Child Benefits Claim Form
Page 2
T
itle for example Mrs, Miss, Ms, Mr, Dr
Y
our surname or family name
Your first name and any middle name(s)
Have you ever been known by any other surname
or family name? Include your maiden name
No
Yes If Yes, please write it below
Your date of birth DD MM YYYY
Your address
Have you lived at this address for more than 12 months?
No If No, please go to question 8
Yes If Yes, please go to question 9
Please tell us your last address
1
2
3
First name
Middle name(s)
4
5
6
Postcode
7
8
Postcode
Do you have a National Insurance (NI) number?
S
ee page 3 of the CH2 Notes
No
Y
es If Yes, please tell us your NI number
Example of a National Insurance number XX 99 99 99 X
Your phone number(s)
Have you claimed Child Benefit for any child(ren) before?
No If No, go to question 14
Yes If Yes, go to question 12
Tell us your Child Benefit number if you know it
Example of a Child Benefit number CHB 99999999 XX
You can find your Child Benefit number on letters
we have sent you or on your bank statements
If you don't know your Child Benefit number you should
still claim now
Are you currently entitled to Child Benefit?
No
Yes If Yes, please tell us the full name and date
of birth of the eldest child you are entitled
to or getting Child Benefit for, then go to
question 23
Child’s date of birth DD MM YYYY
11
10
Daytime number
Evening number
1
2
C H B
13
Child’s surname
Child’s first name
Child’s middle name(s)
9
1 – About you
For office
use 1
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