IMMIGRATION ACT 1972

Undertaking as to the maintenance and accommodation of a domestic worker

TO BE COMPLETED BY THE EMPLOYER

Please complete this form in block capitals

I,                                                                      (name), of 

Hereby undertake that if                                                     (name of employee) is granted leave to enter or remain in the United Kingdom as my worker I shall be responsible for his/her maintenance and accommodation in the United Kingdom, throughout the period of that leave and any variation of it, and that I will maintain and accommodate him/her adequately, providing him/her with his/her own separate bedroom.

  Signed

  Dated

FOR OFFICIAL USE ONLY

Certificate

I certify that this undertaking has been signed  by the employer and that a copy has been given to him/her.

Signature:

Date Stamp: