APPLICATION FOR HIGHLY SKILLED MIGRANT

STATUS

28 YEARS AND OVER

Please complete this form in accordance with the guidance that appears at Annex C of the
notes, and provide documentary evidence as appropriate. Please note – if seeking to apply
for leave to remain in the United Kingdom you should make a separate application on the
FLR(IED) form. (See guidance notes for more information).
You must supply the original documentation where possible.
Submission of fraudulent documentation will lead to refusal of the application.
Please contact the Customer Contact Centre on 0114 207 4074 if you have any further
queries regarding completion of this payment slip.

Payment slip

Section 1: Contact details

1 Contact Name                                    
2 Contact Address                                    
                                   
                                   
                                   
3 Postcode                
4 Contact telephone number                                

Section 2: Application details

Please refer to the Payment Guidance Notes Please tick the appropriate boxes
5 Is the application to be: Paid for, please include the fee of £315.00 exempt
6 Are you applying from within the United Kingdom?
Yes
No
7 Applicant’s surname (Please print)      

Section 3: Payment details

8 Preferred method of payment

UK Postal Order Cheque Please make cheques payable to: Home Office Work Permits (UK)

Account Number Sort Code Cheque No.

                                       
Or please debit my Visa MasterCard Delta Switch
9 Amount £      
10 Payer Name                                      
11 Card Number                                      
12 Card Details: Expiry Date Valid from Issue No    Switch only
               
13 Signature Date      
Now please complete the application form on pages 2-14

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 IF YOU WISH THE HIGHLY SKILLED MIGRANT PROGRAMME TEAM TO ACKNOWLEDGE
RECEIPT OF YOUR APPLICATION AND PROVIDE YOU WITH YOUR HSMP REFERENCE
NUMBER – PLEASE ENTER YOUR DETAILS INTO BOX ‘A’ BELOW.

THIS WILL BE SENT TO YOU ONCE YOUR APPLICATION HAS BEEN RECEIVED BY THE
HSMP TEAM INFORMING YOU OF YOUR APPLICATION REFERENCE NUMBER.

IF YOU WISH US TO ACKNOWLEDGE RECEIPT OF YOUR APPLICATION VIA E-MAIL

PLEASE PROVIDE DETAILS IN THE BOX BELOW

--------------------------------------------------------------------------------------------------------------------------------------
--------------------
Dear Applicant,

Please accept this as confirmation of our receipt of your application

under the Highly Skilled Migrant Programme.

Please note:
Immigration & Nationality Directorate
 We received your application on ………………..
BOX A - If you would like to receive confirmation that your application
 Your Reference Number is ………………..
has been received please insert your full name and correspondence
address or e-mail address into the space below.
 We are currently working on applications received on
………………...
……………………………………………
For further information on current process times and other general
…………………………………………… guidance please refer to our web site
…………………………………………… www.workingintheuk.gov.uk

…………………………………………… If you have any other enquiries please contact us either by telephone
on 0114 207 6020, by fax on 0114 207 6021 or e-mail us at
…………………………………………… [email protected].

Regards

HSMP Team

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HSMP 1 (Form Version 04/06) Valid from 03/04/2006 – 18/06/2006 4
 HIGHLY SKILLED MIGRANT
PROGRAMME

Is the Application to be Please complete this form and provide documentary evidence as
appropriate. Please note – if seeking to apply for leave to remain in
Paid for the United Kingdom you should make a separate application on the
FLR(IED) form. (See guidance notes for more information)
Exempt
You must supply the original documentation where possible.
Submission of fraudulent documentation will lead to refusal of the
application.

This application form is for use by migrants who have had their 28th
birthday and are hence 28 or over.
PERSONAL DETAILS
Family name First names
           
Date of birth
     
Nationality Country of current legal Gender (please tick)
residence
            Male

Female
Are you applying:

In the UK
(Please
tick)
Out of the UK
Current immigration status in the UK (if applying in the UK)
     

Home Office reference number (if known)

     

What is your profession?

