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SHORT TERM ADVANCE LOAN APPLICATION FORM
SECTION 1: Your details
Your name:
Constituency:
SECTION 2: Loan amount required
Amount of loan applied for
(maximum £4,000)
£______________________
SECTION 3: Repayment plan and agreement
Your loan must be repaid to IPSA by 31 March 2016. When you take out the loan we will set up a
regular deduction from your salary. This will start on the date your next salary payment is due, and
continue to the end of the financial year with the final payment being deducted on 31 March 2016.
If for any reason an amount remains outstanding by 31 March 2016 it will become a debt and we will
seek to recover it in accordance with our debt recovery policy.
Please complete the table below to confirm you understand the repayment arrangement and that
you agree for a regular payment to be deducted from your salary. If you would like to set up a
payment plan that ends before 31 March 2016 please indicate the date you would like the last
payment to be made.
I understand that my loan must be repaid in full by 31 March 2016
and I give permission to IPSA to deduct a regular sum from my
salary.
Please tick:

The amount deducted will be equal to the amount of loan paid,
divided by the number of months remaining in the financial year.
We will write to you to confirm the exact amount once we have
processed your application.
If the loan is being repaid over a shorter period (i.e. before 31
March 16) please indicate the date you would like your last
payment to be made.
Enter date of last
payment
_____/_____/_____
SECTION 4: Terms and Conditions
Purpose of the short term loan
1. The short term advance loan is designed to ease your cash flow whilst waiting for
reimbursement claims to be paid.
2. There are other options available to help ease your cash flow, for example, using your payment
card and signing up to direct payments to suppliers which do not require you to make upfront
payments. It is recommended that, before you apply for a short term advance loan, you look
into the other options available.
3. The loan must be used exclusively for expenses that are claimable under the current edition of
the MPs’ Scheme of Business Costs and Expenses.
4. You must submit a claim on the online expenses system for any items funded by the loan.
Amount of short term loan
5. You may apply for a short term advance loan up to a maximum of £4,000.
6. No interest is payable on the loan if it is repaid by 31 March 2016.
Number of short term loans
7. You can only have one short term advance loan outstanding up to £4,000.
Paying back the short term loan
8. It is a condition of taking out the loan that you agree to repay the loan via regular salary
deductions. You must repay the loan in full by 31 March 2016.
9. When you take out the loan we will set up a regular deduction from your salary. This will start on
the date your next salary payment is due, and continue to the end of the financial year with the
final payment being deducted on 31 March 2016.
10. IPSA will require full repayment of the loan within one month following any event or
circumstance (or IPSA becoming aware of any event or circumstance) which in IPSA's opinion
(acting reasonably) (i) is contrary to the terms of the agreement or (ii) materially changes the
basis or understanding on which IPSA originally approved the loan.
11. You will be required to pay back any loan you hold under these arrangements within one month
in the event that it becomes illegal for IPSA to issue such loans or if there are any changes in
circumstances requiring IPSA to repay the funds.
12. Any loan amounts outstanding after 31 March 2016 will become debts and IPSA will seek to
recover sums due in accordance with the debt recovery policy.
Tax implications
13. Please note there may be tax implications if the combined outstanding value of all loans to you
is more than £10,000 at any time during the tax year. Please refer to relevant guidance on loans
on HMRC’s website or contact HMRC if you have any queries.
Publication
14. Please be aware that IPSA publishes details of all loans taken out by MPs as part of our annual
publication each September.
SECTION 5: Declaration
TO BE COMPLETED BY THE MEMBER OF PARLIAMENT
By signing this form you are entering into a legally binding agreement with IPSA that is governed
by the terms and conditions set out within this document. This short term advance loan
agreement and any non-contractual obligations arising out of it are governed by English law.
I certify that:

I have read and understood the terms and conditions for the short term advance loan
arrangement and that I will abide by and comply with them.

The information I have supplied on this form is, to the best of my knowledge, true and complete.
Signature: X_______________________________ Name: ________________________________
Date: ______________________
NEXT STEP
Please post your application to: IPSA, 4th floor, 30 Millbank, London, SW1P 4DU.
Please allow 5 working days for the loan application to be processed and the funds to appear in your
account. If you need to contact us before then, you can do so by emailing us on
[email protected] or by calling our information line on 020 7811 6400.
Data Protection IPSA will process the personal information you provide, and the personal information it obtains, for the
purposes of exercising its statutory functions and as set out in the IPSA Freedom of Information and Data Protection Policy.
IPSA may disclose information to third parties where it is required or permitted to do so by law. IPSA is a public authority
under the Freedom of Information Act 2000 (FOIA). The information it holds may be disclosable under FOIA. Under the
Data Protection Act 1998, you have a right to request a copy of the personal information which IPSA holds on you. To make
a request, please contact IPSA's Data Protection Officer. IPSA may charge the statutory fee for access. For further
information about how IPSA processes your personal information, please contact IPSA's Data Protection Officer at IPSA, 4th
floor, 30 Millbank, London SW1P 4DU
Office use only
All details checked and form completed correctly

Existing loans checked?

Total amount of loan outstanding does not exceed £10,000

Other repayment option agreed

Detail arrangement here:
Case owner (checked by) ……………………………………….
Date……………………………………………………………………….
IRIS case number……………………………………………………