A tuberculosis (TB) certificate is required for some UK entry clearance applications. The current legal test is contained in Appendix Tuberculosis (TB) of the Immigration Rules. It depends on the application being made and the applicant’s recent continuous presence in one or more listed countries; nationality alone does not determine whether a certificate is required.

In broad terms, the requirement applies where an applicant is seeking entry clearance for more than six months, as a fiance(e) or proposed civil partner, or as a Returning Resident, and has been continuously present in one or more listed countries for at least six months, including some time within the six months before the application date.

1. Changes to the Tuberculosis Test Rules for UK Visa Applications

Appendix Tuberculosis took effect on 5 October 2023. It replaced paragraphs A39, B39 and C39 and the former Appendix T with a shorter set of rules governing when a certificate is required, what makes a certificate valid, when a fresh certificate may be requested and when the requirement may be waived.

Paragraphs 36 to 39 of Part 1 of the Immigration Rules continue to address wider medical examination powers. They are distinct from the specific certificate requirement in Appendix Tuberculosis.

2. UK Visa TB Test Requirements

A valid TB certificate must be provided with an application if both the application test in TB1 and the recent-presence test in TB2 are met.

The application test covers entry clearance applications to come to the UK:

• for more than six months, except an application under Appendix Ukraine Scheme;
• as a fiance(e) or proposed civil partner under Appendix FM; or
• as a Returning Resident under Appendix Returning Resident.

The recent-presence test is met where the applicant has been continuously present in one or more countries listed in TB6 for six months or more, and that continuous period includes a period of any length within the six months before the date of application.

Time can run across more than one listed country. Applicants should therefore review their full travel and residence history rather than asking only whether their nationality or current country of residence appears on the list.

3. When Is a TB Test Certificate Not Required?

A certificate will not normally be required where the recent-presence test is not met. It will also not ordinarily be required for entry clearance of six months or less unless the application is as a fiance(e), proposed civil partner or Returning Resident.

Appendix Tuberculosis excludes applications under Appendix Ukraine Scheme from the ordinary rule for entry clearance of more than six months. Current GOV.UK guidance also states that a diplomat accredited to the UK does not need to be tested.

Current GOV.UK guidance refers to a returning UK resident who has not been away for more than two years. The underlying immigration question is whether settlement has lapsed. Different lapse periods can apply to some people with status under the EU Settlement Scheme, so the person’s actual status and length of absence should be checked before assuming that a Returning Resident application is required.

4. TB Test Certificate Validity Period

For Appendix Tuberculosis purposes, a certificate is valid only if it was issued by a medical practitioner approved by the Home Office, confirms that the applicant has been screened for active pulmonary tuberculosis and that it is not present, was issued within the six months immediately before the application date, and has not expired.

The public GOV.UK guidance states that a certificate is normally valid for six months from the date of the chest x-ray. Applicants should check the expiry date shown on the certificate and submit the visa application while it remains valid.

The timing of the clinic appointment should allow for booking delays, any sputum testing and the time needed to prepare and submit the visa application.

5. What to Expect During a TB Test at an Approved Clinic

The test must be completed at a clinic approved by the Home Office. Applicants should check the current instructions for the relevant clinic because appointment procedures, required identification, fees and payment arrangements vary.

An applicant will usually be given a chest x-ray. If the result is unclear, the clinic may ask for a sputum sample. The visa screening process does not require a different type of TB test.

All children who require screening must attend an approved clinic and be assessed by a clinician. Children under 11 will not normally have a chest x-ray. A health questionnaire will be completed and a certificate can be issued where the clinician is satisfied that active pulmonary TB is not present.

A pregnant applicant can choose a chest x-ray with additional shielding in the second or third trimester, a sputum test, or to wait until after delivery. A sputum test may involve an extra fee and a wait of up to eight weeks for the result.

If active pulmonary TB is detected, the clinic cannot issue the required certificate at that stage. The applicant will normally be referred for treatment and may be re-screened after treatment, subject to the clinic’s current procedures and fees.

6. Approved TB Clinics

Only a certificate issued by a Home Office-approved medical practitioner can satisfy Appendix Tuberculosis. The current country and clinic pages should be checked immediately before booking.

Some listed countries do not have an approved testing centre, so an applicant may need to travel to another country. GOV.UK also lists approved clinics in some countries that are not themselves on the TB6 list. Clinic availability, appointment processes and fees are operational details and can change without an amendment to the Immigration Rules.

