Budgeting Loans from the Social Fund Form
4
Part 4
About benefits and entitlements – continued
Has an ex-partner 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 about this person.
/ /
/ /
From To
Their name
Their National Insurance (NI)
number
Their address
Postcode
/ /
Date of birth
Type of benefit or entitlement
Have you made this claim because you
have separated from someone?
No
Yes
Tell us about the person you have separated from.
Are you or your partner expecting a baby?
No
Yes
Is there more than one child expected, if so how many?
Their name
Their date of birth
/ /
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