Form Form

FLR(HSMP) FLR(HSMP)
Version 04/2007 Version 04/2007

This form is valid only for applications made on or after 2 April 2007
Application for an extension of stay (limited leave to remain) in the UK as a Highly Skilled
Migrant Programme (HSMP) participant
Payment Slip
Contact Details of Payer
1.Contact name
2.Contact address

3.Postcode
4.Your reference
(See paragraph 23 of the Payment Guidance Notes)

Details of the applicant(s)

5.Total number of applications (1-10) Please supply details of each application below
6.How many applications are to be: Paid for exempt
Tick the
7.Applicant’s surname Date of birth Number of appropriate box
(Please print) (dd/mm/yyyy) Passports PRCs Paid for Exempt
01
02
03
04
05
06
07
08
09
10

Payment details – please complete where appropriate

Please make payable to:
8.Preferred method of payment UK Postal order Cheque Home Office, Work Permits (UK)
Account No Sort code Cheque No

Or please debit my Visa Mastercard Delta Maestro UK

9.Amount paid £
10.Name on card
11.Card number
12.Card details Valid from / Expiry date /
Issue No. CVV No.
(Maestro UK only) (On rear of card)

13.Signature (card payment only) Date

FLR(HSMP) Version 04/2007 Page 1 of 18 Over 

Form Form
FLR(HSMP) FLR(HSMP)
Version 04/2007 Version 04/2007

This form is valid only for applications made on or after 2 April 2007
Application for an extension of stay (limited leave to remain) in the UK as a Highly Skilled
Migrant Programme (HSMP) participant
This application should be completed in English using BLOCK CAPITALS and BLACK INK.
Section 1: Type of Application – ALL applicants must complete this section.
1.Is this application to be: Paid for Exempt from payment (Please indicate by ticking relevant box)

2.Please indicate by ticking the relevant box, whether you are:

a)Currently in the UK within an immigration category other than HSMP and seeking an initial period of leave
as an HSMP participant.
If so, you will need to complete the following sections of this application form:
1, 2, 3, 4 (if applicable), 5, 6, 11, 12, 13 (if applicable), 14 and 15.

b)Already in the UK as an HSMP participant and seeking to extend your leave in this category.
If so, you will need to complete the following sections of this application form:
1, 2, 3, 4 (if applicable), 5, 6, 7, 8 (if applicable), 9, 10, 11, 12, 13 (if applicable), 14 and 15.

Section 2: Personal Details of Applicant – ALL applicants must complete this section.

3.Title Mr Mrs Miss Ms Other (please state)

4.Surname/family name
5.Surname/family name at birth (if different)
6.First names
7.Gender Male Female
8.Date of birth Day Month Year
9.Nationality
10.Passport number
11.Address in the UK, including postcode
(Please let us know immediately if this changes)

12.Your daytime telephone number (if you have one)

13.Your email address (if you have one)
14.Name of your employer
(if applicable)

15.Your job title

16.Your HSMP reference number

17.Your Home Office reference number

(if you have one)

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Section 3: Immigration Status – ALL applicants must complete this section.
18.From which British Diplomatic post overseas did you
obtain entry clearance and/or a visa?

19.What is your current immigration status in the UK?

(If you are currently in the UK within an immigration category other than HSMP, please check Section 1 of
the Guidance Notes to ensure that you can change your immigration status)

20.When does your current leave expire? Day Month Year

Section 4: Details of your family – Applicants must complete this section where applicable.
21.If you have a partner and/or children under the age of 18 currently living with you in the UK and you are
applying on their behalf for an extension of stay as your dependants, please give their details below.
Name Date of birth Nationality Passport number
Relationship
(dd/mm/yyyy) to you

Section 5: Your Home and Finances and Sponsorship

22.Is your home in the UK: Owned by you?
Rented from a local authority by you?
If so, please give details

Privately rented by you?

Owned or rented by a relative or friend?
Other (please give details)

23.Do you or your partner (or both) pay any mortgage or rent for your home? No Yes
If you have answered yes, how much do you or your partner (or both) pay each month? £
24.Are you receiving any public funds? No Yes
(See Section 3 of the Guidance Notes for a definition of public funds under the Immigration Rules)
If you have answered yes, what are you receiving?
25.Are you working in the UK? No Yes
If you have answered yes, what is your net pay each month? £
26.Does a relative or friend regularly give you money? No Yes
If you have answered yes, how much money do you receive each month? £
27. If you are currently in the UK as a student, postgraduate doctor, postgraduate dentist or a
Fresh Talent: Working in Scotland scheme participant, are you receiving, or have you
No Yes
received for your recent studies in the UK, sponsorship from the British Government, any
other government, or an international scholarship agency?
If you have answered yes, provide written confirmation from your sponsor giving consent to this employment.

