Page 77 - tmp

BCON/NINEDAY
CICS Account and case numbers: 01623514 01623514

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 during these periods.

X:\CICDWP.dot

69