Appendix 1 FLR(FP) / FLR(O)
Request for Fee Waiver in order to exercise ECHR rights
You should only complete this form if you are seeking a fee waiver because you think you
meet the published fee waiver policy. This will be because you are destitute, or would
become destitute if you paid the fee, or because there are exceptional circumstances
relating to your financial circumstances which mean that you are unable to pay the fee for
your leave to remain application.
Definition of destitution
You will only be considered to be destitute if:
a)
You do not have adequate accommodation or any means of obtaining it (whether or
not your other essential living needs are met); or
You have adequate accommodation or the means of obtaining it, but cannot meet
your other essential living needs.
b)
Please ensure that you also complete and submit Form FLR (FP) or FLR (O).
If you wish to use a representative to assist you in completing this form, they should be
registered with the Law Society or the Office of the Immigration Services Commissioner.
You should only complete this form if:

You are applying for leave to remain in the UK on the basis of family or private life
under ECHR Article 8 using form FLR(FP); or

You are applying for leave to remain in the UK on the basis of another ECHR article
or articles using form FLR(O); and in either case

You are destitute according to the definition above, or would become destitute if you
paid the fee, or there are exceptional circumstances relating to your financial
circumstances and ability to pay the fee for your leave to remain application.
You must complete every section of this form.
The decision on whether you qualify for a fee waiver will be made on the basis of the
information you provide in this form and the evidence submitted with it. It is up to you to
provide sufficient information and evidence to show that you are destitute, or would become
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April 2015
destitute if you paid the fee, or that there are exceptional circumstances relating to your
financial circumstances which mean that you are unable to pay the fee for your leave to
remain application.
You will need to provide full documentary evidence along with this fee waiver application to
demonstrate your financial circumstances. The nature of this evidence may vary according
to your individual circumstances, but some examples of relevant documents you may wish
to include are stated below. Documents from an official source should be on letter headed
paper. Letters from charities should show the registered charity number. Copies of bank
and savings documents should be certified by the bank/financial institution.
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Please tick the boxes below to show which documents you are enclosing:
Bank statements
Savings account statements
Tenancy agreement or documents relating to your mortgage
Utility and other relevant bills
Letter confirming employment (the person writing should state their position in the
company and contact details)
Pay slips
P60
P45
Letters from a registered charity or Local Authority confirming you are in receipt of
support
Letters from any friends or family who are providing you with support
Letters confirming you or your spouse/partner are in receipt of public funds
Other documents – please specify what they are.
If you are including other documents please give details in the box below:
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This is not an application for leave to remain. It is an assessment as to whether you qualify
for a fee waiver for your separate FLR(FP) or FLR(O) application form. If you are seeking a
fee waiver, you should submit your FLR(FP) or FLR(O) form and this Appendix 1 form at
the same time. The FLR(FP) or FLR(O) may require you to submit additional documentary
evidence.
If you qualify for a fee waiver, we will contact you and provide you with information about
enrolling your biometric data without having to pay a fee. Failure to provide your biometric
data will result in your application being rejected.
If you are granted a fee waiver, this does not guarantee that your application for leave to
remain will be successful.
If you are not granted a fee waiver, your application will be rejected as invalid for nonpayment of the required fee. You may re-apply for a fee waiver enclosing additional
evidence if you think you meet the published fee waiver policy. Alternatively, you may resubmit your FLR(FP) or FLR(O) application form with the relevant fee.
Section 1 – Personal details
Title:
Name:
Surname:
Maiden name or name used on visa if different from above:
Date of Birth (day/month/year):
Nationality:
Which country did you live in before you came to the UK?
Home Office reference number (if known):
Passport or travel document number (if known):
Gender:
Male
Female
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What is your marital status:
Married
Single
Separated
Divorced
Civil partnership
Same Sex Partner
Widowed
Unmarried partner
Dissolved partnership
Surviving Civil partner
Personal details of your spouse/partner
Is your spouse/partner currently in the UK?
Yes
No
Name of spouse/partner:
Date of birth of your spouse/partner (day/month/year):
Nationality of your spouse/partner:
Personal details of your parents
If you are a child aged under 18 please provide details of your parent(s).
Name of parent 1:
Date of birth of your parent (day/month/year):
Nationality of your parent:
Is this parent currently in the UK?
Yes
No
Yes
No
Name of parent 2:
Date of birth of your parent (day/month/year):
Nationality of your parent:
Is this parent currently in the UK?
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Disability
Do you consider yourself to be disabled?
Yes
Are any of your dependent family members disabled?
No
Yes
No
If yes, please provide full details of your or your dependent family member’s disability (and
enclose relevant documentary evidence of this) and of any impact this has on your financial
circumstances:
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Section 2 – Dependent family members
Please complete this section for any children under the age of 18, or any other dependent
family members, who are living with you in the UK.
