Title, for example
Mr, Mrs, Miss, Ms.
Surname or family name
Please answer the questions on this form in BLOCK CAPITALS.
About you – the carer
All other names in full
All other surnames or family
names you have used or have
been known by
National Insurance (NI)
You can get this from your NI number card, letters about
benefits, payslips or form P60. If you do not tell us your NI
number, this could delay any benefit you may be entitled to.
Letters Numbers Letter
l Use this form to claim Carer’s Allowance.
l Please read the Notes that came with the
claim pack before you fill in the form.
l The form must be filled in by you, the carer,
not the person you look after.
l Please fill in this form with BLACK INK and
l Please answer all of the questions and
send us all the documents we ask for.
l Contact us if you cannot fill in this form or
send us the documents we ask for.
Any benefit you may be entitled to may
This form is available in large print or braille. Please ring
0345 608 4321.
If you have speech or hearing difficulties, you can contact us
by textphone on 0345 604 5312.
Our textphone service does not receive messages from
Calls to 0345 numbers cost no more than a standard
geographic call, and count towards any free or inclusive
minutes in your landline or mobile phone contract.