Loan in full and SLC may take such action as is necessary to obtain such repayment. If I am eligible to apply for a social work bursary from (i) National Health Service (NHS); (ii) Department of Health (DoH) and/or (iii) Student Awards Agency Scotland (SAAS); then in circumstances where I have (i) applied for and not been awarded a social work bursary, I may apply for PGL; (ii) applied for and been awarded a social work bursary, I may not apply for a Postgraduate Loan and in the event of being in receipt of any such Postgraduate Loan, I am obliged to repay the Postgraduate Loan in full and SLC may take such action as is necessary to obtain such repayment. I agree that in the event of receiving an overpayment of financial support, I am obliged to repay this in full and SLC may take such action as is necessary to obtain such repayment. I understand that if I have provided details of my UK passport, SLC will verify those details with Her Majesty s Passport Office. Loan Contract a I confirm I have read and understood the terms and conditions available online at www.gov.uk/postgraduateloan b I acknowledge and agree that any loan(s) made to me by the Secretary of State for Education (the lender ) which includes any persons exercising functions on behalf of the Secretary of State pursuant to section 23(4) of the Teaching and Higher Education Act 1998 as amended from time to time or successor legislation (the Act ) will be on the terms set out in these declarations and in Regulations which are made under section 22 of the Act as amended from time to time. c I acknowledge and agree that in the event that I have: (i) reached the age of 18 years; and (ii) have entered into one or more agreements for a loan under section 22 of the Act (and relative secondary legislation) before I reached the age of 18 years, upon signing this declaration I am agreeing to ratify any and all such student loans. I understand that ratification of any agreement for a loan made with me before I reached the age of 18 years is a statutory precondition of my eligibility for student support after attaining the age of 18 years. d I undertake to repay the lender any loan(s) made to me, together with all and any interest, penalties and charges which apply. e I agree that any loan(s) made to me as a consequence of the acceptance of my application by the lender is a/are contract(s) between me and the lender which binds me from the payment to me of the first loan advance and that the repayment of any such loan(s), together with all and any interest, penalties and charges which apply, will be due by me to the lender as a debt. f I agree that I shall be obliged to make repayment of my loan(s), together with all and any interest, penalties and charges which apply, to such address as shall be notified to me in writing and 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 to time determine and that the service of providing the loan is provided at the lender s principal address. 5

g I agree that any action for repayment and/or in respect of or in connection with my loan(s) and/or all and any interest, penalties and charges which apply, will be brought before the ordinary civil courts and shall be governed by the general rules of civil procedure. h I agree that my request for a loan, the loan and the contract between me and the lender shall be governed by the law of the place of my home address as stated in this application form (or, if my address is outside the United Kingdom, English law). i I irrevocably agree that the courts of the part of the United Kingdom in which my home address stated in this application form is situated (or the English, Scottish and Northern Ireland courts where my address is outside the United Kingdom) shall have non-exclusive jurisdiction to hear any action or proceedings arising out of or in connection with the loan and the contract between me and the lender and I irrevocably submit to the jurisdiction of those courts and waive any objection to the jurisdiction of those courts, provided that this shall not limit the lender s rights to take proceedings against me in any other court of competent jurisdiction. j I agree that from the date I submit this form until the date when 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 Insurance number) and contact details I have provided as required in accordance with the regulations referred to in paragraph b. Customer Reference Number k In 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 b and I undertake to provide the lender with my new and any subsequent contact details until my loan, together with all and any interest, penalties and charges which apply, is fully repaid. l I agree to take all future action requested by the lender and provide the lender with all information required to ensure repayment, in accordance with the regulations referred to in paragraph b. m If I breach any of the terms under which any loan(s) will be made I agree that I will be obliged to pay any charges and penalties which may apply under the Teaching and Higher Education Act 1998 and the regulations made under that Act, as amended from time to time or successor legislation and/or regulations. n I understand that SLC will check my National Insurance number and personal details with the Department for Work and Pensions ( DWP ). If I do not know my National Insurance number, or if the number I provide cannot be authenticated, DWP will trace and give my number to the lender. o If I have broken the terms of this contract I agree that the lender may share information held about me and my account with any person, including the government or a government agency of another country, who may assist in establishing my whereabouts and/or in taking action to recover outstanding loan amounts. DfE Your signature (in ink) X Today s date DAY MONTH YEAR / / 6