Tier 4 (General)

April 2013
Tier 4 Student
This printed application is for informational purposes only.

Please do not send a copy of this application by post, as your official application is submitted online to the UK
Visas and Immigration.
Customise application

Student In Country Customisation

Are you applying from within the UK? Yes

What are you applying for? Tier 4 (General)

Are you eligible to bring dependants with you? No

Is a representative acting for you in relation to this application? No

Who is completing this application? I am

Do you have a BRP? No

Which age group do you belong to? 18 and over

Lead applicant

Personal details

Your personal details

Name as given in your passport or travel document

Title Mr

Family name Nainggolan

Given names Anggi Iqbal

Gender Male

Relationship status Single

Date of birth 27 May 1987

Village, town or city of birth Jakarta

Country of birth Indonesia

Nationality Indonesia

Tell us which other nationalities you currently hold

Do you hold any other nationality? No

Tell us which previous nationalities you have held

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 Have you held any previous nationality? No

Other names that you are known by

Are you currently known by any other name? No

Previous names you have been known by

Have you ever used or been known by another name? No

Contact details in the UK

Where are you currently living?

Address

House number or name 1.2

Street name 11 St. Mungo Avenue

Town or city Glasgow

County Lanarkshire

Postcode G4 0PF

When did you move to this address? 16 June 2014

Your contact details

Landline telephone number <blank>

Mobile telephone number 07539492477

Work telephone number <blank>

Preferred contact number Mobile

Fax number <blank>

Email address [Link]@[Link]

Correspondence address

Is this also your correspondence address? Yes

Reference numbers

Tell us about the reference numbers that have been assigned to you

Have you ever had any UK Visas and Immigration reference numbers Yes
assigned to you?

Do you know this number? Yes

Your UK Visas and Immigration reference number 007066537

Do you have a National Insurance number? No

Have you previously had a National Insurance number? No

Passport or travel document

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 Your passport details

Can you provide a current passport or travel document with your Yes
application?

Is the passport or travel document in your name? Yes

Passport or travel document

Passport or travel document number A4845374

Country of issue United Kingdom of Great Britain and Northern

Ireland

Nationality Indonesia

Date of issue 26 March 2013

Date of expiry 26 March 2018

Issuing authority KBRI London

Have you ever had any other passport or travel document that you have Yes
used to travel to the UK?

Previous passport or travel document

Can you provide a previous passport or travel document with your Yes
application?

Previous passport or travel document

Passport or travel document number S375105

Country of issue Indonesia

Nationality Indonesia

Date of issue 19 September 2008

Date of expiry 19 September 2013

Issuing authority Tangerang

Previous addresses

Please give details of your previous addresses in Northern Ireland and the dates you lived there

Have you previously lived in Northern Ireland? No

Your previous address details

Have you lived at any other address in the UK within the past 5 years? Yes

Your previous address details

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 Address

House number or name 1.3

Street name 15 Grafton place

Town or city Glasgow

County Lanarkshire

Postcode G1 2TD

Date moved to this address 7 December 2012

Date moved from this address 24 August 2013

Personal history

Personal history

Have you been convicted of any criminal offence in the UK or any other No
country?
Do you have any civil judgments against you or any civil penalty under the No
UK Immigration Acts?
Have you ever been charged or indicted in any country with a criminal No
offence for which you have not yet been tried in court?
In either peace or war time have you ever been involved in, or suspected No
of involvement in, war crimes, crimes against humanity, or genocide?
Have you ever been involved in, supported or encouraged terrorist No
activities in any country?
Have you ever been a member of, or given support to, an organisation No
which has been concerned in terrorism?
Have you, by any means or medium, expressed views that justify or glorify No
terrorist violence or that may encourage others to commit terrorist or
other serious criminal acts?

PBS immigration history

Current immigration status

What is your current immigration status in the UK? None of the above

Entry clearance/visa

Did you have a visa/entry clearance when you last applied to come to the Yes
UK?

In which country did you obtain that visa/entry clearance? Indonesia

What is the reference number for that visa /entry clearance (this can be 007065823
found in your passport/travel document)?

Date visa/entry clearance valid from 9 September 2013

Ppt/Travel document not submitted with application

How did you enter the United Kingdom? By air

Port (including airports) at which you entered the United Kingdom Glasgow

Ticket booking or reference number ME5BMN

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 Name of the transport operator Emirates

Previous leave in the UK

Have you ever stayed in the United Kingdom beyond your period of leave? No

Have you ever knowingly used deception when seeking leave to enter or No
remain, entered the United Kingdom illegally or worked in the United
Kingdom without immigration permission to do so (contrary to your
conditions of stay)?
Have you ever been refused entry clearance, leave to enter or leave to No
remain in the UK?

Have you ever been removed, required to leave or deported from the UK? No

Outstanding applications

Do you currently have any other applications with UK Visas and No

Immigration on which you are awaiting a decision?

Outstanding appeals

Do you currently have an immigration appeal before the Tribunal which No

has not yet been determined?

