Child Benefit Claim Form
Page 2
Home Work Mobile Fax
Single Living with a partner
Married Separated
Widowed Divorced
No If no, please tell us your nationality
Y es
No
Yes
No If no , please tell us the name of the country you usuall y live in
Y
es
If you c
ame to liv
e in the UK within the last 12 months,
ple
a
s
e t
el
l us when you arriv
ed
No
Yes
No
Yes
D D M M Y Y
Postcode
Postcode
Daytime phone number
What is this number?
P
lease tell us your last two addresses
Please tell us your marital status
Are you a United Kingdom national?
See notes, page 9
Are you subject to immigration control?
See notes, page 10
Do you usuall y live in the United Kingdom?
Y ou usual ly live in the UK, if
•
you liv
e in the UK or
• you have r ecently come to the UK but
int
end to live here continuousl y or
•
you are a Cr
own Servant working abroad.
See notes, page 10
Ar
e you, or your partner if you ha
v
e one, a
Cro
wn Ser
v
ant w
orking abroad?
Are you, or your partner if you have one,
currently (or have either of you been in the
last 3 months)
• employed in or
•
r
ec
eiving benefit from
any c
ountr
y in the Eur
ope
an Ec
onomic Area
(see notes page 10) or Switzerland?
F
or o
f
f
ice
use 2
P ART 1 PERSONAL DET AILS – continued
Page 2/12
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