To be completed by Skilled Worker and Global Talent visa holders applying for reimbursement of costs incurred when securing or extending their visa.

Please complete and submit, together with your visa fee and IHS receipts to HR Visa Fees.

Personal Details (complete all sections)
First Name(s)
Surname
Employee Number
Email Address

QMUL School/Institute & Centre/Department
Job Title:
Department / School
Employment Start Date

Bank Details
Bank Name
Bank Address
Sort Code
Account Number

Visa Expense Details Please note only standard visa costs, for the employee, are eligible for reimbursement. Additional fees not eligible for reimbursement must not be included below. Where they are they will be deducted from the final total.
Visa Fee	£
Immigration Health Surcharge	£
Total	£

UK Tax Assessment
In order for the expenses to be reimbursed free of tax and National Insurance contributions, you must Incur the expense within 5 years of the date that you *first arrived in the UK to work, and Not have been: Present in the UK for any purpose in the 2 year period prior to this *arrival date; or Resident in the UK for tax purposes (eg. been in paid employment) in either of the two UK tax years prior to your *arrival date. (Note the tax year runs from 6th April to 5th April)
NOTE: *For visa extensions, this is the start date given on the new visa. NOTE: If you do not provide the following dates, the university will deduct UK tax and National Insurance contributions (NIC’s) from the total sum claimed and you will need to contact the UK tax authority, HMRC, to recover any tax you should not have paid.
1. Date you first arrived in the UK to work: (*see note above) Click or tap to enter a date.
2. Were you present in the UK for any purpose (for example vacation or conference) in the 2 year period prior to the date you first came to the UK to work*?
YES ☐	NO ☐
3. Were you resident in the UK for tax purposes (eg. worked in the UK) in either of the 2 tax years prior to the date you first came to the UK to work*?
NOTE: You would be considered a resident if you were in the UK for 183 days or more in the relevant tax year
YES ☐	NO ☐
If no to Q3. above please move onto page 3. If yes to Q3. Above please provide the following information
NOTE: You would be considered a resident if you were in the UK for 183 days or more in the relevant tax year
Relevant Tax Year	Dates resident in the UK in the relevant tax year
From 6th April:	To 5th April:	From:	To:
From 6th April:	To 5th April:	From:	To:

Signed Declaration
I confirm that the information provided is accurate and if I resign or my employment is terminated within 3 years of the reimbursement, I will be required to repay the visa reimbursement as set out in the Visa Reimbursement policy. I understand that, as the reimbursement of visa fees is classed as earnings by the UK tax authority, the University must deduct tax and national insurance contributions (NICs), where appropriate. I may therefore receive less back from the University than I have paid to the UKVI. I understand that the University may need to disclose this information to the UK tax authorities.
Signature
Date
Please complete submit, along with your visa fee and IHS receipts, to HR Visa Fees

HR Office Use Certified for payment by authorised signature
Cost Centre
Payment Terms	Full ☐ Less Tax NI ☐
Name
Signature
Date