Public funds

Public funds

Have you ever claimed any public funds? No

T4 course details

T4 sponsor details

Sponsor's licence number J5TNG1750

Sponsor name Glasgow Caledonian University

Is this correct? Yes

Sponsor's address

House number or name Glasgow Caledonian University

Street name Cowcaddens Road

Town or city Glasgow

County Lanarkshire

Postcode G4 0BA

T4 course details

Do you have a CAS? Yes

CAS number E4G5YV9D11Y0X8

What is the level of qualification you will be awarded when you NQF7 / SCQF11
successfully complete your course?

Title of your course of study MSc Management

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 Date the course starts 8 September 2014

Date the course ends 18 September 2015

Is the address of your primary site of study the same as your Tier 4 Yes
sponsor's address?

T4 UCAS details

Is your sponsor a Higher Education Institution? Yes

Did you apply for your course through UCAS? No

How can you demonstrate your English language ability? My CAS confirms I speak, listen, read and write in
English to B2 level

Maintenance (funds)

Maintenance (funds)

How much are your course fees as stated on your Confirmation of 10000
Acceptance of Studies (CAS), in pounds sterling?
Have you or your parent(s)/legal guardian(s) already paid any of your Yes
course fees?

How much has been paid? 3500

What evidence are you providing with your application that this amount Information on the CAS
has been paid?
Do you have current leave as a Tier 4 Student, as a Student or as a Yes
Postgraduate Doctor or Dentist?

Have you, during your current period of Tier 4 leave: Started and completed the course of study for
which your current leave was granted?
How long was the course you completed, or if you are still studying, how Less than 6 months
much of your current course have you completed to date?

Where are you intending to study? Outer London or anywhere else in the United
Kingdom
Have you or your parent(s)/legal guardian(s) already paid any money to No
your sponsor for accommodation?

Are you receiving money from an official financial sponsor? No

Are all of the funds in your name? Yes

T4 general attributes

T4 general attributes

What is the level of the course you are applying for? NQF7 / SCQF11

Do you need to obtain permission from the Academic Technology No

Approval Scheme (ATAS)?
Are you being sponsored by a government or international scholarship No
agency - or have you been sponsored by one of these bodies within the
past 12 months?

Supporting documents

Documents for Anggi Iqbal Nainggolan

Evidence of Identity - all of these documents must be submitted

Current passport or travel document. This document is mandatory, if it is not submitted this Yes
application may be rejected as invalid.

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 Previous passport or travel document Yes

Evidence of Identity - this document is mandatory, if it is not submitted this application may be rejected as invalid.

Two passport photographs Yes

Evidence of your finances - if there is any maintenance left to pay, one or more of the following documents must be submitted.

Your personal bank or building society statement Yes

Electronic bank statement and supporting letter. No

Electronic bank statement stamped by your bank Yes

Your building society pass book No

Letter from your bank or building society Yes

Letter from a regulated financial institution confirming funds held No

Letter from a regulated financial institution confirming a loan No

Documents used to obtain your CAS – if your sponsor listed one or more of the following documents on your CAS, each of these
documents must be submitted.

Original certificate(s) of qualifications Yes

Translation(s) of the certificate(s) No

Original transcript(s) of results Yes

Translation(s) of the transcript(s) of results Yes

Declaration

Maintenance for Anggi Iqbal Nainggolan

I need £17380.00 to cover my maintenance (monthly living costs and course fees for the first Yes
year of my course, or for the length of my course if less than one year). I certify that:

• I have paid £3500.00 to my sponsor for my maintenance and, where required, I am providing
specified evidence of this with my application.

• I have £13880.00 available to me in the manner specified in the Immigration Rules for my
remaining maintenance and, where required, I am providing specified evidence of this with my
application.

• All the money I am using is available to me in the manner specified in the Immigration Rules
and is for my living costs in the UK and will remain so available unless used to pay for living costs
in the UK or my course fees.

• When I am providing evidence of cash funds, this money has been held for a consecutive 28
day period ending no more than 31 days before this application.

Declaration

The information I have given in my application is complete and is true to the best of my
knowledge and belief.

The photographs I have submitted with my application are a true likeness of me.

The documents I have submitted in support of my application are complete and correct to the

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 best of my knowledge and belief.

I agree to co-operate with UK Visas and Immigration officials, or any other person charged by
the Secretary of State for the Home Office, with conducting pre-issue and post-issue checks in
relation to my application.

If there is a material change in my circumstances or any new information relevant to my

application becomes available before it is decided, I will inform UK Visas and Immigration.

I am aware that the rules and requirements governing applications may change in the future
and that I should not assume the current rules and requirements will continue to apply.

Please read the following statements and confirm that you agree by placing a tick in the box
below.

• I confirm that I have read and that I understand and agree the above declarations.
• I confirm that the information I have given in this application is complete and is true to the best
of my knowledge and belief.
• I agree to the use of the data provided in this application in accordance with the UK Visas and
Immigration’s Information Charter.
• 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 may be used can be obtained from the Home Office website:

Use of data (opens in a new window)

• I consent to UK Visas and Immigration informing my sponsor of the outcome of my application.

I confirm that I agree to all the above statements Yes

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