Use this application form for applying for an request for an Assisted Prison Visit to someone who is in the Prison of United Kingdom. This form is also an request for Help for travelling expenses for visiting a close relative who is in prison. This form may only be used in the United Kingdom. The form has 4 Pages out of which the first page preview is given below.
APPLICATION FOR ASSISTED PRISON VISITS For official use only
Help with travelling expenses to visit close relatives in prison
Please read the Information Booklet that came with this form
before you fill it in. All sections must be completed in black
ink. Please use block capitals.PART 1 – ABOUT YOU
Title (Mr/Mrs/Miss/Ms)
Surname
Forenames
Date of Birth
National Insurance Number
Address
Postcode
Phone No Code Number
Have you applied to us before? Yes [ ] No [ ]
Name of prison being visited HMP/YOI
At which Post Office will you
cash your girocheque?Are you the prisoner’s:
Close relative? [ ] (See Information Booklet, Section 2.1)
What is your relationship to
the person you are visiting?Partner? [ ] (See Information Booklet, Section 2.2)
Were you living as a couple, in an established relationship, immediately before
the period of prison custody was imposed? Yes [ ] No [ ]Sole Visitor? [ ] (See Information Booklet, Section 2.3)
All close relatives, partners and sole visitors must complete this section.
Do you need someone to help you during the journey? (see Information
Booklet, section 2.5 and 6.1d.)Yes [ ] No [ ] If YES complete below?
Note: your escort is also required
Medical [ ] Aged 75 years or over [ ] to complete a claim form.If Medical enclose your Disability Living Allowance award notice or ask your
doctor to confirm the special needs in writing. There is no need to delay sending
this form but please forward the doctor’s letter as soon as you receive it.Yes [ ] No [ ]
Are you escorting someone to the prison? If YES go to Part 3