Assisted Person Vists Application Form (Page 3 of 4) in pdf

Assisted Person Vists Application Form Page 3

PART 4 - ABOUT THE PERSON YOU ARE VISITING

Surname

Forenames

Date of Birth

Male

Female

Prison Number

For completion by APVU only

Estab

DTIC

Status

Signature

Date

(if applicable)

EDR

PART 5 - CHILDREN

Will you be taking any close relatives of the prisoner who are aged under 18 on the visit

Yes

Fill in details below

Go to Part 6

Surname

Forenames

Relationship to the

Date of birth

Prisoner

Do you receive benefits, Universal Credit or a Tax Credit award for the above child/children?

Yes

Go to Part 6.

Ensure you have completed Part 3 then go to Part 6.

PART 6 - VISIT DATES

Enter visit date/s made or that you wish to make in the future

You can claim for two assisted prison visits every four weeks. Claims must reach APVU within 28 days of the earliest

visit. If you are applying for rail tickets in advance you must tell us if the dates have changed before you receive the

tickets, see contact details in section 7.

Assisted Person Vists Application Form Page 3