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

PART 7 - TRAVEL DETAILS

Yes

Are you travelling by car?

If travelling by public transport tell us each stage of your journey including the name of rail stations. If you are applying

for train tickets in advance we need to know the times of your trains, allowing time to get to the prison. You must travel

by the cheapest means possible i.e. Off-peak. It is important that you tell us if the date(s) of your planned visits change

before we issue your tickets, call 0300 063 2100, 9am to 5pm (Monday to Friday, except Bank Holidays) or e-mail

assisted.prison.visits@noms.gsi.gov.uk

Please supply your e-mail address

Yes

Do you have a credit or debit card to prove identity for collecting tickets from a Fastticket machine

Time of

From

Time of

Means of transport

Fare

departure

arrival

Tick this box if you are claiming the additional light refreshment allowance.

by ticking the box you are certifying

that expenditure was made by you on the day. APVU reserve the right to ask for receipts.

I request approval to stay overnight.

PART 8 - DECLARATION

I declare that the information I have given in this form is, to the best of my knowledge, true and all supporting evidence

is genuine.

I will send in my original award notice whenever my Tax Credits, Universal Credit, Pension Credits or Health Certificate

is renewed or amended.

I declare that any monies, rail warrants or tickets I receive for any future visits will only be used by me to visit the

prisoner, or I will return the money, rail warrants or tickets to the APVU. A completed Confirmation of a Visit form and all

tickets or receipts must reach the APVU within 28 days of the visit taking place or I will attach them to the next claim if

sooner.

I understand that a false declaration may lead to prosecution and / or my suspension from the Assisted Prison Visits

Scheme.

I authorise you to make the necessary checks with the DWP.

Signature

Date

Read through the form to make sure you have completed it correctly and send in all tickets, receipts and Confirmation

of a Visit forms. This form must be signed.

Send your completed application to: APVU, PO BOX 2152, Birmingham, B15 1SD

Assisted Person Vists Application Form Page 4