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Payment Information Form
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* Indicates required question
Title
*
Your answer
Full name
*
Your answer
What is your sex?
*
Male
Female
Phone Number
*
Your answer
Postcode
*
Your answer
Address
*
Your answer
NI Number
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Name and Address of Bank
*
Your answer
Sort Code
*
Your answer
Account Number
*
Your answer
PLEASE SELECT ONE OF THE FOLLOWING STATEMENTS
A.This is my first job since last April and I have not been receiving taxable Jobseeker’s Allowance or taxable incapacity Benefit or a state or occupational pension.
B.This is now my only job, but since last 6 April I have had another job or have received taxable Jobseeker's Allowance or Incapacity Benefit. I do not receive a state or occupational pension.
C. I have another job or receive a state or occupational pension
*
A
B
C
Email address
*
Your answer
Do you have a student or postgraduate loan?
*
Yes
No
You have Plan 1 if any of the following apply:
• you lived in Northern Ireland when you started
your course
• you lived in England or Wales and started your course
before 1 September 2012
You have Plan 2 if:
You lived in England or Wales and started your course
on or after 1 September 2012.
You have Plan 4 if:
You lived in Scotland and applied through the
Students Award
*
Plan 1
Plan 2
Plan 4
N/A
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