BELHAVEN HILL SCHOOL BURSARY APPLICATION SESSION 2011/12

PUPIL(S) INFORMATION
(include the names of all pupils in which you are applying for a bursary)

Name(s) Home address Date(s) of birth Class(s) for 2011/12 If pupil(s) is not currently attending Belhaven, please state which school they are attending

FAMILY INFORMATION Name of Father His profession, business or trade Name and address of employer or business address Unemployed Employed Self Employed

Name of Mother Her profession, business or trade Name and address of employer or business address

Unemployed

Employed

Self Employed

If you have other children attending Belhaven (not included above), please state below, their name, their class and if they are in receipt of a bursary from the school. Name: Name: Name: Class Class Class Bursary? Bursary? Bursary? YES YES YES NO NO NO

How many other dependent children (other than those stated above) do you have in your household? Please state below. Name: Name: Name: Date of birth Date of birth Date of birth

REGISTERED OFFICE 61 DUBLIN STREET EDINBURGH EH3 6NL. REGISTERED NO. 41034 SCOTLAND A CHARITABLE COMPANY LIMITED BY GUARANTEE NO. SC007118

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FAMILY INFORMATION (Contd)

Please give further details of other dependent children named above who currently attend senior schools or who have attended senior schools in the past year. Name Senior school to be attended in 2011/12 Level of bursary awarded by senior school for 2011/12 Senior school attended in 2010/11 Level of bursary awarded by senior school for 2010/11

Please enclose documentary evidence of any bursary awards received from other dependent children attending senior schools in the current or past year.

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DETAILS OF INCOME 2010/11 ACTUAL Gross salary / Self employed profits Father 2011/12 ESTIMATE

Gross salary / Self employed profits Mother

Superannuation

Social security benefits received from the government (incl. tax credits, income support, housing benefit etc)

Investment income (incl. bank interest, dividends etc)

Separation or maintenance allowance

Property income (as taken from your tax return)

Any other income not declared above

Please tick below the documents that you are enclosing to support the above information -

P60 March pay advice HMRC self-assessment return Accountant's statement Copy of business accounts Other (please specify)

If you would like to provide additional information with regard to your monthly household income and expenditure, there is a further page at the end of this application form to do so. It is not compulsory to complete this, however if you feel that this will support your application, please feel free to complete this.

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DETAILS OF ASSETS OWNED (at date of application) BANK ACCOUNTS Total cash and deposits held in your bank accounts OWNED PROPERTY Do you own a property? YES NO

Please state below the address, approximate valuation and the mortgage outstanding on each property you own. Please show your home address as the first property. Property address Home Approximate valuation Mortgage outstanding

INVESTMENTS If you own any investments, please give details below. Investment Approximate valuation

OTHER ASSETS If you own any other significant assets, please provide details and approximate value below Other assets Approximate valuation

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INCOME AND ASSETS OWNED BY CHILDREN

2010/11 ACTUAL Income received by your children (Include income earned from investments held in the childs name or income / capital being received from grandparents, family Trusts or other sources).

2011/12 ESTIMATE

BANK ACCOUNTS Total cash and deposits held in your child / childrens bank accounts

ASSETS Does your child / children own any other assets? (Include value of any trust funds) Assets description Approximate valuation

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DECLARATION

I/We declare that, to the best of my/our knowledge and belief, all the information given in this application is true and contains a full statement of my/our income from all sources during the periods shown. I/We understand that the provision of false information may lead to my/our child being disqualified from benefits of the scheme.

SIGNATURES (To be signed by both parents)

Father

Date

Mother

Date

If only one parent has signed above, please tick the appropriate box to show why. Divorced Separated Deceased Living overseas Other (explain) If divorced, separated or widowed please provide documentary evidence.

The completed form should be sent to the address below, along with all supporting documentation. Where documentation is not yet available, please state in the application when this will become available.

Secretaries Belhaven Hill School 61 Dublin Street Edinburgh EH3 6NL

BELHAVEN HILL SCHOOL BURSARY APPLICATION SESSION 2011/12 MONTHLY HOUSEHOLD INCOME & EXPENDITURE SUMMARY

INCOME TOTAL TAKE HOME PAY / BUSINESS DRAWINGS / BENEFITS

MONTHLY EXPENDITURE DETAILS

(To nearest )

TOTAL EXPENDITURE