Details of your dependent family member
Name:
Place of birth:
Date of birth (day/month/year):
Gender: Male
Female
Nationality:
Home Office reference number (if known):
Details of your dependent family member
Name:
Place of birth:
Date of birth (day/month/year):
Gender: Male
Female
Nationality:
Home Office reference number (if known):
If you have more than 2 dependent family members, please provide details on a separate
sheet of paper.
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Section 3 – Your current accommodation
3.1 What address can we contact you at?
House/Flat Number:
Street Name:
Town or City:
:
County:
Post Code:
3.2 Is this where you are currently living? Yes
No
3.3 If yes, when did you move into your current address?
If no, where are you currently living? Please provide the full address. If you are homeless
please state this clearly.
House/Flat Number:
Street Name:
Town or City:
County:
Post Code:
:
3.4 Please provide details of any previous UK addresses:
House/Flat Number:
Street Name:
Town or City:
County:
Post Code:
Continue on a separate page if necessary.
3.5 Have you been asked to leave the accommodation in which you are currently living?
Yes
No
3.6 If Yes, please provide details of why this is:
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3.7 Do you own or rent your home? Please specify:
Own home
Rent home
Neither own nor rent home
3.8 If you do not own or rent your home who presently provides you with accommodation?
Friend
Relative
Refuge
Local Authority
Registered charity
Other
If you have stated “other” please give details in the box below:
3.9 Whom do you live with and what is their relationship to you?
3.10 Do you pay for your accommodation costs or contribute towards them?
Yes
No
If yes, please specify how much you pay, and how regularly you pay this (weekly/monthly):
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3.11 Does anyone support you financially or by providing your essential living needs such
as food? If so, who?
3.12 Are they able to continue supporting you?
Yes
No
If you ticked the “no” box, please explain why.
3.13 Are you homeless tonight?
Yes
No
3.14 Will you be homeless shortly?
Yes
No
If yes, please explain why:
3.15 If yes, on what date will you become street homeless (day/month/year):
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Section 4 – Your financial details
Please note we require evidence of your finances, including bank statements,
building society savings books or other formal documentation in support of your
application for a fee waiver. If you are being supported by a friend or relative, we
require written evidence in the form of a letter confirming this, with formal
documentation showing that person’s financial resources. If you are being
supported by a registered charity or a Local Authority, we also require formal
documentation to evidence this. Please provide full details of exactly what the
support consists of, why you are eligible for such support and when the support
began.
4.1 Have you received any support from friends since arriving in the UK?
Yes
No
If yes, please provide details:
4.2 Have you received any support from relatives since arriving in the UK?
Yes
No
If yes, please provide details:
4.3 Do you have any of the following assets (you must tick any or all of the assets you
have):
Cash savings in the UK or overseas
Money held in a bank account in the UK or overseas
Investments
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Property in the UK
Property outside the UK
Land in the UK
Land outside the UK
Jewellery (except for wedding jewellery)
TV, DVD player, electrical goods
Car or other vehicle
4.4 Can you sell any of these non-cash assets?
Yes
No
4.5 If you ticked yes, please explain why you have not sold the asset. If you ticked no,
please explain why you cannot sell the asset.
4.6 What is the value of each of the assets you ticked in question 4.3?
Please specify the relevant currency:
4.7 If you have money or investments held in a bank account in the UK or overseas,
please provide the name of the bank or building society/other in which the funds are held
and the name of the country in which the account is held:
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4.8 If the bank account(s) held is not in the UK, are you able to access it from within the
UK?
Yes
No
4.9 Please list any other material or monetary assets you own, and their approximate
value:
4.10 Are you currently working in the UK, or do you have a confirmed offer of employment?
Yes
No
4.11 If you ticked yes above because you are working in the UK, please provide details of
the nature of the employment or self-employment:
4.12 If you ticked yes above because you are working in the UK, please provide details of
your employment income and how frequently it is paid (weekly/monthly/annually):
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4.13 If you ticked yes above because you have a confirmed job offer, please provide details
here, including the amount of employment income you expect to earn, and how frequently
this will be paid, and when the employment will begin:
Section 5 – Public funds
5.1 Do you receive any of the following public funds?
You must declare any or all of the following you receive:
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


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Attendance allowance
Carer’s allowance
Child benefit
Child tax credit
Contribution-based jobseeker’s allowance
Contribution-based employment and support allowance
Council tax support
Disability living allowance
Housing benefit
Housing and homelessness assistance
Incapacity benefit
Income-based jobseeker’s allowance
Income-related employment and support allowance
Income support
Personal independence payment
Pension credit
Severe disablement allowance
Social fund payment
State pension credit
Working tax credit
Yes
No
If yes, please state for each public fund you are receiving:
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Type of benefit or
allowance
Date you started
receiving it
(day/month/year)
How often do
you receive it?
How much do you
receive?
Please continue on a separate sheet if necessary.
Section 6 – Spouse/partner/parent financial details
Please note: you need only provide details of your parent(s) if you are living with one or
both of them and they are currently supporting you, or if you are a child aged under 18.
