PLEASE USE BLACK INK TO COMPLETE THIS FORM

TD112 BRP
Version 02/2012

APPLICATION FOR A HOME OFFICE TRAVEL DOCUMENT AND A BIOMETRIC IMMIGRATION DOCUMENT
In addition to this application form, you need the following two documents: - TD 112 BRP guidance notes (version 02/2012) - UKBA photograph guidance for travel document applications You can download these documents from our website at www.ukba. homeoffice.gov.uk Our application forms change periodically. If you obtain this form some time before applying, please check that it is still the version which must be used when you are ready to apply. The address to which you must post this application by recorded or special delivery (complete with all the necessary documents and the correct fee) is: UK Border Agency Travel Documents BRP PO Box 588 Durham DH99 1AA
WORKING TOGETHER TO PROTECT THE PUBLIC
TD112 BRP Application Form (Version 02/2012) - Page 1

This form is to be used for applications made on or after 29 February 2012

H O M E O F F I C E T R AVEL DOCUM ENT S - F EES

Immigration status in the UK Refugee Type of Document Fee for an adult Fee for a child (aged under 16) document and validity document and validity 49 - valid for 5 years or in line with leave 49 - valid for 5 years or in line with leave 149 - normally valid for up to a maximum of 5 years or in line with leave 49- valid for one journey out of the UK

Convention Travel 77.50 - valid for 10 Document (blue) - 1951 years or in line with Convention leave Stateless Persons Document (red) - 1954 Convention 77.50 - valid for 10 years or in line with leave 238 - normally valid for up to a maximum of 5 years or in line with leave 77.50 - valid for one journey out of the UK

Stateless person

Limited or indefinite Certificate of Travel leave to enter/remain (black) (without refugee status) Any person who is not British wishing to leave the UK permanently THE FEE One way Travel Document (IS137)

P A Y M ENT GUIDANCE
The fees for each document are set out at the top of this and the next page. More information is available in the separate guidance notes. If you are unsure how much you need to pay, please call 0870 606 7766. Applications for any type of Home Office travel document may be made by post only - our Public Enquiry Offices do not deal with these applications. Applicants aged 16 or over must apply for an adult document. Paying more or less than the listed amount(s) will delay the consideration of your application. We do not refund the fee if your application is refused or withdrawn. HOW CAN YOU PAY? You can pay by one of the methods specified below, please do not send cash: Cheque Postal order Credit card1 - Visa (including Electron), MasterCard or Amercian Express (Amex) Debit card - Delta, Maestro* (including Solo) Bankers draft

We do not accept any other form of payment. * Maestro - we will only accept Maestro cards issued in the UK. CHEQUES AND POSTAL ORDERS You must make the cheque or postal order(s) payable to The Home Office and cross the cheque or postal order(s) A/C Payee only. Write the full name, nationality and date of birth of the applicant on the back of the cheque and/ or each postal order and keep the postal order receipt(s). Make sure that the date and the amount (words and figures) are correct and that the cheque is signed properly. Please attach your cheque or postal order(s) to the front of the application form. COMPLETING THE PAYMENT DETAILS PAGE To ensure that your payment is processed without any delay, please note the points below when completing the payment details on page 3. 1-2 The address at 1 should be the contact ad dress in the UK for any correspondence. If it is not your home address (eg a solicitor or other authorised immigration adviser may be submitting the application), give the contact name at 2.

1 Please note that when making large or multiple payments using your credit card, the anti fraud measures that banks operate sometimes stop the full payment being taken. This is because either the maximum limit on a single transaction, or the number of transactions allowed in a given period of time, has been exceeded. To prevent this you must ensure that you inform your bank of your intention to make large or multiple payments in advance so that your bank allows the full payment to be taken when you submit your application.

TD112 BRP Application Form (Version 02/2012) - Page 2

This should be the full name of the applicant as given in his or her passport, travel document, identity card or immigration status document. Date of birth - for example, 3 January 1980 should be written 03 01 1980 in the spaces provided. Complete only if paying by card. The Card Verification Value (CVV) is a 3-digit security code found on the back of the card on the signature strip - it consists of the last 3 digits. For Amex the security code consists of 4-digits and is found on the front of the card.