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Section 6: Personal History – ALL applicants must complete this section.
You must answer all the questions in this section on behalf of yourself and any dependants included in this application.
It is an offence under Section 26(1)(c) of the Immigration Act 1971 to make a statement or representation which you
know to be false or do not believe to be true. Information given will be checked with other agencies.
28.Do you or any dependants included in this application have any criminal convictions in the UK Yes No
or any other country (including traffic offences) or any civil judgments made against you?

If you have answered Yes to question 28 above please give details below for each criminal conviction and/or civil
judgment, starting with the most recent one - but first see Note 1 about criminal convictions. If you or any
dependants included in this application have received more than two sentences and/or civil judgments, give details
on a copy of this page and enclose it with this form.

Note 1 Convictions spent under the Rehabilitation of Offenders Act 1974 need not be disclosed. More information
about this Act is given towards the end of this section.
Name of person convicted or against whom a civil
judgment was made
Nature of the criminal offence or the civil action (give
details on a separate sheet and enclose it with this
form if you need more space)

Date of sentence/judgment
Details of the sentence or civil judgment (give details
on a separate sheet if you need more space)

Country where the sentence was passed or the civil

judgment was made

Name of person convicted or against whom a civil

judgment was made
Nature of the criminal offence or the civil action (give
details on a separate sheet and enclose it with this
form if you need more space)

Date of sentence/judgment
:
Details of the sentence or civil judgment (give details
on a separate sheet if you need more space)

Country where the sentence was passed or the civil

judgment was made
For help in answering the questions below, please see the definitions on the next page.

29.Have you or any dependants included in this application ever been charged in any country Yes No
with a criminal offence for which you have not yet been tried in court?

30.In times of either peace or war have you or any dependants included in this application ever Yes No
been involved, or suspected of involvement, in war crimes, crimes against humanity or
genocide?
31.Have you or any dependants included in this application ever been involved in, supported or Yes No
encouraged terrorist activities in any country?

32.Have you or any dependants included in this application ever been a member of, or given Yes No
support to, an organisation which has been concerned in terrorism?

33. Have you or any dependants included in this application ever, by any means or medium, Yes No
expressed views that justify or glorify terrorist violence or that may encourage others to
terrorist acts or other serious criminal acts?

34.Have you or any dependants included in this application ever engaged in any other activities Yes No
which might indicate that you may not be considered to be persons of good character?

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Section 6: Personal History (continued)
35.If you have answered Yes to question 29, 30, 31, 32, 33 or 34 above please give further details in the space
provided below. If you need more space, continue on a separate sheet.

REHABILITATION OF OFFENDERS ACT 1974

The Rehabilitation of Offenders Act 1974 enables criminal convictions to become 'spent' or ignored after a
'rehabilitation period'. The length of the rehabilitation period depends on the sentence given. For a custodial
(prison) sentence the rehabilitation period is decided by the original sentence, not the time served. Prison
sentences of more than two and a half years can never become spent and should always be disclosed. Further
information on rehabilitation periods can be found at Nacro's Resettlement Plus Helpline on 0207 840 6464 or by
obtaining a free copy of their leaflet on 0207 840 6427.
DEFINITIONS
For the purposes of answering questions 33 and 34, the following information provides guidance on actions
which may constitute war crimes, crimes against humanity, genocide or terrorist activities.
This guidance is not exhaustive. The full definitions of war crimes, crimes against humanity and genocide can be
found in Schedule 8 of the International Criminal Court Act 2001 at
www.opsi.gov.uk/acts/acts2001/20010017.htm or purchased from The Stationery Office (telephone 0870 600
5522). It is your responsibility to satisfy yourself that you are familiar with the definitions and can answer the
questions accurately on behalf of yourself and any dependants included in this application.
War crimes
Grave breaches of the Geneva Conventions committed during an armed conflict. This includes an internal armed
conflict and an international armed conflict. The types of acts that may constitute a war crime include wilful
killing, torture, extensive destruction of property not justified by military necessity, unlawful deportation, the
intentional targeting of civilians and the taking of hostages.
Crimes against humanity
Acts committed at any time (not just during armed conflict) as part of a widespread or systematic attack, directed
against any civilian population with knowledge of the attack. This would include offences such as murder,
torture, rape, severe deprivation of liberty in violation of fundamental rules of international law and enforced
disappearance of persons.
Genocide
Acts committed with intent to destroy, in whole or in part, a national, ethnical, racial or religious group.
Terrorist activities
Any act committed, or the threat of action, designed to influence a government or intimidate the public and made
for the purposes of advancing a political, religious or ideological cause and that involves serious violence against
a person; that may endanger another person’s life; creates a serious risk to the health and safety of the public;
involves serious damage to property; is designed to seriously disrupt or interfere with an electronic system.
Organisations concerned in terrorism
An organisation is concerned in terrorism if it commits or participates in acts of terrorism; prepares for terrorism;
promotes or encourages terrorism (included the unlawful glorification of terrorism); or is otherwise concerned in
terrorism.
If you are currently in the UK within an immigration category other than HSMP, please go to Section 11.
If you are already an HSMP participant and are seeking to extend your leave in this category, please
continue to the next section.

