ChildBenefitClaimForm.pdf

Child Benefit claim

April 2006

Please read the notes that came with this form before you fill it in.

They will give you more information about Child Benefit and help you to fill in this claim form.

Please make sure you

• answer all the questions on this form that apply to you, and your partner if you have one

• give us details of an account into which we can pay your Child Benefit

• send us all the documents we ask for.

If you do not, it may take longer to pay you Child Benefit, or we may not be able to pay you at all.

PART 1 PERSONAL DETAILS

National Insurance number.

See notes, page 9

If you do not know your National Insurance number , No

have you ever had one or used one at any time?

Yes

Title, enter MRS, MISS, MS, MR or other title

Surname or family name

First name(s)

All other surnames or family names you have

been known by. Please include maiden name,

all former married names and all changes of

family name.

Date of birth

D D M M Y Y

Address (including postcode)

If you, or your partner if you have one, are a

Crown Servant working abroad, enter one of

the following

• your full BFPO address or

• an address care of a member of HM Armed

Forces unit or

• for civil servants, your employing

department’s address.

For office

use 1

Postcode

Have you ever claimed Child Benefit before?

If you are still getting Child Benefit, tick Yes.

Yes

Please tell us the Child Benefit number we gave you

C H B

You can find this on letters we have sent you. If you cannot

find the number do not delay sending this form back to us.

Are you getting any Child Benefit now?

Yes

Please tell us the full name of the eldest child you are

getting Child Benefit for

What is this child’s date of birth?

D D M M Y Y

Page 1

PART 1 PERSONAL DETAILS – continued

Daytime phone number

What is this number?

Home

Work

Mobile

Fax

Please tell us your last two addresses

Postcode

Please tell us your marital status

Single

Living with a partner

Married

Separated

Widowed

Divorced

Are you a United Kingdom national?

See notes, page 9

If no, please tell us your nationality

Yes

Are you subject to immigration control?

See notes, page 10

Yes

Do you usually live in the United Kingdom?

You usually live in the UK, if

• you live in the UK or

• you have recently come to the UK but

intend to live here continuously or

• you are a Crown Servant working abroad.

See notes, page 10

If no, please tell us the name of the country you usually live in

Yes

If you came to live in the UK within the last 12 months,

please tell us when you arrived

D D M M Y Y

For office

use 2

Are you, or your partner if you have one, a

Crown Servant working abroad?

Yes

Are you, or your partner if you have one,

currently (or have either of you been in the

last 3 months)

• employed in or

• receiving benefit from

any country in the European Economic Area

(see notes page 10) or Switzerland?

Yes

Page 2

PART 2 PARTNER’S DETAILS

If you have a partner, read the notes on pages 11 and 17 to 21 to help you decide who should claim Child Benefit.

They tell you about protecting your Basic State Pension if you give up work to care for a child you get Child Benefit for.

Do you have a partner?

Go to Part 3

Yes

Please answer the questions below

Is your partner a United Kingdom national?

See notes, page 9

If no, please tell us your partner’s nationality

Yes

Is your partner

• already getting, or

• waiting to hear if they can get

Child Benefit for any children?

Go to Part 3

Yes

Give details below

Your partner’s name (in full)

Your partner’s National Insurance number

Your partner’s Child Benefit number

C H B

Full name of the eldest child your partner

gets Child Benefit for (or is waiting to hear

about Child Benefit for)

See notes, page 4

What is this child’s date of birth?

D D M M Y Y

PART 3 CHILDREN YOU WANT TO CLAIM FOR

Please tell us about the children you want to claim for now. Do not tell us about any children you already get

Child Benefit for. Please enter the name exactly as shown on the child’s birth or adoption certificate.

If you want to claim for more than 4 children, use the space in Part 6 to tell us about them.

1st CHILD

Surname

Other name(s)

Sex

Male

Female

For office

use 3

Date of birth

D D M M Y Y

2nd CHILD

Surname

Other name(s)

Sex

Male

Female

For office

use 4

Date of birth

D D M M Y Y

Page 3

PART 3 CHILDREN YOU WANT TO CLAIM FOR continued

Please tell us about the children you want to claim for now. Do not tell us about any children you already get

Child Benefit for. Please enter the name exactly as shown on the child’s birth or adoption certificate.

If you want to claim for more than 4 children, use the space in Part 6 to tell us about them.

3rd CHILD

Surname

Other name(s)

Sex

Male

Female

For office

use 5

Date of birth

D D M M Y Y

4th CHILD

Surname

Other name(s)

Sex

Male

Female

For office

use 6

Date of birth

D D M M Y Y

We need to see the original

• birth certificate, or

• adoption certificate

for each child in this claim.

Please tell us how many certificates you are sending with this form.

If you cannot send any certificates with the form please tell us why

in Part 6

How many birth certificates

Do not send photocopies.

For office use only - not for completion by DO – birth certificates extraction

If you have, or someone else has, received

Child Benefit for the child in the past, do not

send us the birth certificate.

How many adoption certificates

Has anyone else ever claimed Child Benefit

for any of the children you want to claim for?

See notes, page 12

Yes

If yes, please tell us about the person who made the claim

The full name of the person who claimed (if you know it)

The address the claim was made from (if you know it)

Postcode

The Child Benefit number (if you know it)

C H B

For Child Benefit Office use only - not for completion by DWP office or HMRC Enquiry Centre – birth certificates extraction

Signature 1

Name in capitals

Signature 2

Name in capitals

Date

Child 1

Child 2

Child 3

Child 4

Page 4

PART 3 CHILDREN YOU WANT TO CLAIM FOR continued

Have any of 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

adoption certificate?

Yes

If yes, please tell us the child’s current name and previous name

Child’s name

Previous name

Child’s name

Previous name

Child’s name

Previous name

Child’s name

Previous name

Are any of the children you want to claim for

living with someone else?

See notes, page 12

Yes

If yes, please tell us the names of the children

For office

use 7

Have any of the children you want to claim for

lived with someone else in the last 3 months?

Yes

If yes, please tell us their names and the date they came to live

with you

D D M M Y Y

For office

use 8

D D M M Y Y

Are you including any children on this claim

that are not your own?

See notes, page 12

Please note, stepchildren and children you

have legally adopted count as your own

Go to Part 5, page 7

For office

use 9

Yes

Go to Part 4, page 6

Page 5

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