8-12 11

AUTHORISED SIGNATURE

4567 123

123

CVV
AMERICAN EXPRESS

CVV

1234 123456 12345

1234

1234

If you do not provide the CVV number, we cannot take the payment and your application will be rejected as invalid. 12 It is the cardholder as named on the credit/ debit card who must sign and date.

TD112 BRP Application Form (Version 02/2012) - Page 3

PAYMENT DETAILS: FORM TD112 BRP

Please complete in block capitals and black ink after first reading the payment guidance on pages 2 and 3.
Tell us which document you are applying for by ticking one of the boxes below. Adult Convention Travel Document Stateless Persons Document Child Adult Certificate of Travel Child

77.50 77.50

49 49

238 77.50

149 49

One Way Travel Document

1 Contact address in the UK for correspondence

Postcode
2 Contact name in the UK if different from that of the applicant

Applicants full name

Day 4

Month

Year

Date of birth

PAYMENT DETAILS
5

Amount - please tick the amount you are paying

49
Postal order

77.50
Cheque

149
Debit or credit card

238
Bankers draft

6 7

How are you paying? Please tick a box.

Paying by cheque - please give cheque details below

Cheque number Account number Sort code

Paying by card - please complete 8-12 below

8

Which card are you using for payment? Please tick a box. Name on card Card number
Valid from

Visa / Electron

MasterCard / Amex

Delta

Maestro / Solo

10

Expiry date

11

Card details Cardholders signature

(3 digit number

Card security number - CVV

or 4 digit number for Amex)

Issue No. (where available)

12

Date
TD112 BRP Application Form (Version 02/2012) - Page 4

If you are producing a double-sided copy of this application form, please include this page and make sure it falls on the reverse of the payment details page in the two-sided copy. For administrative reasons, its important that the rest of the form begins with Section 1 - Your Details facing upwards.

PLEASE USE BLACK INK TO COMPLETE THIS FORM

PLEASE USE BLACK INK TO COMPLETE THIS FORM

Version 02/2012

TD112 BRP

SECTION 1 - YOUR DETAILS

1.0 Tell us which document you are applying for by ticking one of the boxes below. Adult Convention Travel Document Stateless Persons Document Child Certificate of Travel Adult Child

One Way Travel Document

1.1 Home Office reference number - this will usually be given on your status letter. 1.2 Your title - please tick 1.3 Your date of birth Mr
Day

Mrs
Month

Miss

Ms
Year

Other

If other, what is your title?

1.4 Your gender - please tick

Male

Female

1.5 Your surname or family name as in your passport, travel document or ID card (see Note 1 below)

1.6 Your first name(s) as in your passport, travel document or ID card (see Note 1 below)

1.7 Any other name(s) by which you have been known

1.8 Reason for change - for example, marriage, adoption, statutory declaration or deed poll (see Note 1 below)

Note 1

If your name is different from the one on your birth certificate and/or your passport(s), travel document(s) or ID card(s),you must provide relevant documentary evidence to explain the change - such as a marriage or divorce certificate, adoption order, deed poll or statutory declaration.

1.9 Your national insurance number (if you have one) 1.10 Your present nationality

1.11 Any previous nationality that you have held 1.12 Your place of birth - town or city and country 1.13 Passport, travel document or ID number 1.14 How long have you lived in the UK? Years
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Months

SECTION 1 - YOUR DETAILS

1.15 Your daytime telephone number Your mobile telephone number

1.16 Your e-mail address

1.17 Your UK address - please inform us immediately if this changes.

Postcode Name and address in the UK for all correspondence about your application if different from 1.17. Please note that we will not send
correspondence to hostels, hotels or PO Box addresses.