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Section 7: Points Scoring Assessment (Only complete this section if you are already in the UK as an
HSMP participant and are seeking to extend your leave within this category)
Before an extension of your limited leave to enter/remain in the UK under the Highly Skilled Migrant Programme can
be granted, in addition to meeting all the other immigration requirements for a grant of leave in this category, you will
need to establish that you qualify for the award of a minimum of 75 points under the Points Scoring criteria
associated with HSMP extensions. This section of the application form requires you to state the number of points
you are claiming under each of the available points scoring areas, and to specify the documentation submitted with
your application as evidence that you qualify for the award of the points claimed.

If your initial HSMP approval was granted under either the MBA Provision of HSMP, or under the GP Priority
Application category, you will need to meet the full point scoring assessment at extension. (Further advice on this
point can be found in Section 3 of the guidance notes that accompany this application form).

When completing this part of the application form, you should refer to Annex B of the accompanying guidance notes
for applicants.

Please note, you must submit the documentation specified on the application form in respect of any points being
claimed. Documents submitted must be original. We may seek to verify the documents provided. If this is not
possible it may lead to refusal of the application.

If you have previously sent in evidence to gain points for your HSMP status approval, it is not necessary for you to
re-submit that information for any subsequent HSMP applications. If you have gained higher qualifications or have
evidence which may enable you to claim more points when applying for an extension to your leave, you may submit
fresh examples of the required evidence.

QUALIFICATIONS
Points Claimed:

You can claim points for the highest level educational qualification that you hold. This qualification must be
equivalent to the recognised standard of UK Bachelors, Masters or PhD.
36.Please tick one box only to indicate the points being claimed in this area:

PhD* 50 points

Masters* 35 points

Bachelors* 30 points

(* or equivalent vocational or professional qualification)

37.Please provide details of your higher education, vocational or professional qualifications for which you wish to claim
points:
Qualification Subject Date of Award Awarding Body

Evidence Provided:

You must provide your original degree certificate or original professional/vocational award certificate in support of
points claimed. Where you are claiming points for an equivalent professional or vocational qualification, you must
also provide evidence from the appropriate UK professional body to confirm its equivalence to a UK qualification

If you are applying to extend existing leave under HSMP and have previously submitted an original document in
support of an earlier HSMP application, you will not need to provide this document again.

If you are already here under HSMP and have gained a higher qualification than previously submitted for which you
wish to claim points, you must provide your original degree certificate or original professional award certificate in
support of your claim.

Questions continue on next page

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 38.Please tick the relevant boxes to indicate what evidence you have supplied:

Original Certificate Letter from UK professional body

confirming equivalency of
professional/vocational qualification
Evidence not included as original
certificate provided with previous HSMP
application

39.Exceptional circumstances: If your certificate has yet to be issued, or if you have other compelling reasons for
being unable to submit your award certificate please state your reasons in the box below. You must also provide
evidence to support your request for exceptional consideration.

If you are unable to submit your award certificate and you have explained your reasons above, you must provide:

For academic qualifications both pieces of evidence stated below:

Original letter from institution
Original academic transcript:
confirming award:

For professional qualifications both pieces of evidence stated below:

Original letter from awarding Letter from UK professional body
institution: confirming equivalency of qualification:

PREVIOUS EARNINGS FROM YOUR WORK

Points Claimed:
You can claim points for your previous earnings obtained from your work. The period over which your earnings will
be assessed will depend upon how long you have already been in the UK under HSMP.

