Disability Allowance Form Page 12
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360B7157A6
Part 5
Details of your qualified child(ren)
33.Do you wish to apply for qualified child(ren)?
Yes
No
If ‘Yes’, how many children do you wish to claim for?
under age 18
age 18 - 22 in full-time education
Do they live with you?
Yes
No
Please state child’s:
Child 1
Surname:
First name(s):
PPS No.:
Date of birth:
D D
M M
Y Y Y Y
Child 2
Surname:
First name(s):
PPS No.:
Date of birth:
D D
M M
Y Y Y Y
Child 3
Surname:
First name(s):
PPS No.:
Date of birth:
D D
M M
Y Y Y Y
Child 4
Surname:
First name(s):
PPS No.:
Date of birth:
3179140184
3179140184
3179140184
3179140184
D D
M M
Y Y Y Y
You must attach written confirmation from the school or college
for the children aged 18 - 22.
Note: A separate sheet of paper can be used for details of other children you have.
Page 10
D662EDBF
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