Child Benefits Claim Form
Page 5
Name
3 – Children you want to claim for continued
Name
N
ame
Name
Social worker
Child 1 continued
Does this child live with you? See page 4 of the CH2 Notes
No
Yes If Yes, go to question 43
What is the name and address of the person this child
lives with?
Has this child lived with anyone else in the last 12 months?
See page 4 of the CH2 Notes
No If No, go to question 46
Yes
What is the name and address of the person this child
lived with?
What date did the child come to live with you?
DD MM YYYY
Are you adopting or planning to adopt this child through
a local authority?
No Yes
Do you want to claim for any more children now?
No If No, go to question 62
Yes If Yes, go to question 48
47
4
1
P
ostcode
4
2
Postcode
46
45
44
43
Name
C
hild 1
Child's surname or family name
As shown on the birth or adoption certificate
Child's first name and any middle name(s)
As shown on the birth or adoption certificate
Is this child male or female?
Male
Female
Child’s date of birth DD MM YYYY
Has this child ever been known by any other name?
No
Yes If Yes, please write it below
Is this child your own? See page 4 of the CH2 Notes
No Yes
Has anyone else ever claimed Child Benefit for this child?
See page 4 of the CH2 Notes
No If No, go to question 41
Yes If Yes, please tell us their name and address
Go to question 41
F
irst name
Middle name(s)
34
3
6
3
7
3
8
35
Postcode
40
39
Name
Name
Name
For
o
ffice
use 4
For
office
use 3
For
office
u
se 6
For
office
use 5
For official use only
Page 5/9
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