Please ensure that you provide contact details for each previous employer. This should include the name and
address of each employer, a named contact to confirm the information and the telephone number, fax number and
e-mail address of the employer.

If your previous grant of leave to enter/remain under HSMP was for a period of more than 12 months:

You can claim points for previous earnings from your work over a period of 12 months out of the 15 month period
directly preceding the date of your application.

If your previous grant of leave to enter/remain under HSMP was for a period of 12 months or less:

You can claim points for previous earnings from your work over a period of 8 months out of the 12 month period
directly preceding the date of your application.
40.Was your previous grant of leave under HSMP for a Yes, go to question 41 No, go to Question 44
period of more than 12 months?

41.Please give details of the period for which you are claiming points (this must be a period of 12 months within the 15
months directly preceding the date of your application.)

Start date of earnings period claimed for:

End date of earnings period claimed for:

Questions continue on next page

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 42.Please tick one box only to indicate the points being claimed for previous earnings during the above period:

£40,000 + 45 Points £23,000 - £25,999 20 Points

£35,000 - £39,999 40 Points £20,000 - £22,999 15 Points

£32,000 - £34,999 35 Points £18,000 - £19,999 10 Points

£29,000 - £31,999 30 Points £16,000 – £17,999 5 Points

£26,000 - £28,999 25 Points

43.If any of the earnings for which points are being claimed were earned overseas, please provide a breakdown of
overseas and UK earnings, by completing the following boxes:
Previous earnings in the UK: £

Previous earnings overseas: £

(Please note, the earnings detailed in the boxes above must be provided in pounds sterling and should add up to
the total earnings for which points are being claimed, as indicated in question 42.)

(Now go to Question 45 below)

44.Please give details of the period for which you are claiming points (this must be a period of 8 months within the 12
months directly preceding the date of your application.)
Start date of earnings period claimed for:
End date of earnings period claimed for:
45.Please tick one box only to indicate the points being claimed for previous earnings during the above period:

£26,500 + 45 Points £15,300 - £17,299 20 Points

£23,300 - £26,499 40 Points £13,300 - £15,299 15 Points

£21,300 - £23,299 35 Points £12,000 - £13,299 10 Points

£19,300 - £21,299 30 Points £10,650 – £11,999 5 Points

£17,300 - £19,299 25 Points

46.If any of the earnings for which points are being claimed were earned overseas, please provide a breakdown of
overseas and UK earnings, by completing the following boxes:

Previous earnings in the UK: £

Previous earnings overseas: £

(Please note, the earnings detailed in the boxes above must be provided in pounds sterling and should add up
to the total earnings for which points are being claimed, as indicated in question 45.)
Questions continue on next page

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 Evidence Provided:

You must provide the documents specified below. Please refer to Annex B of the guidance notes for applicants for
further information on claiming points under Previous Earnings.

If you are claiming points for previous earnings where you have had more than one job, several part-time jobs,
employment and other business activities etc., you will need to provide the required evidence in respect of each of
the jobs/business activities for which you are claiming points.

Evidence of Salaried-Earnings:
47. If any of the earnings for which you are claiming points are from salaried employment, you will need to supply your
Income Tax Return (P60) and wage slips to cover the full period for which you are claiming points.

Please tick the relevant boxes to confirm what evidence you have supplied in respect of salaried earnings covering
the period for which points are being claimed:
Original wage slips covering period claimed for:

Income Tax Return covering period claimed for:

48.Exceptional circumstances: if you are unable to supply either or both of the documents listed above to cover the
full period claimed, and you have compelling reasons for being unable to submit this evidence, please state your
reasons in the box below. You must also provide evidence to support your request for exceptional consideration.

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49. If you have completed Question 48 above, you must also supply either one of the documents listed below (where
you have been able to supply one of the documents listed above) or both of the documents listed below (where
you have been able to provide neither of the documents listed above).

Please tick the relevant boxes to indicate what alternative evidence you have supplied in respect of salaried
earnings for the period claimed:
Bank statements covering period claimed for:
Letter from your employer stating salary as claimed:

50.If you have been in employment as an independent contractor, and you do not have wage slips for the period
claimed, you must supply each of the four pieces of evidence listed below, covering the period for which points are
being claimed.