     
Current address

     

E-mail      
Telephone numbers      
Fax number      
Name and address of legal representative in the UK (if applicable)

     

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E-mail      
Telephone numbers      
Fax number      

PART ONE
Qualifying criteria HO use only

In order to obtain entry under the HSMP, you will need to supply evidence demonstrating that
you score 65 points or more.

Masters in Business Administration (MBA) Provision

The MBA provision applies to those who have been awarded an MBA from the list of 50 eligible
institutions published by the Treasury. If you completed your MBA at the time that your MBA is
on the list, then you can be awarded 65 points for this MBA
65 points tick here
Please give details of your MBA qualification.
Date Awarded Awarding Institution
           

Evidence you have supplied in support of claimed qualifications (please tick) Your score (max 65)
Certificate from eligible institution. If this is not available the following should be supplied.

Academic reference stating you are awaiting graduation

IF YOU ARE APPLYING UNDER THE MBA PROVISION, PLEASE NOW GO TO PART TWO OF THE
APPLICATION FORM (PAGE 9)

STANDARD HSMP APPLICATION (28 YEARS AND OVER)

1 Educational background

A PhD*, or 30 points Please tick

one box
A Masters Degree* (e.g MA MSC, MBA), or 25 points only

A Degree* (e.g BA, BSC) 15 points

or equivalent vocational or professional qualification

Please give details of your higher education, vocational or professional qualifications and
membership.
Qualifications and Dates Subject Awarding Institution
                 

Professional memberships:

Evidence you have supplied in support of claimed qualifications (please tick) Your score (max 30)

Certificate from Awarding body Academic reference

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2 Work experience
a) Minimum 5 years’ graduate level work experience, or 25 points
PhD held and 3 years’ graduate level work experience

b) As a) and including senior or specialist level work experience for 2 years 35 points
c) Minimum 10 years’ graduate level work experience including at least 5 years
senior or specialist level work experience 50 points

Please give relevant details of your employment (continue on a separate sheet if necessary)
Name and address
From To Type of business Job title
of employer
Month and year Month and year                  
           

What evidence have you supplied in support of claimed work experience:

Employer Reference(s) Tax Returns for Business Your score (Max 50)

Other - please specify      

3 Past earnings from your work HO use only

During the past twelve months, how much have you earned from your economic activities?

You earned
      = Income band      

In which country did you earn this income?

      = Country code      

Income band Tick one box only

1 25 points
2 35 points
3 50 points
Your score (Max 50)

     

Country code
Income bands A B C D E C
At least At least At least At least At Least
£40,000 £17,500 £12,500 £7,500 £3,500
Income band 1
£100,000 £43,750 £31,250 £18,750 £8,750
Income band 2
£250,000 £109,375 £78,125 £46,875 £21,875
Income band 3

Please refer to Guidance for Applicants for list of country codes.

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Please supply two forms of evidence and indicate below what evidence you have supplied
in support of earnings. (please tick)

Last 12 months wage slips Evidence from employer(s)

Income Tax Return Other – please specify      

4 Achievement in your chosen field

Provide brief details of your achievement in your chosen field.

     

Evidence of achievement in chosen field. Please tick as appropriate.

Industry prize Ownership intellectual property rights

Published work* Published testimonials/profile
Peer group reviews Scholarship/research rewards
Academic reference Press articles
Industry reference
Other      

*Please include a photocopy of relevant pages and publishers notes

You should provide at least three different types of evidence demonstrating the
achievement.

Significant achievement in your chosen field, or 15 points

Exceptional achievement in your chosen field 25 points

Your score (Max 25)

     

Please see the guidance notes for guidance on what amounts to exceptional and significant
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achievement.

5 HSMP priority applications (for general practitioners)

In order to score points in this area you must hold full General Medical Council (GMC)
registration and also one of the other three credentials listed below. This scoring area is for
General Practitioners (GPs) only and is not open to Veterinary Surgeons or Dentists.

