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23/12/2008 17:46 3208B031B67 TULIP EFSS PAGE 05/87

BCOM/NINHDAY
Cicall Account and case numbers: 55508590 01623514

2.

Did / do you or your partner receive any
other income or benefits, such as state
retirement pension, tax credits or No
incapacity benefit?
If Ye|, please list them below and
provide proof

£

£

£
Have you applied for Working Tax Credit?

If Yes when did you apply

3

Have you / your partner reapplied for.

Income Support YES |

Jobseekers Allowance

If YES, when did you reapply

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

36