Please tick the relevant boxes to confirm that you have supplied each of the documents required below:
Income Tax return covering period claimed for:
Copies of contracts over the period claimed for, showing the full amount
of earnings claimed:
Invoices to cover the period claimed for, showing the full amount
claimed:
Bank statements to cover the period claimed for, showing the full amount
claimed:
Evidence of Self Employed Earnings:
51.If any of the earnings for which you are claiming points are the result of business/self employment activities, you
must supply both of the following pieces of evidence to cover the full period for which points are claimed:

Please tick the relevant boxes to confirm that you have supplied each of the documents required below:

Applicant’s Income Tax Return covering period claimed for:

Applicant’s Bank statements covering period claimed for:
Questions continue on next page

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 52.In addition to the documents required at Question 51 above, to claim points for self employed/business earnings,
you must also supply one of the following combinations of documents to cover the full period for which points are
claimed. Please tick the relevant box to confirm which of the combinations of documents you have supplied:

A)Company audited accounts and Company Tax Return (one of these documents should confirm
payment of the total amount claimed); or
B)Unaudited business/management accounts confirming the total amount that you are claiming
and either:
• Business bank statements and a business tax return; or
• Copies of contracts totalling the full amount payable and corroborating invoices
detailing your payment
UK EXPERIENCE
Points Claimed:

You can claim points in this area if you are claiming points under the Previous Earnings points scoring area above.
Points will be awarded in the following circumstances:

If your previous grant of leave to enter/remain under HSMP was for a period of more than 12 months:

At least £16,000 of the previous earnings for which you have claimed points in the previous section, were earned in
the UK.

If your previous grant of leave to enter/remain under HSMP was for a period of 12 months or less:

At least £10,650 of the previous earnings for which you have claimed points in the previous section, were earned in
the UK.

No additional evidence is required in this area. You must however complete Question 53 to claim the points
available for UK Experience.

53. If you are claiming points for UK Experience, please indicate this by ticking the following box: 5 Points

AGE ASSESSMENT

Points Claimed:
You can claim points in this area if you are younger than 34 years of age at the time you submit your valid
application to Work Permits (UK).
54. Please tick one box only to indicate the points being claimed in this area:

29 or under 20 points
30 or 31 10 points
32 or 33 5 points

Evidence Provided:
You are required to submit your current passport or other travel document with your application. This should suffice
also as evidence of your age, for the purposes of awarding points in this area.
TOTAL POINTS CLAIMED
55.Please complete the following table, to confirm the points being claimed under each of the points scoring attributes:

Attribute Qualifications Previous earnings UK Experience Age Assessment Total

Points
Claimed
IMPORTANT
• If you have claimed 75 points or more, do not complete the next section, but go straight to Section 9.
• If you have failed to claim 75 points and are Self Employed, go to Section 8
• If you have failed to claim 75 points and are in employment, do not continue to complete this
application form, but refer to Paragraph 100 of the guidance notes for further advice.

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Section 8: Transitional Arrangements for Self Employed Persons (HSMP extension applications only)
These arrangements allow for a further period of leave to be granted to applicants who have failed to meet the
minimum 75 points required under the Points Scoring Assessment but who are able to demonstrate that they
have established themselves in business in the UK during their preceding period of leave under HSMP.

Where an applicant can establish that they meet the requirements laid out in this Section of the application
form, this will be accepted in lieu of the points scoring requirement laid out in Section 7 above. Applicants must
however, in all cases, complete Section 7 of the application form in addition to Section 8.

Please note – Even where the requirements of this Section of the application form are met, the applicant must
also satisfy the other immigration requirements for a further grant of limited leave to remain under HSMP.
These include a separate mandatory English Language requirement (set out in Section 9 of the application
form), which must be satisfied before a further period of leave under HSMP can be granted.
Please complete the following three questions:
56.Was your last approval under HSMP granted prior to 8 November 2006? Yes No
57.Are you currently engaged in self employment/business activities in the UK? Yes No
58.Have you completed Section 7 of this application form and failed to meet 75 points? Yes No
• If you have responded YES to each of the above questions you should complete the rest of Section 8.
• If you have not responded YES to each of the above questions, you are not eligible to have your
application considered under these transitional arrangements and should refer to paragraphs 99–105 of
the guidance notes for further advice.
Requirements:
Under this Section of the application, you must provide evidence to establish each of the following:
• You have, during your preceding period of leave under HSMP, set up your own business, either singly or with
others; and
• Your business has been established and actively trading for at least the last four months prior to your
application; and
• Your business has ongoing contractual/business commitments to cover at least the next six months.

