A Claim Form For Housing Benefit And Council Tax Support Page 4

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page 4
Part 2
About children
We need to know about any children in your household who are:
• under 16,
• aged 16 or 17 and registered for work or youth training, or
• aged 16, 17 or 18 and in education doing a course not higher than GCE A-level, SCE Higher level or GNVQ (advanced).
Are there any children in your household as
No
Go to Part 3.
described above?
If there are more than three children. Please continue on page 22.
Yes
If you do need to use page 22, please tick this box.
First child
Second child
Third child
Last name
Other names
Date of birth
/
/
/
/
/
/
What is the child’s sex?
The child’s relationship to
you
The child’s relationship to
your partner
Usual address, if different
from yours
Child Benefit number
Who gets the Child Benefit
for them?
We need to see proof of this.
Remember to tell us about Child Benefit and Child Tax Credit in Part 8.
Is the child disabled?
No
No
No
Yes
Yes
Yes
Does that disability make it
No
No
No
difficult for the child to
Yes
We may write to you
Yes
We may write to you
Yes
We may write to you
share a bedroom with other
for more information
for more information
for more information
children?
about this.
about this.
about this.
Is the child registered
No
No
No
blind?
Yes
We need to see proof
Yes
We need to see proof
Yes
We need to see proof
of this.
of this.
of this.
Does the child get Disability
No
No
No
Living Allowance?
Yes
How much?
Yes
How much?
Yes
How much?
Care
£
£
£
Mobility
£
£
£
Do you or your partner pay
No
No
No
any childminding costs for
Yes
Please tell us about it
Yes
Please tell us about it
Yes
Please tell us about it
this child to a registered
below.
below.
below.
childminder, a nursery or
an after-school club?
Tell us the name and
registration number of the
minder.
How much do you pay a
£
a week
£
a week
£
a week
week?
We need to see proof of this.
We need to see proof of this.
We need to see proof of this.

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