Student Signature Form - 2013/14
Customer Reference Number:

Forename(s):

Surname:

Student Declaration Our Data Protection Statement sets out who will use the information provided on your application and what they will use it for. Before signing this form please read our statement online at www.studentfinanceni.co.uk/dataprotection This declaration covers all of the student finance available to students for academic year 2013/14. You should read the specific terms and conditions about loans, Childcare Grant and Disabled Students’ Allowances because they will affect you if you apply for them at any time in academic year 2013/14. If you don’t apply for these in academic year 2013/14 their specific terms and conditions will not affect you.

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Your application for financial support may be delayed unless you sign and date 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 If it is not I understand I might be refused financial support, or prosecuted and my financial support withdrawn. • I agree to give my Education and Library Board (ELB) 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 agree that in the event of receiving an overpayment of financial support, I am obligated to repay this in full. Disabled Students’ Allowances (DSA) • I understand that any equipment I receive through DSA must be used for my course of study and my ELB is not responsible for paying any repair costs. Childcare Grant • I understand that if I do not take up my childcare, or if I change to a childcare