Evidence Provided:
59.To establish you satisfy the requirements outlined above, you must provide each of the following documents.
Please tick the relevant boxes to confirm these documents have been supplied.

Registration documents with HMRC confirming you are registered for tax:
Copies of contracts and invoices for services delivered, covering at least the last four months:

60.The following documents must also be provided, where available. Please tick the relevant boxes to indicate
whether these documents have been supplied:
Copies of documents establishing contractual/business commitments covering the next six months:

A business plan/business projections covering a period which includes the next six months:
61.If the documents detailed at Question 60 above are not available, you may provide the following alternative
documentation. Please tick the relevant boxes to indicate whether these documents have been supplied:

Draft management/business accounts:

Plus two of the following:

Utility Bills showing the name of your business:

VAT Return:

Company Registration certificate with Companies House:

Copies of any registration documents (such as Local Health

Authority Registration):

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 Lease of Premises for business use:

Insurance documentation for your business:

Section 9: English Language Requirement (HSMP extension applications only)

Before an extension of your limited leave to enter/remain in the UK under the Highly Skilled Migrant Programme can be
granted, in addition to meeting all the other immigration requirements for a grant of leave in this category, you will need
to establish that you satisfy the mandatory English Language Requirement.

You will need to provide the required evidence of your English Language ability (as set out below) even if you are a
national of a country where the main language is English.

Annex D of the FLR(HSMP) Guidance Notes provides further advice on completing this section of the application form.

Required Qualification
62.To satisfy the English Language Requirement, you must demonstrate that you possess one of the following English
Language qualifications. Please tick the relevant box below to indicate which of these qualifications you possess.
(If you do not possess either, please go straight to question 66)
International English Language Testing System (IELTS), Band 6

Bachelors Degree, equivalent to UK Bachelors, taught in English

Required Evidence

63.Please tick the relevant box(es) to indicate what evidence you have supplied in respect of your English Language
qualification:
International English Language Testing System (IELTS), Band 6

Original IELTS Report Form at Band 6

Bachelors Degree, Equivalent to UK Bachelors, taught in English

Original letter from awarding body
Original Degree Certificate And
confirming degree was taught in English
Exceptional Circumstances

64. If your degree certificate has not yet been issued, or you have other compelling reasons for being unable to
submit your degree certificate, please state your reasons in the box below:

65. If you have completed question 64 above, you must provide the following documents. Please tick the appropriate
boxes to confirm that you have supplied these documents.
Letter from Awarding Institution confirming award of
And Academic Transcript
UK Bachelors level qualification taught in English

Alternative English Language Qualification

66. If you do not possess either IELTS 6, or a Bachelors degree, equivalent to a UK Bachelors degree, taught in
English, but possess an alternative English Language Qualification that is of an equivalent level to IELTS 6, Work
Permits (UK) will consider this. Only where UK NARIC is able to confirm that the qualification is of an equivalent
level to IELTS 6 will the English Language requirement be considered to have been met.
Please provide details of the alternative English Language qualification supplied below:

Qualification (including level) Awarding Body Date of Award

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 Please tick the following box to confirm that the original certificate issued in respect of the qualification detailed
above, has been supplied with your application:

Section 9: English Language Requirement (continued)

English Language Requirement - Transitional Arrangements

67.If you do not currently possess an English Language qualification to satisfy the requirements under this
Section, but are intending to arrange an IELTS Band 6 test within the next ten weeks, please tick the following
box:

IMPORTANT – The English Language requirement above is mandatory. If you do not possess a qualification
that satisfies this requirement, and have not ticked the box at question 67 above, your application will be
refused.

Section 10: Additional Information (HSMP extension applications only)

This section of the application form contains a series of questions that relate to economic activities undertaken by you
during your period of approved leave to enter/remain in the UK under the Highly Skilled Migrant Programme to date.
The questions contained within this section of the form will not be used to assess your application, and are used for
monitoring purposes only.

68.What is your current profession?

69.What business sector are you currently working in?

