IHS Refund Application Form

Immigration Health Surcharge Application
Sponsor Licence Number (Found on your Certificate of Sponsorship (CoS), below "Certificate of sponsorship status")*
Please ensure that you are entering the Sponsor License Number found at the top of your CoS to continue this form. Please note that this is not the same as your Certificate of Sponsorship number.
Please note that this form can only be used by those who entered the UK on a Temporary Work – Government Authorised Exchange (TW GAE, formerly known as Tier-5) visa sponsored by the Academy of Medical Royal Colleges (AoMRC)

If you were not sponsored by the AoMRC, please contact the organisation listed under "Sponsor name" on your CoS.

Further information can be found on gov.uk.

If you believe you are recieving this message in error, please contact mti@aomrc.org.uk and be sure to quote your CoS number.
Given name*
Family name*
Date of birth of main MTI applicant*

DayMonthYear
Date
Email address *
Please confirm you authorise the Academy to contact you at the email address provided should we require more information*

I confirm
Certificate of Sponsorship number. PLEASE NOTE: [this number will start with C5 and be followed by a 9-digit format with numbers and letters]*
Immigration Health Surcharge number [this will start with IHS or IHSC followed by nine numbers] PLEASE NOTE: Do not include PA01 in the IHS reference number*
Please ensure you enter the correct reference number above.

If your reference starts with "IHS", it should be 12 characters long

If your reference starts with "IHSC", it should be 13 characters long

If your reference number is longer than 13 characters, this is not the correct reference number.
Unique Response Number (please make a note of this as it will help you track your application)
Admin field - payment before March 2020 (needs to stay hidden)
Do you have any dependents?*

YesNo
First dependent
Given name of first dependent*
Family name of first dependent*
Date of birth of first dependent*

DayMonthYear
Date
First dependent's Certificate of Sponsorship number [this number will start with C5 and be a 9-digit format with numbers and letters]*
First dependent's Immigration Health Surcharge number [this will start with IHS or IHSC followed by nine numbers]*
Would you like to add a second dependent?*

YesNo
Second dependent
Given name of second dependent*
Family name of second dependent*
Date of birth of second dependent*

DayMonthYear
Date
Second dependent's Certificate of Sponsorship number [this number will start with C5 and be a 9-digit format with numbers and letters]*
Second dependent's Immigration Health Surcharge number [this will start with IHS or IHSC followed by nine numbers]*
Would you like to add a third dependent?*

YesNo
Third dependent
Given name of third dependent*
Family name of third dependent*
Date of birth of third dependent*

DayMonthYear
Date
Third dependent's Certificate of Sponsorship number [this number will start with C5 and be a 9-digit format with numbers and letters]*
Third dependent's Immigration Health Surcharge number [this will start with IHS or IHSC followed by nine numbers]*
Would you like to add a fourth dependent?*

YesNo
Fourth dependent
Given name of fourth dependent*
Family name of fourth dependent*
Date of birth of fourth dependent*

DayMonthYear
Date
Fourth dependent's Certificate of Sponsorship number [this number will start with C5 and be a 9-digit format with numbers and letters]*
Fourth dependent's Immigration Health Surcharge number [this will start with IHS or IHSC followed by nine numbers]*
Would you like to add a fifth dependent?*

YesNo
Fifth dependent
Given name of fifth dependent*
Family name of fifth dependent*
Date of birth of fifth dependent*

DayMonthYear
Date
Fifth dependent's Certificate of Sponsorship number [this number will start with C5 and be a 9-digit format with numbers and letters]*
Fifth dependent's Immigration Health Surcharge number [this will start with IHS or IHSC followed by nine numbers]*
Would you like to add a sixth dependent?*

YesNo
Sixth dependent
Given name of sixth dependent*
Family name of sixth dependent*
Date of birth of sixth dependent*

DayMonthYear
Date
Sixth dependent's Certificate of Sponsorship number [this number will start with C5 and be a 9-digit format with numbers and letters]*
Sixth dependent's Immigration Health Surcharge number [this will start with IHS or IHSC followed by nine numbers]*
Please note that it may take a few seconds for the Unique Response Number (URN) to generate. Please do not submit this form until a URN is displayed in the relevant box.
Error message
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Immigration Health Surcharge Application

First dependent

Second dependent

Third dependent

Fourth dependent

Fifth dependent

Sixth dependent