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Part 3 - Anyone else who lives with you

Does anyone else live with you? If No go to Part 4
Now tell us about anyone else who lives with you, who are not included in Parts 1 or 2 who usually live

with you.
If you need to tell us about more than FOUR people, use a separate sheet of paper.
Include all people who normally live with you, but not tenants, sub-tenants or boarders.

Person 1
Surname First names Date of birth Relationship to you

National Insurance number Do they get Income Support, Do they work 16 What is their gross
Jobseeker's Allowance/ hours or more a income? (see note
Employment and Support week? below) £
Allowance or Pensions Credits?
Yes [ ] No [ ]
Yes [ ] No [ ] Applied for
(date):.................................

Person 2
Surname First names Date of birth Relationship to you

National Insurance number Do they get Income Support, Do they work 16 What is their gross
Jobseeker's Allowance/ hours or more a income? (see note
Employment and Support week? below) £
Allowance or Pensions Credits?
Yes [ ] No [ ]
Yes [ ] No [ ] Applied for
(date):................................

Person 3
Surname First names Date of birth Relationship to you

National Insurance number Do they get Income Support, Do they work 16 What is their gross
Jobseeker’s Allowance/ hours or more a income? (see note
Employment and Support week? below) £
Allowance or Pensions Credits?
Yes [ ] No [ ] Yes [ ] No [ ]
Applied for (date): ................

HB/CTB 07 04/2013 6 QC » nmc
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