(please tick one of the following boxes):

Administration, Business and Management Services Agricultural Activities

Construction and Land Services Education and Cultural Activities

Entertainment and Leisure Services Financial Services

Health and Medical Services Hospitality and Catering

Information Technology Law and Related Services

Manufacturing Public sector/Not-for-profit

Retail and Related Services Science and Engineering

Sporting Activities Telecommunications

Other

70.Are you self-employed? Yes, go to question 71 No, go to Section 11

71.How many people do you employ in the UK? (state number)

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Section 11: Documentary Evidence. ALL applicants must complete this section.

• The documents and photographs required in support of your application, as well as those of any
dependants included in the application, are listed below.
• You only have to provide those that are relevant to your application.
• Tick the boxes next to the relevant items to show the documents and photographs you are sending.
Please note: In addition to the documents listed below, if you are already in the UK under HSMP and are
seeking to extend your leave in this category, you will need to submit additional documentation to
support your claim for points under Section 7 of this application form or (where applicable) to support
statements made under Section 8. You will also need to provide the documentation required to establish
that you meet the mandatory English Language Requirement laid out at Section 9 of this application form.
Please refer to the guidance notes to check what additional documentation you will need to submit with
your application for these purposes.

Two recent passport-sized photographs of yourself with your name written on the back of each photograph.
Two recent passport-sized photographs of each dependant applying for an extension of stay in the UK included in
this application, with their name written on the back of each photograph.

Your current passport or travel document – if you last entered the UK on a previous passport or travel document
please also provide this document if you have it.

Current passport(s) or travel document(s) for each dependant applying for an extension of stay in the UK and
included on this application form – if they last entered the UK on a previous passport(s) or travel document(s),
please also provide these documents if you have them.

Your police registration certificate (if you have been asked to register with the police)

The police registration certificate(s) of each dependant applying for an extension of stay in the UK (if they have
been asked to register with the police) included on this application form.

A full birth certificate (ie one that shows the parents’ name) for each dependant child included on this application,
for whom you are applying for an extension of stay in the UK.

Your marriage certificate/civil partnership document, if you are applying for an extension of stay in the UK for your
spouse/civil partner.

If you are not married or in a civil partnership and you are applying for an extension of stay in the UK for a partner
(opposite-sex or same-sex), you should provide document(s) showing that you and your partner have been living
together in a relationship akin to marriage or civil partnership, which has subsisted for 2 years or more.

If you are changing your immigration category from that of a student, you should send your original degree
certificate.

If you have answered yes to question 27, you should send written confirmation from your sponsor giving consent to
you remaining in the UK to undertake this employment.

Evidence that you have the funds to maintain and accommodate yourself and any dependants without recourse to
public funds. The evidence must be formal documents such as bank statements, a building society passbook, or
wage slips (but do not send us cheques, travellers cheques or credit cards). If a relative or friend is supporting you,
the evidence should be a letter from him/her confirming this together with formal documents showing their financial
situation. (The documents provided should cover at least the last 3 months.)

If you are unable at present to send us any documentation or photographs specified please explain your reasons
below:

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Section 12: Applicant's Declaration – ALL applicants must complete this section.

You must now read the declaration below and sign it. It must be signed by you (the applicant) and not by a
representative or other person acting on your behalf.
• I hereby apply for an extension of stay in the UK for myself, and any dependants listed in this form.
• The information I have given in this form is complete and is true to the best of my knowledge.
• I declare that the photographs submitted with this form are a true likeness of myself and any dependants
included in the application, as named on the back of each photograph.
• I confirm that if, before this application is decided, there is a material change in my circumstances or new
information relevant to this application becomes available, I will inform Work Permits (UK).
• I understand that all the information provided by me to the Home Office will be treated in confidence but 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.

• I understand that the Border and Immigration Agency may also use the information provided by me for
training purposes.
• I agree to co-operate with Work Permits (UK) officials, or any other officials charged by the Secretary of
State for the Home Department, with conducting pre issue and post issue checks on compliance with the
immigration employment document application.
• I am aware that the rules and regulations governing leave applications may change in the future and I do not
assume that the requirements covering any future applications will be the same.
• 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 seek to obtain leave to remain in the United Kingdom by means which include deception.

Please tick this box if you do not wish to receive further information and publicity from the Home Office.

Your signature Date

Name (CAPITALS please)

Would you like correspondence and documents relating to this application to be sent to your Yes No
employer or representative?

If you answer yes please get them to complete the declaration on the next page.

