Preliminary Information Questionnaire

Confidentiality and what it means when you provide information

 The information you give us on this form about your asylum claim will
not be disclosed to the authorities of your own country;
 Information may be shared with other UK government departments or
agencies, local authorities, international organisations and other bodies
to enable them to carry out their functions;
 We may also share information with other countries, which may be
responsible for considering your claim;
 Any information we share is to enable the Home Office and other
organisations to carry out their functions, including the prevention and
detection of crime. We will not share any information if this would put
you or your family at risk in your own country;
 You must not provide information that you know to be false to support
your claim or omit facts that you think may harm your claim. Doing so
may affect the credibility of your claim. You may be prosecuted for
providing false information to support an unfounded claim and may
face up to 2 years in prison.

This form MUST be completed in English and returned to the Home Office
address below by xx/xx/xxxx
1. Claimant Information
Please complete the section below as fully as you are able to (if you do not
have an email address or telephone number please leave these blank):

Home Office
Reference:
Name(s):
Family Name:
Date of Birth:
Town/City of Birth:
Country of Birth:
Nationality:
Email Address:
Telephone Number:
Mobile Number:

Please ensure that all details provided above are correct.

Incorrect information may result in a delay in producing your Biometrics
Residence Permit, if you are granted leave to remain.
2. National Insurance Number (NINo)
If you have been given permission to work or study in the UK, you will have
been given a NINo. The NINo is used to collect national insurance
contributions. You pay National Insurance contributions to qualify for certain
benefits and the state pension.

Have you or your dependants ever applied for a NINo?

If yes, please provide your NINo details below.

If your dependants have a NINo, please provide these details as well:

Full Name National Insurance Number

Example National Q Q 1 2 3 4 5 6 A
Insurance Number

Incorrect information may result in a delay in producing your Biometric

Residence Permit if you are granted leave to remain.
3. Your reasons for claiming asylum in the UK
This form is to help you provide information about the reasons why you need
protection in the UK. The information requested is to help the Home Office
understand why you are afraid to go home ahead of your asylum interview

A Home Office decision maker will consider whether your claim for protection
falls within the Refugee Convention or Humanitarian Protection policy.

Please give us the following information:

a. Why do you fear returning to your home country and what do you fear will
happen if you were to return?

b. Details of any specific events in which you were personally involved that
relate to your asylum claim and any specific person, organisation or group
you fear. Please include dates for these events, where you can.

c. How did you travel to the UK including details of anything that happened to
you on your journey?
d. Details of anything that has happened since you arrived in the UK which
has made you afraid to return home.

You only need to complete this question if you are including a child /
children who are under 18 years old on your claim for asylum.
We understand that your child(ren) also want to claim asylum. If that is not the
case please provide details below:

Are there any risks that your child(ren) face on return to their country of origin
which are different to the risk(s) that you have told us that you face? (delete as
applicable)
No
Yes (please provide details below);
Please use additional sheets if required.
1. Addresses in home country
Please tell us all the places you have lived in your home country over the past
five years and how long you lived there:
2. Education
How many years have you spent in education? Please name the schools that
you attended, and years spent at those schools:
3. Employment home country
What was your last job role before you left your home country? Who was your
employer and what was their address?
4. Medical Information
Tell us about any medical conditions that you have and any treatment you have
been receiving. Please include evidence of your conditions, where possible.
You should include details of any mental health conditions or support you are
receiving.
You should also include details of any mental health care or support you are
receiving:
(Note: If your position is unchanged, please confirm this below)
5. Family
In this section we would like to ask some questions about your family. Please
note that providing this information below does NOT add them onto your asylum
claim. If your spouse/partner was not present when you claimed asylum, they
will have to attend the asylum intake unit with you to be added to your claim.
You will need to do this before a decision is made on your claim. You can add
any children born in the UK to your claim but you must contact us and we will
tell you how to do this. You can still provide their details on this form.

