Carers Allowance Claim Form
About you – the carer c
ontinued
2
Date of birth
/ /
Day Month Year
Postcode
Address
If you have speech or hearing difficulties and would like
us to contact you by textphone, tick here.
When do you want your
Carer’s Allowance claim
to start?
You must give us an exact
date or your claim may be
delayed.
If you do not fill in the
day, month and year, we
cannot accept your claim
and will return this form to
you.
/ /
Day Month Year
06 / 01 / 2014
Example of an exact date
Please make a note of this
date as we will ask you
about it again later.
For more information please read page 6 of the Notes.
i
About your Carer’s Allowance
Daytime phone number
where we can contact you
or leave a message. Please
include the dialling code.
Mobile number
If you live in Wales and
would like us to contact
you in Welsh, tick this box.
Page 2/27
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