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2.

Yes No

Did / do you or your partner receive any other income or
benefits, such as state retirement pension, tax credits or
incapacity benefit?
If Yes, please list them below and provide proof

£

£

£

Have you applied for Working Tax Credit? Yes No

If Yes, when did you apply

3

Have you/your partner reapplied for

Income Support YES NO

Job Seekers Allowance YES NO

If YES, when did you reapply

If you have reapplied for benefit, it may not be continuous from the date that your
previous entitlement ended. Therefore, we will not be able to pay you more benefit
unless we have proof of your income

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