1.18 Name of the person or representative

1.19 Address of the person or representative

Postcode 1.20 Telephone number of the person or representative

1.21 If an immigration adviser is representing you, their Office of the Immigration Service Commissioner (OISC) reference

SECTION 2 - SPONSORS DETAILS

Complete this section if you have been sponsored to come to the UK. If you were not sponsored, go to section 3.
2.1 Your sponsors full name

2 . 2 His/her Home Office reference

2.3

His/her date of birth

Day

Month

Year

2 . 4 Your sponsors relationship to you

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SECTION 3 - BIOMETRIC RESIDENCE PERMITS

It is mandatory to complete this section as required. See Note 2 about Biometric Residence Permits. Note 2 In accordance with regulations 3 and 4 of the Immigration (Biometric Registration) (Amendment) Regulations 2009, anyone applying for a Biometric Travel Document must also apply for a biometric immigration document, otherwise known as a Biometric Residence Permit. For information about Biometric Residence Permits, please see the separate TD112 BRP guidance notes (version 02/2012), which you should read before completing this form.
3.1

Do you have a Biometric Residence Permit? If yes please give the number

Yes

No

3.2 3.3

Are you a Family member of an EEA national exercising their Treaty Rights in the UK?

Yes

No

Please give below the details of any previous immigration applications in any name you have made in either the UK or abroad. If you need more space, continue on a separate sheet and enclose it with this application form. The name in which you made the application Date of application Country in which application was made British diplomatic post if application made abroad

3.4 3.5

Have you had your fingerprints taken as part of a previous UK immigration application made in the UK or abroad? If yes, go to 3.5

Yes

No

Please give the details specified below in each case. If you need more space, continue on a separate sheet and enclose it with this application form. The name in which your fingerprints were taken Date on which they were taken Place at which they were taken British diplomatic post if they were taken abroad

Children under 16 applying A child under the age of 16 must be accompanied by a parent or a specified responsible adult when they have 3.6 their fingerprints and/or photograph taken. Please complete the appropriate box below and provide details of the parent or specified responsible adult who will be accompanying the child. See Note 3 Home Office Reference Date of birth Name of Parent Place of birth Number

Name of responsible adult

Date of birth

Place of birth

Relationship to child

Note 3 Under the biometric registration regulations, any child under the age of 16 who is required to apply for a biometric immigration document must have their fingerprints and/or a photograph taken in the presence of a responsible adult who is the childs parent or guardian, or another person who for the time being takes responsibility for the child. If there is any reason preventing a parent from accompanying any child under the age of 16, the parent must nominate the responsible adult who will be accompanying them. The responsible adult accompanying any child under the age of 16 will need to provide an acceptable form of identification, such as a passport or UK photo driving licence. If that person is not the parent or guardian of the child, they must have a letter confirming that they are a responsible adult who has a close connection to the child and has been authorised to accompany him or her.
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SECTION 4 - PERSONAL HISTORY

It is mandatory to complete this section as required. Please note that this application will be invalid If you do not. You must answer every question in this section. 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.
4.1

Do you have any criminal convictions in the UK or any other country (including traffic offences) or any civil judgments made against you?

Yes

No

If you have answered yes to question 4.1 above, give details below for each criminal conviction and/or civil judgment, starting with the most recent one - but first see Note 4 about criminal convictions. Note 4 Convictions spent under the Rehabilitation of Offenders Act 1974 need not be disclosed. More information about the Act is given towards the end of this section. State name(s) in which convicted and/or against whom a civil judgment was made.

Nature of the criminal offence(s) and/or civil action(s) -give details on a separate sheet and enclose it with this form if you need more space.

Details, including date(s), of the sentence(s) and/or civil judgment(s) - give details on separate sheet and enclose it if you need more space.

Country or countries where the sentence(s) was/were passed or the civil judgment(s) was/were made.