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Section 13: Representative/Employer Declarations
If a representative or your employer is dealing with this application on your behalf, please complete the details below.
Name of your employer or representative company
Address (including post code)

Name of contact (if different from below)

Telephone number
Fax number
E-mail address
This declaration MUST be signed by an employer or representative.
• I have been appointed by the applicant to make this application.
• I confirm that the applicant has completed and signed the application, and that the application is, to the best of my
knowledge and belief, true and complete.
• Once the application is decided I will provide the applicant with all correspondence from you relating to your
decision.
• I declare that I am permitted to provide immigration advice and immigration services by section 84 of the
Immigration and Asylum Act 1999.
• 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 do an act which facilitates the commission of a
breach of immigration law by an individual who is not a citizen of the European Union, knowing or having
reasonable cause to believe that the act has this effect.
• I am (tick as appropriate)

Registered or exempted by the Office of Immigration Service Commissioner (OISC)

My OISC number is:
Authorised to practice by a designated professional body or supervised by such a person
• The Law Society • The General Council of the Bar
• The Law Society of Scotland • The Faculty of Advocates
• The Law Society of Northern Ireland • The General Council of the Bar of Northern Ireland
• The Institute of Legal Executives
Designated professional body is:
My supervisor is (if appropriate):
Registered with or authorised by an EEA body responsible for regulation of the provision of legal advice in that
EEA state; or employed or supervised by the person registered as defined in section 84(2) (d), (e) and (f).
The registered or authorised EEA body is:
My supervisor is (if appropriate):
Within a category of person specified in an Order made by the Secretary of State under subsection 84(4)(d) of
the Immigration and Asylum Act 1999.

Please tick this box if you do not wish to receive further information and publicity from the Home Office.

Signed Date

Name (CAPITALS please)

Position
For and on behalf of (the representative/employer)

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Section 14: Document Checklist – ALL applicants must complete this section.
• Please complete this part of the form, as it will help us (a) to make sure that we have received the documents
which you have supplied and (b) to keep a record of them while they are in our possession. The list of
documents is a standard one showing the main documents received with applications for which there is a fee.
You are only expected to provide those which are relevant to your application as specified in Section 11:
Documentary Evidence of the FLR(HSMP) form.
IMPORTANT - In addition to the documents listed in Section 11 above, if you are already in the UK under
HSMP and are seeking to extend your leave in this category, please ensure you check what additional
documents you must submit to support your claim for points under Section 7 of this form or (where applicable)
to support statements made under Section 8. Please also ensure that you check what documents you must
submit to establish that you satisfy the mandatory English Language Requirement set out at Section 9 of this
application form.
• In the left hand of the box below, please enter as directed the number of documents of the kind described
which you have provided with your application.
Please state in the boxes below how many of the FOR OFFICIAL USE ONLY
following you have enclosed  Please do not write on this side of the box
Passports
Travel documents
Birth certificates
Marriage certificates/Civil Partnership Document
Police Registration Certificates
FOR OFFICIAL USE ONLY
Fee exempt application? No Yes Application valid? No Yes

Signature Date

Section 15: Personal checklist for the form FLR(HSMP) – All applicants must complete this section
Please make the following checks before submitting your application. They should help to ensure that it is valid.
Are you sure that form FLR(HSMP) is the right form for your application?
Is the form valid for use? See the date on the front page.
Have you completed all the relevant sections of the form?
Have you sent us the following documents specified in Section 11?
Current passport(s) or travel document(s) and photographs, including those of any dependants included
in the application;
Police registration certificate(s), if applicable; and,
Evidence of funds and any other document(s) specified in Section 11, which are relevant to your
application and those of any dependants.
If you are unable at present to send us any documentation or photographs specified in Section 11, have you
given an explanation and said when you will be able to send them?
If you are already in the UK under HSMP and are seeking to extend your leave in this category, have you
included all documentation required to support your claim of points under Section 7 and (if applicable) to
support statements made under Section 8 of the application form, and to establish that you satisfy the
mandatory English Language Requirement set out at Section 9 of the application form?
Have you signed and dated the declaration in Section 12 of the form?
Finally, please make sure that the application is addressed exactly as in Section 5 of the Guidance Notes, ie
Work Permits (UK) – FLR(HSMP)
PO Box 3976
Sheffield
S1 9BN

This form and the accompanying guidance notes may be included or reproduced in any non-Home Office
website or publication. However, such inclusion or reproduction does not constitute an endorsement of any
services offered or provided by the owners of the website or publication, or of the content of the website or
publication.

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