Application For Benefit While Temporarily Away From Home

Entries marked with * are mandatory.

This form is to apply for benefit while you are living away from your home. If you give false information, or you do not tell us information that is relevant, you may be prosecuted under the Theft Acts 1968 and 1978 or the Social Security Act 1992.
Your Details
Claim Details
Does anyone still live at the property? *

Do you intend to return to this property? *

If you are in prison, please answer the following questions:
Residential Care
If you are in residential care, please answer the following questions:
Is this a trial stay?