Legally entitled to work in medical general practice in the UK 50 points

Evidence Full GMC Registration, and

A vocational training certificate issued by the UK or another EEA member

state1; or
A certificate of acquired right issued by the UK or another EEA member
state 1; or
A certificate of equivalent experience issued by the Joint Committee on
Postgraduate Training for General Practice2orthe Postgraduate Medical
Education and Training Board.
Your score (Max 50)
     

1 EEA certificate, validated by GMC

2 JCPTGP certificate. Since 30 September 2005 this has been replaced with the Statement of Eligibility for Registration
issued by the Postgraduate Medical Education and Training Board (PMETB).

6 Partner’s achievements HO use only

In order to score points in this area, you must provide evidence that you have a spouse, civil
partner, unmarried partner or same sex partner3 who is educated to degree level or is currently
or has previously been employed in a graduate level job. They must be intending to live with you
in the UK. Your partner must also not already be settled (permanently resident) in the UK.

For married couples or civil partners you must supply: a marriage certificate or civil
partnership document plus three other items from the list below (see notes for guidance)

For unmarried or same sex partners you must supply: four items from the list below (see
notes for guidance)

Evidence you have supplied in support of claimed relationship:

Marriage certificate Civil partnership document

Joint utility bills or statements

Joint mortgage agreement Joint tenancy agreement

Others permitted in the HSMP guidance (please specify)

Evidence of partners’ achievements:

A Degree (e.g. BA, BSc) or equivalent vocational

or professional qualification, or

Is currently employed in a graduate level job.

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Please give details of your spouse’s, civil partner’s, unmarried partners’ or same sex partner’s
higher education, vocational or professional qualifications and membership.

Qualifications and Dates Awarding Institution

           

Evidence you have supplied in support of claimed qualifications (please tick):

Certificate from awarding body Academic reference

Alternatively, please give relevant details of your spouse’s, civil partner’s, unmarried partners’ or
same sex partner’s employment (continue on a separate sheet if necessary).

Name and address

From To Type of business Job title
of employer
Month and year Month and year                  
           

Evidence you have supplied in support of claimed work experience:

Reference Other (please specify)      

Your score (max 10)

3
To be eligible for entry and stay in the United Kingdom as an unmarried or same sex partner you must have been living
together in a relationship akin to marriage, which has subsided for 2 years or more, and you must intend to live together as
partners during your stay in the United Kingdom. Also any previous marriage or similar relationship by either partner must
have permanently broken down.

Total scores
Section MBA 1 2 3 4 5 6 Total
Points
scored

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PART TWO
Can you continue your career in the UK?
7 What type of work or self-employment do you intend to do in the United Kingdom?

(For example telecommunications engineer, information technology consultant, medical researcher)

     

8 Do you speak English? (Please tick one)

Yes Please provide evidence (including relevant qualifications) of proficiency in English.

No Please supply evidence that you will be able to carry out your intended work in the
United Kingdom without the need to speak English.

9 Do you hold necessary relevant qualifications and/or memberships to work in your chosen field (in the UK)?

Yes Please provide evidence of this.

No Please supply evidence of ability to obtain required qualifications/membership to work in
chosen field

10 Are you aware of any impediments to you taking work in your chosen field (such as debarment from required
organisation)?

Yes Please disclose full details of this and produce evidence of ability to have impediments
overturned.
No

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11 What arrangements have you made to seek work upon your arrival in the UK?

     

12 Do you have an offer of work?

Yes, provide documentary evidence from a prospective employer as to potential role.

Contracts Interview invitation

Employer letter Job offer

No

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13 What annual salary do you expect to earn in the UK?

£      

Evidence

Job offer Contract of employment

Employment agency forecasts Job adverts for relevant posts

Other, please detail      

PART THREE
General Information
14 Have you ever been or are you currently bankrupt?

Yes If so, please provide full details and evidence of dischargements.

No

15 Have you ever been charged or convicted of any criminal or civil offence?

Yes If so, please give details.

