Form Cb 1 - Application Form For Child Benefit Page 2
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16How to fill in first page of this form
To help us in processing your application:
•
Print letters and numbers clearly.
•
Use one box for each character (letter or number).
Please see example below.
1 2 3 4 5 6 7 T
1. Your PPS No.:
2. Title: (insert an ‘X’ or
Mr.
Mrs.
Ms.
Other
X
specify)
M U R P H Y
3. Surname:
M A U R E E N
4. First name(s):
5. Your first name as it
M A R Y
appears on your birth
certificate:
M C D E R M O T T
6. Birth surname:
7. Your mother’s birth
K E L L Y
surname:
2 8
0 2
1 9 7 0
8. Your date of birth:
D D
M M
Y Y Y Y
Contact Details
1
N E W
S T R E E T
9. Your address:
O L D
T O W N
D O N E G A L
T O W N
County
D O N E G A L
Postcode
O N E
N U M B E R
P E R
B O X
10.Your telephone number:
M O B I L E
O N E
N U M B E R
P E R
B O X
L A N D L I N E
O N E
C H A R A C T E R
P
E R
11.Your email address:
B O X
SAMPLE
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Parent category: Legal