7. Waiving the TB Test Requirement for UK Visas

TB5 gives the decision maker a discretion to waive the requirement where they are satisfied that the applicant is unable to obtain a certificate and that it is reasonable to waive the requirement on the specific facts of the case.

This is not a general exemption for inconvenience, cost or delay. A waiver request should explain why an approved certificate cannot be obtained, provide evidence of attempts to obtain one and address why a waiver is reasonable in the particular circumstances.

8. Consequences of Not Providing a TB Test Certificate

Where Appendix Tuberculosis applies, a valid certificate should be provided with the entry clearance application. Failure to provide a required certificate may result in refusal.

A different issue arises where a valid certificate was submitted but becomes old while the application is awaiting a decision. TB4 permits the decision maker to require a new valid certificate if the certificate supplied with the application expired more than six months before the application is considered and the other requirements for entry clearance are met. This does not remove the obligation to provide a valid certificate at the application date.

9. Do I Require a TB Certificate for an Application Made Inside the UK?

Appendix Tuberculosis itself governs entry clearance applications. Most applications for permission to stay made inside the UK therefore do not require a TB certificate.

There is an important route-specific exception under the Hong Kong BN(O) rules. An applicant applying for permission to stay on that route may need a certificate where their last grant was for six months or less and they were present in a TB6-listed country for more than six months immediately before that grant. The requirement can be met where the applicant provided the relevant certificate with a successful entry clearance application in the 12 months before the in-country application.

Corresponding provisions apply across the BN(O) Status Holder, partner and child, Adult Child and Adult Dependant Relative categories. Each applicant’s immigration history should be checked separately.

10. Key Terms

Active pulmonary tuberculosis: TB affecting the lungs that is active at the time of screening.

Approved clinic: a clinic or medical practitioner approved by the Home Office for UK visa TB screening.

Entry clearance: permission obtained before travelling to the UK under the relevant immigration route.

Listed country: a country included in paragraph TB6 of Appendix Tuberculosis.

Sputum sample: a sample of mucus from the lungs that may be tested where the chest x-ray result is unclear.

11. Official Information and Further Resources

Applicants should use the current Appendix Tuberculosis, the GOV.UK TB test guide and the Home Office-approved clinic pages when checking the requirement and arranging screening. General medical information about symptoms and treatment is available from the NHS.

12. Contact Our Immigration Barristers

For expert advice and assistance relating to a TB certificate, a waiver request or any related UK visa application, contact our immigration barristers on 0203 617 9173 or complete our enquiry form below.

13. Frequently Asked Questions: TB Test Requirement for UK Visa Applicants

Is the UK visa TB test requirement based on nationality?

No. It depends on the application being made and continuous presence in one or more countries listed in TB6. Nationality alone is not the legal test.

Who must provide a TB certificate with a UK visa application?

An applicant who meets the recent-presence test must provide a certificate when applying for entry clearance for more than six months, as a fiance(e) or proposed civil partner, or as a Returning Resident.

Can time in different listed countries be combined?

Yes. TB2 refers to continuous presence in a country or countries on the list, so the qualifying period can run across more than one listed country.

How long is a UK visa TB certificate valid?

The certificate must have been issued within six months before the application and must not have expired. GOV.UK states that it is normally valid for six months from the date of the chest x-ray.

Can I use a TB certificate from any clinic?

No. The certificate must be issued by a medical practitioner approved by the Home Office for UK visa screening.

Do children need a TB test certificate?

A child who falls within the Rules must attend an approved clinic. Children under 11 will not normally have a chest x-ray, but a clinician must assess them and issue a certificate where appropriate.

What options are available to a pregnant applicant?

A pregnant applicant can choose a shielded chest x-ray in the second or third trimester, a sputum test, or to wait until after delivery.

Can the TB certificate requirement be waived?

Yes, but only where the decision maker is satisfied that the applicant is unable to obtain a certificate and that a waiver is reasonable on the specific facts.

What happens if my certificate expires while my application is pending?

The Home Office may require a new certificate if the submitted certificate expired more than six months before the decision and the application is otherwise grantable.

Is a TB certificate required for an application made inside the UK?

Usually not, but limited Hong Kong BN(O) route provisions can require a certificate where the applicant’s previous short grant and prior presence in a listed country meet the route-specific test.