No

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 CHECKLIST FOR SUPPORTING EVIDENCE SUPPLIED WITH YOUR HSMP APPLICATION
Please complete the checklist below listing what documentation you have provided for
consideration in each category of the scoring criteria
Photocopies cannot be assessed
MBA provision TICK AS APPLICABLE HO
Give Brief details of the item provided and the use
awarding institute including the date of graduation
     
ORIGINAL – Yes

EDUCATIONAL BACKGROUND
Give brief details of each item provided
      ORIGINAL – Yes
      ORIGINAL – Yes

WORK EXPERIENCE
Give brief details of each reference provided
      ORIGINAL – Yes
      ORIGINAL – Yes
      ORIGINAL – Yes
      ORIGINAL – Yes
      ORIGINAL – Yes
      ORIGINAL – Yes

PAST EARNINGS
At least 2 pieces of evidence should be provided
1st Document
ORIGINAL – Yes
     
2nd Document
ORIGINAL – Yes
     
ACHIEVEMENT IN YOUR CHOSEN FIELD
At least 3 pieces of evidence should be provided
1st Document
ORIGINAL – Yes
     
2nd Document
ORIGINAL – Yes
     
3rd Document
ORIGINAL – Yes

HSMP PRIORITY APPLICATIONS

1st Document
ORIGINAL – Yes
     
2nd Document
ORIGINAL – Yes
     
PARTNER’S ACHIEVEMENTS
     
ORIGINAL – Yes

EVIDENCE OF 2 YEAR RELATIONSHIP

1st Document
ORIGINAL – Yes
     
nd
2 Document
ORIGINAL – Yes
     
3rd Document
ORIGINAL – Yes
     
th
4 Document
ORIGINAL – Yes
     

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Authority to disclose personal information

• I understand that the UK government may contact any government authority, including
police, judicial and state authorities in all countries in which I have resided, to seek the
release to the UK government authorities of all records and information they may possess on
my behalf concerning investigations, arrests, charges, trials, convictions and sentences.

• I also understand that any past/present employer, educational establishment or financial

authority may be contacted to verify evidence submitted in support of my application.

• I understand this information will be used to assist in evaluating my suitability for

admission to the UK under the Highly Skilled Migrant Entry programme or any other category
of entry to the UK for immigration purposes.

• I authorise the UK immigration authorities to contact the above with regard to my

application.

Signed

Dated

Declaration

• I confirm I intend to make the UK my main home. This is essential andmust be maintained. 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 the Home Office.
• I understand that all information given by me will be treated in confidence but may be disclosed
to other Government Departments and Agencies and Local Authorities to enable them to carry
out their functions.

• I am aware that it is an offence under the Immigration Act 1971, as amended by

the Immigration and Asylum Act 1999, to make to a person acting in execution of the Act a
statement or representation which the maker knows to be false or does not believe to be
true, and to obtain or to seek to obtain leave to enter the United Kingdom by means which
include deception.

Signed

Dated

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Representative declaration
If a representative is dealing with this application on behalf of the applicant, please complete the details below.

Name of representative company      

Address (including postcode)      

Name of contact if different from above      

Telephone number      

Fax number      

E-mail address      

This declaration must be signed by the representative
• I have been appointed by the applicant to make this application.
• I confirm that all the facts relating to this application have been given to me by the applicant and to the best
of my knowledge and belief are true and complete.
• I confirm that the applicant has been and signed the completed application.
• Once the application is decided I will provide the applicant with all correspondence from you relating to your
decision.

Please tick the box if you do not wish to receive further information and publicity from Work Permits (UK).
Signed Date      
Name
Title      
(CAPITALS please)
Position      
For and on behalf
of (the      
representative)

It is important that all those in the business of providing advice ot services in connection with work
permit applications check their status under the regulatory scheme with the Office of the Immigration
Services Commissioner (OISC), and, if necessary, obtain the appropriate exemption or registration from
the OISC. If they do not do so, Work Permits (UK) may be unable to deal with them in connection with
any work permit applications which they submit. For further information, please see the OISC website at
www.oisc.gov.uk.

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