You must answer questions 4.2 to 4.7 below even if you have answered no to question 4.1. For help in answering these questions, please see the definitions on the next page.
4.2

Have you or any dependants applying with you ever been charged in any country with a criminal offence for which you have not yet been tried in court? In times of either peace or war have you ever been involved, or suspected of involvement, in war crimes, crimes against humanity or genocide? Have you ever been involved in, supported or encouraged terrorist activities in any country? Have you ever been a member of, or given support to, an organisation which has been concerned in terrorism? Have you by any means or medium, expressed views that justify or glorify terrorist violence or that may encourage others to terrorist acts or other serious criminal acts? Have you ever engaged in any other activities which might indicate that you may not be considered to be persons of good character?
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Yes

No

4.3

Yes

No

4.4

Yes

No

4.5

Yes

No

4.6

Yes

No

4.7

Yes

No

SECTION 4 - PERSONAL HISTORY

If you have answered yes to question 4.2, 4.3, 4.4, 4.5, 4.6 or 4.7 on the previous page, you must give further details in the space provided below. If you need more space, continue on a separate sheet and enclose it with this form.

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 Nacros Resettlement Plus Helpline on 020 7840 6464.

DEFINITIONS For the purposes of answering questions 4.3 to 4.7, 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 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 applying with you. 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 persons life; creates a serious risk to the health or 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 (including the unlawful glorification of terrorism); or is otherwise concerned in terrorism.
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SECTION 5 - DETAILS OF PASSPORTS, TRAVEL DOCUMENTS OR ID CARDS HELD BY YOU

Please give details in the box below of any passports, travel documents, identity cards or similar documents which you hold. These may include current or expired Home Office travel documents, national passports, other travel documents including UFFs, immigration status documents, Biometric Residence Permits, identity cards or visa promise letters. Such details are required from everyone applying for a Home Office travel document, including children under 16. If any of the documents mentioned above have been lost or stolen, you must provide us with a police report and a crime reference number, together with an explanation of how and when the document was lost or stolen.

Type of document

Document number

Place and country where document was issued

Date on which it was issued

Date on which it expires (or expired)

If you are unable to provide the document(s) listed above with your application, please explain why in the space below.

TD112 BRP Application Form (Version 02/2012) - Page 11

SECTION 6 - OBTAINING DOCUMENTATION FROM YOUR OWN NATIONAL AUTHORITIES

You do not need to complete this section if you have been granted refugee status or recognised as a stateless person. 6.1 If you have not been granted refugee status or recognised as a stateless person, please explain below why you cannot obtain a passport or travel document from your own national authorities, and enclose with this application a letter from your Embassy/High Commission showing that they have formally and unreasonably refused your application for a passport or travel document. You should indicate why you believe the refusal to be unreasonable.

6.2

If you cannot provide the evidence requested at 6.1, please explain why in the box below and enclose any relevant documentary evidence in support of your explanation.

SECTION 7 - APPLICANTS AGED 17 or Under

This section must be completed in all cases where the applicant is under 18 years of age. Applicants aged 17 or under - the parent or other person (or body) with parental responsibility for the applicant must give the necessary consent by completing 7.1, 7.2 and 7.3. Applicants aged 16 or 17 with no parent or other person (or body) with parental responsibility - only 7.2 has to be completed but an explanation for the absence of anyone to give consent must be provided in a letter with this form.
7.1

Relationship to applicant - tick one box Mother Legal guardian Other If other, what is your relationship?
No

Father
7.2

Has the custody of the applicant ever been made the subject of a court order or di- Yes rection, or any other formal or informal agreement prohibiting their removal from the UK? If yes, please give details in a letter or other document and enclose it and any custody papers with your application. 7.3 CONSENT

I consent to this application for a travel document and to the applicant travelling abroad - please tick the box If the applicant is a ward of court, consent must be given by an appropriate official of the court. Full name of parent, guardian or other person giving consent

