Child Benefit Claim Form

Page 5
N
o
Y es If yes, plea se tell us the child’ s current name and pr evious name
No
Y es If yes, plea se tell us the names o f the children
No
Y es If yes, plea se tell us their names and the date they came to live
with you
No
Go to
Part 5, page 7
Y
es
Go to
P
ar
t 4, page 6
D D M M Y Y
D D M M Y Y
D D M M Y Y
D D M M Y Y
Child’ s name
Pre vious name
C
hild’ s name
Pre vious name
Child’ s name
Pre vious name
Child’ s name
Pre vious name
P ART 3 CHILDREN YOU W AN T TO CLAIM FOR continued
Have any o f the children you want to claim for
used a different name
from the one they have now , or
from the one shown on their birth or
a
doption certificate?
Are any of the children you want to claim for
living with someone else?
See notes, page 12
Have any o f the children you want to claim for
liv
ed with someone else in the last 3 months?
Are you including any children on this claim
that are not your own?
See notes, page 12
Plea
s
e no
t
e
,
s
t
epchildr
en and childr
en you
have legal ly adopted count as your own
For office
use 7
For office
us
e 8
F
or o
f
fice
use 9
Page 5/12
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Child Benefit Claim Form PDF

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