Budgeting Loans from the Social Fund Form
About you and your partner
Part 3
3
About benefits and entitlements
Are you or your partner currently getting
Income Support, income-based
Jobseeker’s Allowance, Pension Credit or
payment on account of one of these
benefits or entitlements?
No Go to Part 9.
Yes
Tell us the date you have
been getting any of these
benefits or entitlements in
the last 3 years.
Has a partner or an ex-partner received
Income Support, income-based
Jobseeker’s Allowance, Pension Credit or
payment on account of one of these
benefits or entitlements for you, in the last
three years?
No
Yes
Tell us about this person.
Their name
Their National Insurance (NI)
number
Their address
Postcode
/ /
Date of birth
/ /
Date of separation
/ // /
From To
/ /
/ /
From To
Have you, or your partner if you have one,
received any of these benefits or entitlements,
in the last three years?
l
Working Families Tax Credit
l
Working Tax Credit which includes a disability
or severe disability element
l
Child Tax Credit at a rate higher than the
family element.
From April 2005 to April 2006 this means a Child
Tax Credit of £548 a year or more, or £1096 a
year or more if you have a baby under one.
l
Housing Benefit
l
Council Tax Benefit.
No
Yes
Tell us which one. If more than one, tell us about the one you have been getting the longest.
Type of benefit or
entitlement
/ /
/ /
From To
/ /
/ /
From To
Page 5/16
Free Download
Budgeting Loans from the Social Fund Form PDF
Favor this template? Just fancy it by voting!
(0 Votes)
0.0
Related Forms
1 Page(s) | 978 Views | 14 Downloads