Signature of the person giving consent

Date

TD112 BRP Application Form (Version 02/2012) - Page 12

If you are aged 16 or over, you must read and sign the declaration below. If you are under the age of 16, your parent, guardian or other person (or body) with legal responsibility for you must sign on your behalf.
I hereby apply for a travel document and a Biometric Immigration Document. I confirm that I am present in the United Kingdom. The information I have given in this form is complete and is true to the best of my knowledge. I confirm that the photographs submitted with this form are a true likeness of myself and that I have read and understood the UK Border Agency photograph guidance. I confirm that apart from any document(s) mentioned in section 5 of the application form, I do not have any other passport(s), travel document(s) or ID card(s). I confirm that I have not taken up residence in any other country which would allow me to apply for a travel document from the authorities of that country. 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 UK Border Agency. I understand that all information provided by me to the UK Border Agency will be treated in confidence; 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; and that, if such bodies provide the UK Border Agency with any information about me which may be relevant for immigration purposes, it may be used in reaching a decision on my application. I understand that my details may in certain circumstances be passed to fraud prevention agencies to prevent fraud and money laundering. I am also aware that such agencies may provide the UK Border Agency with information about me. And I note that the UK Border Agency website contains details explaining when information may be passed to or from fraud prevention agencies and how that information may be used. I understand that documents provided in support of this application will be checked for authenticity; and that false documents will be retained and may result in my application being refused and in my prosecution and subsequent removal from the United Kingdom. I understand that the UK Border Agency may also use the information provided by me for training purposes. 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 seek to obtain leave to remain in the United Kingdom by means which include deception. If you are 16 or over your signature below will be scanned onto your travel document. Please ensure that it is written clearly in black ink within the signature box without touching the lines. Signature Date

SECTION 8 - DECLARATION

TD112 BRP Application Form (Version 02/2012) - Page 13

This section should be completed by a professional person (see Note 5) who is not a relative of yours. It should be completed for all applications for Home Office travel documents.
Note 5 For the purposes of this application, a professional person is defined as one of the following: - Bank Manager - Doctor - Magistrate - Minister of Religion - Police Officer - Prison Officer - Probation Officer - Social Worker - Solicitor - Teacher - Immigration Adviser regulated by the Office of the Immigration Service Commissioner at level 1 or above - Adviser accredited under the Immigration and Asylum Accreditation Scheme at probationer level or above

SECTION 9 - DECLARATION BY PROFESSIONAL PERSON

You must also certify and sign one photograph of the applicant using the wording below I confirm that this photograph is a true and correct likeness of:
9.1 please tick 9 . 2 Full name

Title -

Mr

Mrs

Miss

Ms

Other

If other, what is their title?

Professional persons details and signature 9 . 3 Full name

9 . 4 Profession

9.5 Name of business/organisation

9.6

OISC/Law Society/GMC/Police Warrant number if applicable

9 . 7 Business address

Postcode
9.8

Telephone number

Official stamp

9.9

Official stamp

If you belong to an organisation which has an official stamp, please stamp the box with it. The stamp should clearly show the name and address of the company or organisation you work for. If you do not have an official stamp, please provide a letter or other document confirming your professional status. 9.10 Signature

Date

TD112 BRP Application Form (Version 02/2012) - Page 14

PHOTOGRAPHS AND DOCUMENTS CHECKLIST

Please complete this part of the form to help us check that we have received your photographs and documents. At A, tell us how many of each of the listed items you are providing with your application. At B, list any other documents provided by you and state how many in each case. Continue on a separate sheet if necessary and enclose it with this form. All documents must be originals.
A. Listed items How many? B. Other documents How many?

Photographs of applicant countersigned as per Section 9 Note 5 Passport(s) Travel document(s) including UFF Home Office immigration status document Police report and crime reference number if passport(s) lost or stolen Police report and crime reference number if Home Office travel document(s) is lost or stolen Police report and crime reference number if immigration status document is lost or stolen Police registration certificate

Please note that in some cases, we may have to ask for other documents in addition to those specified in this form.

FINAL CHECKS
To ensure that your application is complete, please make the following final checks. Tick each box that is relevant to your application. Have you completed the correct application form? Have you completed all sections as required? Have you provided the photographs as specified in Section 9 and are they in the approved format? If you are unable to send us any of the documents specified in section 5 which are relevant to your application, or if you are unable to provide originals, have you given an explanation and said when you will be able to send them? Finally, if you are posting it, please make sure that the application is addressed exactly as shown below . UK Border Agency Travel Documents BRP PO Box 588 Durham DH99 1AA
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Have you completed the payment details page and made the correct payment? Have you provided your current passport or travel document and all other relevant documents specified in section 5 and are they originals Have you, or a parent or guardian if you are under 18, signed and dated the declaration in section 8