6.1 Is your spouse/partner or either of your parents currently employed or working in the
UK, or do they have a confirmed offer of employment?
Yes
No
6.2 If you ticked yes above because your spouse/partner or either of your parents is
working in the UK, please provide details of the nature of the employment or selfemployment:
6.3 If you ticked yes above because your spouse/partner or either of your parents is
working in the UK, please provide details of their employment income and how frequently it
is paid (weekly/monthly/annually):
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6.4 If you ticked yes above because your spouse/partner or either of your parents has a
confirmed job offer, please provide details here, including the amount of employment
income they expect to earn, and how frequently this will be paid, and when the employment
will begin.
6.5 Does your spouse/partner or either of your parents have any of the following assets
(you must tick any or all of the assets they have):
Cash savings in the UK or overseas
Money held on a bank account, in the UK or overseas
Investments
Property in the UK
Property outside of the UK
Land in the UK
Land outside the UK
Jewellery (except for wedding jewellery)
TV, DVD player, electrical goods
Car or other vehicle
Can your spouse/partner or either of your parents sell any of these non-cash assets?
Yes
No
6.6 If you ticked yes, please explain why they have not sold the asset. If you ticked no,
please explain why they cannot sell the asset.
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6.7 What is the value of each of the assets belonging to your spouse/partner or either of
your parents that you ticked in question 6.5?
Please specify the relevant currency:
6.8 If your spouse/partner or either of your parents has money or investments held in a
bank account within the UK or overseas, please provide name of bank or building
society/other in which the asset is held and the name of the country where these assets
are:
6.9 If the bank account(s) held is not in the UK, is your spouse/partner or either of your
parents able to access it from within the UK?
Yes
No
6.10 Does your spouse/partner or either of your parents receive any public funds?
Yes
No
Question 5.1 has a list of what constitutes public funds. Please refer to this list if you are
unsure.
If Yes, please state for each public fund your spouse/partner is receiving:
Type of benefit or
allowance
Date your
spouse/partner
started receiving it
(day/month/year)
How often
does he or
she receive
it?
How much does he
or she receive?
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Please continue on a separate sheet if necessary.
Section 7 – basis of fee waiver application
7.1 An applicant can qualify for a fee waiver on one of three grounds. Please tick the basis
on which you are applying:
I am destitute because (a) I do not have adequate accommodation or any means of
obtaining it (whether or not your other essential living needs are met); or (b) I have
adequate accommodation or the means of obtaining it, but cannot meet my other
essential living needs.
I am not destitute but I would become destitute if I paid the application fee.
I am not destitute and would not become destitute if I paid the application fee, but I
have exceptional circumstances relating to my financial circumstances which mean I
am unable to pay the fee.
Please provide further details below, and continue on a separate sheet if necessary:
Section 8 – Additional Information
Please provide any additional information that you would like us to take into account in
determining whether you qualify for a fee waiver. Please continue on a separate sheet if
necessary.
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Declaration
I can confirm that I have included all the necessary information and evidence that
supports this application for a fee waiver.
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 make to a person acting in execution of any of those Acts a statement or
representation which I know to be false or do not believe to be true, or to obtain or to seek
to obtain leave to remain in the United Kingdom by means which include deception.
I confirm that I have provided full and complete details of my financial situation and that of
my spouse/partner, and confirm that the information provided is accurate and truthful. I
will notify the Home Office if my circumstances change whilst my application is being
considered.
I understand that all information provided by me to the Home Office will be treated in
confidence; that it may be disclosed to other government departments, agencies, local
authorities, the police, foreign governments and other bodies for immigration purposes or
to enable them to perform their functions; and if such bodies provide the Home Office with
any information about me, which may be relevant for immigration purposes, it may be
used in reaching a decision following this application.
I understand that my details may in certain circumstances be passed to fraud prevention
agencies to prevent and detect fraud and money laundering. I also understand that such
agencies may provide the Home Office with information about me. Further details
explaining when information may be passed to or from fraud prevention agencies and
how that information can be obtained from the www.gov.uk website.
I have completed Section 9 of FLR(O) or sections 15 and 16 of the FLR(FP) which give
consent for the Home Office to request verification checks of the documents I have
supplied.
Signature:
Print Name:
Date:
The consent from the applicant, and friends or relatives of the applicant to allow the Home
Office to verify that information and supporting documentation supplied with FLR(O) and
this form is correct is contained in sections 15 and 16 of the FLR(FP) and section 9 of the
FLR(O). Any friend, relative or other party whom the applicant has stated will provide
financial support and/or is a joint customer with the applicant with a bank or utility
company must ensure that they have also completed sections 15 and 16 of the FLR(FP).
or section 9 of the FLR(O).
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Checklist:
Have you fully completed this form?
Have you enclosed full documentary evidence required by this form?
Have you also enclosed a fully completed FLR(FP) or FLR (O) form? (If not, or if
you have enclosed the wrong form, your application will be rejected).
Sign and Lock>>
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