Housing Benefit And Council Tax Support Claim Form Page 4
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18Part B
About children
1.
Please tell us about all the children who normally live with you.
If there are more than three children in your household, please use Part K to tell us all the information we
ask for on this page.
First Child
Second Child
Third Child
Surname
First name(s)
Date of birth
/
/
/
/
/
/
(dd/mm/yyyy)
Boy or girl?
The child’s relationship
to you
The child’s relationship
to your partner
Usual address if
different from yours
Do you get Child Benefit
Yes
No
Yes
No
Yes
No
!
for this child?
Do you pay childcare for
Yes
No
Yes
No
Yes
No
!
this child?
Are they registered
Yes
No
Yes
No
Yes
No
!
blind?
Do they get Disability
Yes
No
Yes
No
Yes
No
!
Living Allowance?
2.
Do any of these children need their own bedroom due to health or disability?
Yes
No
If ‘Yes’, please give us proof, for example a letter from their doctor.
If you pay childcare, please fill in a Childcare Costs Certificate (you can download this form from our website).
Page 4
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