(IF KNOWN) IR Ref: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

To
The Student Loans Company
100, Bothwell Street
Glasgow
G2  7JD

## Self Assessment: - Early Settlement

| Borrower's Name                                                     | _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _   |
|---------------------------------------------------------------------|-----------------------------------------------------------------------|
| NINO                                                                | _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _                       |
| Date of birth                                                       | _ _/_ _ /_ _ _ _                                                      |
| Agent / Personal                                                    |                                                                       |
| Representative*                                                     | _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _   |
| _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |                                                                       |
| _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |                                                                       |
| _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |                                                                       |
| _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |                                                                       |
| _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ |                                                                       |

The above borrower has Died - Date of Death  _ _/ _ _/ _ _ _ _
Emigrated from  _ _ / _ _ / _ _ _ _   New Address:_ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _ 
_ _ _ _ _ _ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _ _ _ _ _ _
              
Early settlement has been requested and tax liability for the year _ _ _ _/ _ _ _ _ has been informally agreed.  No Student Loan repayment via Self Assessment has been included. The taxpayer / agent / personal representative* has been advised to contact you regarding settlement of the Student Loan.

Tel: No: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Contact Name: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _