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BCON/NINEDAY
CICS Account and case numbers: 016235.14 01623514 BCON/NINEDAY
CICS Account and case numbers: 01623514 01623514

2. 4

Yes No If you have answered NO to questions 1 & 2, please provide details of how you pay

Did / do you or your partner receive any other your day to day living needs i.e. food, clothing, heating etc... If you are supported by
income or benefits, such as state retirement friends/family we will need to see evidence of this.
pension, tax credits or incapacity benefit?
If Yes, please list them below and provide proof

£

£

£

5
Have you applied for Working Tax Credit? Yes No

Did / do you and your partner have any bank or Yes No

If Yes, when did you apply building society accounts, savings or investment
during this period?

If Yes, please list them below and provide proof of the amounts
held for the above period. Please provide the last two full months
3
statements for every bank or building society for you and your

Have you/your partner reapplied for partner including the one that your Income Support or Job Seekers
Allowance was paid in to.

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
during these periods.

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