Please provide the details of your family below:

Spouse/Partner Name:

Spouse/Partner Date of Birth:

Spouse/ Partner Country of Birth:

Spouse/ Partner Town/City of Birth:

Spouse/ Partner nationality:

Date of marriage (if married):

Date you started living with your

partner?

When did you last have contact with

them?

Where is your Spouse/ Partner now?

Home Office reference for your

spouse/partner: (if applicable)

Contact details for your

spouse/partner

Address

Phone

Mobile

Email
Please provide details of all your children.
You must include any you currently have responsibility for and any who have
not travelled to the UK with you. This includes children you have adopted or
provide care for. If you have lost contact with your children, you should still
record their details below.

Name of Child
Date of Birth
Place and Country of Birth
Nationality
Current Location
Last contact with child
Relationship to child
(biological, adopted, carer,
foster etc)

Name of Child
Date of Birth
Place and Country of Birth
Nationality
Current Location
Last contact with child
Relationship to child
(biological, adopted, carer,
foster etc)

Name of Child
Date of Birth
Place and Country of Birth
Nationality
Current Location
Last contact with child
Relationship to child
(biological, adopted, carer,
foster etc)
If you need more space to provide further details of other children, please
continue on a separate sheet. Mark each extra street with your full name
and your Home Office reference number.
If your child is in the UK and are attending school, please tell us:

Name of Child School Name and Full Address

If you have been in contact with Social Services please tell us:

Local Authority

Key Worker name

and contact details

Tell us about any medical conditions that your child, children, spouse or
partner may have, or any treatment that they may be receiving. You
should also include details of any mental health care or support they are
receiving:
6. Documentation in support of your claim
Any documents you submit must be original documents, not photocopies. We will
return them to you later. If the documents are not in English, your legal
representative will assist you in translating your documents in English prior to
submitting them. You must enclose a certified English translation as well. If you do
not have a certified English translation, we may not be able to accept them. If you
submit photocopies, please explain why you do not have the original.

You must provide all documentation at your disposal regarding your age,
background, identity, nationality, previous places of residence and travel routes.

Please list all documents you wish to submit providing the following:
 What the document is
 How the document relates to your asylum claim
 What language(s) it is written in
If not currently in your possession, when will you be submitting it

If you need more space to provide further details, please continue on a

separate sheet. Mark each extra sheet with your full name and your Home
Office reference number.
Declaration
You must now read the declaration below and sign it. You are responsible for
the accuracy of the statements in this form. The declaration must be signed by
you.
I believe the information I have given to be true.
I am aware that making false statements could be considered a criminal offence
under immigration legislation.

Signed .......................................................................................
Date ..........................................................................................

If a representative has completed the form for you, they will need to complete
one of the two declarations below.
Declaration 1. For Legal Representatives only:

I declare that I have assisted (insert name of applicant):

..............................................................................................................................
in completing this form. I confirm that I am authorised to act as a Legal
Representative under Section 84 of the Immigration and Asylum Act 1999.
I have read the completed form back to the person named above in a language they
understand to confirm that the contents are correct.
Signed: ..........................................................................................................................
.......

Name: (in capitals):

………………………………………………………………………………………………
Date: .............................................................................................................................
....
Representative’s
name: ............................................................................................................................
....
Representative’s business name:
………………………………......................................................................................
Representative’s business address:
…………………………………………………………………………………………….
Email
address: ........................................................................................................................
.........
Telephone number:
………………………………………………………………………………....................
Declaration 2. Voluntary Sector or individual that has assisted you in
completing this form:

I declare that I have assisted (insert name of applicant):

...............................................................................................................................
I have read the completed form back to the person named above in a language they
understand to confirm that the contents are correct.
Signed ...................................................................................................................

Name (in capitals): …………………………………………………………………….

Date .......................................................................................................................
Name: ………………………………………………………………..
Organisation name: …………………………………………………….
Organisation/individuals address: ………………………………………………….
Email address: ………………………………………………………………………….
Telephone number: ……………………………………………………………………..